The global burden of congenital heart disease

Abstract

Although the incidence of congenital heart disease (CHD) is similar worldwide, the burden of supporting these patients falls more heavily on countries with high fertility rates. In a country with a fertility rate of about eight per woman, the population has to support four times as many children with CHD as in a country with a fertility rate of two. Countries with the highest fertility rates tend to have the lowest incomes per capita, thus accentuating the disparity. Countries with high fertility rates have more children with congenital heart disease per wage earner. Improving local health services and controlling infectious diseases (diarrhoeal illness, rheumatic fever, measles, rotoviral infection) are important but are mere 'band-aids' compared to improving education, empowering women and reducing birth rates.

Fig. 1.

Annual births in selected countries. Data from United Nations Children’s Fund accessed at http://data.un.org/Data.aspx?d=SOWC<f=inID%3A75. Map from Wikipedia accessed at http://en.wikipedia.org/wiki/World_population. The panel at the side indicates the population ranges of the different countries, with China and India each having over one billion inhabitants.

Fig. 2.

Total annual births of children with congenital heart disease by continent, based on Table 1 and data on total births. The panel at the side indicates the population ranges of the different countries.

Fig. 3.

Fertility rates by country. Published with permission from the World Health Organisation.

Fig. 4.

Number of children born with congenital heart disease per million population.

Fig. 5.

Age distribution in Singapore with a low fertility rate, and Niger with a high fertility rate. Based on data from the Department of Statistics, Singapore, and US Census Bureau International data base.

Fig. 6.

Distribution of cardiovascular centres in selected countries and continents. The area of the bubble is proportional to the population.

Fig. 7.

Causes of global mortality in children under five years old.

Fig. 8.

Distribution of rotovirus mortality across the world. Reproduced with permission from the World Health Organisation.

Fig. 9.

Fertility rate versus income per capita for several countries on different continents. The continents are colour coded, and the area of the circles is proportional to each country’s population. Note that countries in Africa with high fertility rates are at the lowest end of the income scale.

Fig. 10

Fertility rate versus deaths under five years of age per 1 000 live births. The area of the circle is proportional to the population. There is a direct relationship between fertility rate and child mortality, with African countries being worst off.