Objective To systematically evaluate the incidence and mortality burden of ischemic heart disease (IHD) in the elderly population (aged ≥60 years) globally and in China from 1990 to 2021, utilizing the Global Burden of Disease (GBD) 2021 database, and to predict its future trends, thereby providing data support for precise prevention and control decisions regarding IHD in an increasingly aging society. Methods Data on the incidence and mortality burden of IHD among the elderly globally, in China, and across five sociodemographic regions were extracted from the GBD 2021 database. Joinpoint regression analysis was used to examine the temporal trends of the age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR). A Bayesian age-period-cohort model was employed to predict the trends of IHD burden from 2022 to 2040. Results In 2021, the number of IHD cases among the elderly was 21 975 600 globally and 5 445 100 in China. From 1990 to 2021, the global ASIR showed an overall decreasing trend (AAPC=?0.55%, P<0.001), whereas China exhibited an overall increasing trend (AAPC=0.41%, P<0.001). In 2021, the number of IHD deaths among the elderly was 7 444 000 globally and 1 742 800 in China. Similarly, the global ASDR demonstrated an overall decreasing trend from 1990 to 2021 (AAPC=?1.27%, P<0.001), while China showed an opposite trend (AAPC=0.68%, P=0.001). Additionally, in both 1990 and 2021, the ASIR and ASDR of IHD among elderly males (globally and in China) were higher than those among elderly females in the same period. In 2021, the age groups with the highest proportion of IHD cases among the elderly (both globally and in China) were 65–69 years and 70–74 years, while the 80–84 and 85–89 years groups had the highest proportions of IHD deaths. Predictive analysis indicated that from 2022 to 2040, the number of IHD cases and deaths among the total elderly population, both males and females, is likely to show a continuous upward trend both globally and in China. Conclusions The burden of IHD among elderly population remains substantial and growing globally and in China, in terms of incidence and mortality. Comprehensive strategies are urgently required, including policy guidance and health education to enhance public awareness, as well as early screening, diagnosis, and treatment to reduce the risk of disease progression. Such efforts are essential to effectively mitigate the increasingly heavy disease burden of IHD in the aging population.
