Global, Regional, and National Burden of Myocarditis and Cardiomyopathy, 1990-2017

Abstract

Objective: To estimate the burden of myocarditis (MC), alcoholic cardiomyopathy (AC), and other cardiomyopathy (OC) for 195 countries and territories from 1990 to 2017. Methods: We collected detailed information on MC, AC, and OC between 1990 and 2017 from the Global Burden of Disease study 2017, which was designed to provide a systematic assessment of health loss due to diseases and injuries in 21 regions, covering 195 countries and territories. Estimates of MC, AC, and OC burden were produced using a standard Cause of Death Ensemble model and a Bayesian mixed-effects meta-regression tool, and included prevalence, deaths, years lived with disability (YLDs), and years of life lost (YLLs). All estimates were presented as counts, age-standardized rates per 100,000 people and percentage change, with 95% uncertainty intervals (UIs). Results: Worldwide, there were 1.80 million (95% UI 1.64-1.98) cases of MC, 1.62 million (95% UI 1.37-1.90) cases of AC and 4.21 million (95% UI 3.63-4.87) cases of OC, contributing to 46,486 (95% UI 39,709-51,824), 88,890 (95% UI 80,935-96,290), and 233,159 (95% UI 213,677-248,289) deaths in 2017, respectively. Furthermore, globally, there were 131,376 (95% UI 90,113-183,001) YLDs and 1.26 million (95% UI 1.10-1.42) YLLs attributable to MC, 139,087 (95% UI 95,134-196,130) YLDs and 2.84 million (95% UI 2.60-3.07) YLLs attributable to AC, and 353,325 (95% UI 237,907-493,908) YLDs and 5.51 million (95% UI 4.95-5.99) YLLs attributable to OC in 2017. At the national level, the age-standardized prevalence rates varied by 10.4 times for MC, 252.6 times for AC and 38.1 times for OC; the age-standardized death rates varied by 43.9 times for MC, 531.0 times for AC and 43.3 times for OC; the age-standardized YLD rates varied by 12.4 times for MC, 223.7 times for AC, and 34.1 times for OC; and the age-standardized YLL rates varied by 38.4 times for MC, 684.8 times for AC, and 36.2 times for OC. Between 1990 and 2017, despite the decreases in age-standardized rates, the global numbers of prevalent cases, deaths, YLDs, and YLLs have increased for all the diseases. Conclusion: Accurate assessment of the burden of MC, AC, and OC is essential for formulating effective preventative prevention and treatment programs and optimizing health system resource allocation. Our results suggest that MC, AC, and OC remain important global public health problems with increasing numbers of prevalent cases, deaths, YLDs, and YLLs over the past decades, and there are significant geographic variations in the burden of these diseases. Further research is warranted to expand our knowledge of potential risk factors and to improve the prevention, early detection and treatment of these diseases.

Keywords: cardiomyopathy; global burden of disease; mortality; myocarditis; prevalence.

Figure 1

Age-specific numbers and rates of prevalent cases and deaths for myocarditis and alcoholic cardiomyopathy by sex, 2017. (A) Age-specific numbers and rates of myocarditis prevalent cases; (B) Age-specific numbers and rates of alcoholic cardiomyopathy prevalent cases; (C) Age-specific numbers and rates of myocarditis deaths; (D) Age-specific numbers and rates of alcoholic cardiomyopathy deaths.

Figure 2

Age-standardized prevalence rates of myocarditis (A) and alcoholic cardiomyopathy (B) for 195 countries and territories, both sexes, 2017. ATG, Antigua and Barbuda; Isl, Islands; FSM, Federated States of Micronesia; LCA, Saint Lucia; TLS, Timor-Leste; TTO, Trinidad and Tobago; VCT, Saint Vincent and the Grenadines.

Figure 3

Age-standardized death rates of myocarditis, alcoholic cardiomyopathy, and other cardiomyopathy for 21 world regions, both sexes, 2017.

Figure 4

Temporal trends in age-standardized death rates of myocarditis (A) and alcoholic cardiomyopathy (B) for 21 world regions by SDI, both sexes, 1990–2017. For each region, points from left to right depict estimates from each year from 1990 to 2017. SDI, Socio-demographic Index.