Global, regional, and national burden of congenital heart disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Abstract

Background: Previous congenital heart disease estimates came from few data sources, were geographically narrow, and did not evaluate congenital heart disease throughout the life course. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, this study aimed to provide comprehensive estimates of congenital heart disease mortality, prevalence, and disability by age for 195 countries and territories from 1990 to 2017.

Methods: Mortality estimates were generated for aggregate congenital heart disease and non-fatal estimates for five subcategories (single ventricle and single ventricle pathway congenital heart anomalies; severe congenital heart anomalies excluding single ventricle heart defects; critical malformations of great vessels, congenital valvular heart disease, and patent ductus arteriosus; ventricular septal defect and atrial septal defect; and other congenital heart anomalies), for 1990 through to 2017. All available global data were systematically analysed to generate congenital heart disease mortality estimates (using Cause of Death Ensemble modelling) and prevalence estimates (DisMod-MR 2·1). Systematic literature reviews of all types of congenital anomalies to capture information on prevalence, associated mortality, and long-term health outcomes on congenital heart disease informed subsequent disability estimates.

Findings: Congenital heart disease caused 261 247 deaths (95% uncertainty interval 216 567-308 159) globally in 2017, a 34·5% decline from 1990, with 180 624 deaths (146 825-214 178) being among infants (aged <1 years). Congenital heart disease mortality rates declined with increasing Socio-demographic Index (SDI); most deaths occurred in countries in the low and low-middle SDI quintiles. The prevalence rates of congenital heart disease at birth changed little temporally or by SDI, resulting in 11 998 283 (10 958 658-13 123 888) people living with congenital heart disease globally, an 18·7% increase from 1990 to 2017, and causing a total of 589 479 (287 200-973 359) years lived with disability.

Interpretation: Congenital heart disease is a large, rapidly emerging global problem in child health. Without the ability to substantially alter the prevalence of congenital heart disease, interventions and resources must be used to improve survival and quality of life. Our findings highlight the large global inequities in congenital heart disease and can serve as a starting point for policy changes to improve screening, treatment, and data collection.

Funding: Bill & Melinda Gates Foundation.

Figure 1

Mortality of congenital heart disease in children under 1 year of age, 1990–2017 (A) Mortality per 100 000 infants by country in 2017 and (C) by SDI from 1990 to 2017. (B) Proportion of infant deaths by country in 2017 and (D) by SDI from 1990 to 2017. Subnational data are available for Brazil, China, India, and the USA. ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. LCA=Saint Lucia. SDI=Socio-demographic Index. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.

Figure 1

Mortality of congenital heart disease in children under 1 year of age, 1990–2017 (A) Mortality per 100 000 infants by country in 2017 and (C) by SDI from 1990 to 2017. (B) Proportion of infant deaths by country in 2017 and (D) by SDI from 1990 to 2017. Subnational data are available for Brazil, China, India, and the USA. ATG=Antigua and Barbuda. FSM=Federated States of Micronesia. LCA=Saint Lucia. SDI=Socio-demographic Index. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.

Figure 2

Leading causes of death in children younger than 1 year The heat map depicts rank order of causes of death (by death rate per 100 000) in children younger than 1 year in 1990 and 2017. The rank of congenital heart disease increased from ninth to seventh globally and 17th to 11th in low SDI countries from 1990 to 2017. SDI=Socio-demographic Index.

Figure 3

Trends in prevalence of congenital heart disease from 1990 to 2017 Data are prevalence (95% UI). (A) all-age prevalence and (B) age-standardised prevalence by Socio-demographic Index and congenital heart defect sub-category with 95% uncertainty intervals. SDI=Socio-demographic Index.