Global, regional, and national characteristics and incidence of sudden death from 1948 to 2022: a systematic review and modelling study

Background: Sudden death (SD) poses great health and social challenges worldwide. There are a few studies investigating the epidemiological characteristics and disease burden of SD globally. The study aimed to assess the epidemiological characteristics and global burden of SD in different population and regional groups, and to determine the incidence of SD and its influencing factors. Methods: We conducted a systematic review and spatiotemporal analysis to estimate global, regional, and national SD incidence. A comprehensive search was conducted across four databases, including PubMed, Embase, the Cochrane Library and Web of Science, between 1 July 2003 and 30 June 2023. The included studies reported the incidence of SD in the general population of a country or region, or provided data on which the incidence could be calculated. We utilised a Bayesian hierarchical linear mixed model to estimate global, regional, and national SD incidence and to describe the characteristics. Results: Our search identified 9797 records, with 108 studies meeting our inclusion criteria. The incidence of SD was significantly different among super-regions. South Asia was estimated to have the highest incidence for 4.01 cases (95% confidence interval (CI) = 1.40, 7.51) per 100 000 person-years on a log-transformed basis, followed by South East Asia, East Asia, and Oceania. Among them, Guyana showed the highest estimated incidence of 5.06 cases (95% CI = 2.78, 8.20) per 100 000 person-years, followed by India of 4.89 cases (95% CI = 2.08, 7.76) per 100 000. Sub-Saharan Africa had the lowest estimated incidence, at 1.79 cases (95% CI = -1.83, 3.98) per 100 000 person-years. The temporal trends in SD incidence rates exhibited remarkable heterogeneity across regions. The downward trend was most pronounced in high-income countries, while Sub-Saharan Africa maintained a stable high incidence rate. Conversely, Latin America and the Caribbean exhibited continuous growth, with the Andean sub-region showing the most striking trend. Risk factors associated with SD include diabetes, hypertension, hyperlipidaemia, and heart disease. Conclusions: This study provides a comprehensive assessment of the global incidence of SD. The findings emphasise the need for targeted strategies to effectively reduce the burden of SD. Registration: PROSPERO: CRD42023432992.