Abstract Body (Do not enter title and authors here): Introduction

Hypertension related cardiovascular diseases (CVDs) are major contributors to disability-adjusted life years (DALYs). In conflict-affected nations, chronic care and disease reporting often collapse during public health emergencies. Traditional DALY trends may fail to capture this instability.

Hypothesis

We hypothesized that a composite model incorporating DALY burden, volatility, and a novel Crisis-Sensitivity Score could accurately predict surveillance fragility in fragile health systems and distinguish countries with unstable reporting behavior. Our study aims to propose a predictive framework to assess CVD surveillance fragility using burden, variability, and system reactivity metrics.

Aim

This study aims to propose a predictive framework to assess CVD surveillance fragility using burden, variability, and system reactivity metrics.

Methods

We extracted DALY rates (2017–2021) for ischemic heart disease, stroke, and hypertensive heart disease from the Global Burden of Disease (GBD) database for conflict-affected and comparison countries. We developed a crisis-sensitivity score based on the average absolute year-on-year percent change in composite DALYs. This was integrated into a linear regression model predicting the previously developed DALY Fragility Index, which also included 2021 DALY burden, 5-year trend slope, and standard deviation of annual values.

Results

Jordan demonstrated the highest Crisis-Sensitivity Score (2.81%), indicating high cardiovascular burden volatility, while Kenya showed the lowest (0.49%). In regression analysis, all four predictors — DALY burden, trend slope, variability, and crisis sensitivity — were positively associated with surveillance fragility. The model achieved a high explanatory value (R square = 0.996), confirming the structural integrity of the index and its potential utility as a predictive tool for identifying unstable cardiovascular surveillance environments.

Conclusion

The Crisis-Sensitivity Score, combined with a fragility index, identifies countries where CVD burden shifts significantly during crises. This approach reveals how surveillance gaps and underreporting in conflict-affected regions may distort global DALY estimates, affecting priority-setting and funding decisions by institutions like the CDC, NIH, and USAID. By highlighting high-volatility areas and monitoring gaps, the model supports equity-driven, resilient CVD strategies aligned with the AHA’s mission to reduce global health disparities.