Abstract
Ischemic heart disease (IHD) remains the predominant cause of global mortality, necessitating accurate incidence forecasting for effective prevention strategies. Existing statistical models inadequately capture nonlinear epidemiological patterns, while deep learning approaches lack clinical interpretability. We constructed an interpretable predictive framework combining particle swarm optimization (PSO), bidirectional long short-term memory (BiLSTM) networks, and a novel multi-scale attention mechanism. Age-standardized incidence rates (ASIRs) from the Global Burden of Disease (GBD) 2021 database (1990-2021) were stratified across 24 sex-age subgroups and processed through 10-year sliding windows with advanced feature engineering. SHapley Additive exPlanations (SHAP) provided a three-level interpretability analysis (global, local, and component). The framework achieved superior performance metrics: mean absolute error (MAE) of 0.0164, root mean squared error (RMSE) of 0.0206, and R(2) of 0.97, demonstrating a 93.96% MAE reduction compared to ARIMA models and a 75.99% improvement over CNN-BiLSTM architectures. SHAP analysis identified females aged 60-64 years and males aged 85-89 years as primary predictive contributors. Architectural analysis revealed the residual connection captured 71.0% of the predictive contribution (main trends), while the BiLSTM-Attention pathway captured 29.0% (complex nonlinear patterns). This interpretable framework transforms opaque algorithms into transparent systems, providing precise epidemiological evidence for public health policy, resource allocation, and targeted intervention strategies for high-risk populations.