Changing epidemiology of calcific aortic valve disease: 30-year trends of incidence, prevalence, and deaths across 204 countries and territories

Abstract

Calcific aortic valve disease (CAVD) is associated with increased morbidity and mortality. We aimed to elucidate the 30-year epidemiology of CAVD globally. Global CAVD incidence, prevalence, and deaths increased 3.51-, 4.43-, and 1.38-fold from 1990 to 2019, respectively, without any decreasing trends, even after age standardization. In 2019, Slovenia had the highest age-standardized rate (ASR) of CAVD incidence (62.21/100,000 persons) and prevalence (1,080.06/100,000) whereas Cyprus had the highest ASR of deaths (8.20/100,000). Population aging was an important contributor to incidence. Compared with women, more men had CAVD and men had earlier peaks in disease prevalence. High systolic blood pressure, diet high in sodium, and lead exposure were the main risk factors for deaths owing to CAVD. The estimated annual percentage change, a measure to estimate the variation of ASR, was significantly associated with the ASR and sociodemographic index (SDI) in 2019 for incidence and prevalence across all 204 countries and territories (all p<0.0001). With increased lifespan and risk factors, the overall burden of CAVD is high and remains on the rise, with differences by sex, age, and SDI level. Our findings serve to sound the alarm for organizations, institutions, and resources whose primary purpose is to improve human health.

Keywords: 30-year trends; calcific aortic valve disease; epidemiology; incidence; prevalence.

Figure 1

The disease burden of CAVD globally, and in five SDI quintiles from 1990 to 2019. (A) Incident cases; (B) ASIR; (C) prevalent cases; (D) ASPR; (E) deaths; (F) ASDR. Abbreviations: CAVD, calcific aortic valve disease; SDI, socio-demographic index; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASDR, age-standardized deaths rate.

Figure 2

The disease burden of CAVD in 21 GBD regions from 1990 to 2019. (A) Incident cases; (B) ASIR; (C) prevalent cases; (D) ASPR; (E) deaths; (F) ASDR. Abbreviations: CAVD, calcific aortic valve disease; GBD, global burden of disease; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASDR, age-standardized deaths rate.

Figure 3

The trends of CAVD for both sexes in 204 countries and territories from 1990 to 2019. (A) The EAPC in ASIR; (B) the EAPC in ASPR; (C) the EAPC in ASDR. Abbreviatons: CAVD, calcific aortic valve disease; EAPC, estimated annual percentage change; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASDR, age-standardized deaths rate.

Figure 4

The proportions of CAVD incident cases varied from 1990 to 2019 attributed to population growth, population aging, and epidemiological change in (A) the globe; (B) low SDI quintiles; (C) low-middle SDI quintiles; (D) middle SDI quintiles; (E) high-middle SDI quintiles; and (F) high SDI quintiles. Epidemiological change refers to the CAVD incident cases variation when age structure and population remained constant. CAVD, calcific aortic valve disease; SDI: socio-demographic index.

Figure 5

2019 absolute number of prevalent cases and prevalence rates per 100,000 persons of CAVD by sex and age in (A) the globe; (B) low SDI quintiles; (C) low-middle SDI quintiles; (D) middle SDI quintiles; (E) high-middle SDI quintiles; and (F) high SDI quintiles. Abbreviations: CAVD, calcific aortic valve disease; SDI: socio-demographic index.

Figure 6

Risk factors contributing to CAVD-caused deaths in (A) the globe; (B) low SDI quintiles; (C) low-middle SDI quintiles; (D) middle SDI quintiles; (E) high-middle SDI quintiles; and (F) high SDI quintiles. Abbreviations: CAVD, calcific aortic valve disease; SDI: socio-demographic index.

Figure 7

The correlation of CAVD between (A) EAPC of ASIR and EAPC of ASPR; (B) EAPC of ASIR and EAPC of ASDR; (C) EAPC of ASPR and EAPC of ASDR; (D) EAPC of ASIR and ASIR in 2019; (E) EAPC of ASPR and ASPR in 2019; (F) EAPC of ASDR and ASDR in 2019; (G) EAPC of ASIR and SDI in 2019; (H) EAPC of ASPR and SDI in 2019; and (I) EAPC of ASDR and ASDR in 2019. The circles represent countries that were available in the GBD 2019. The size of circle is increased with the SDI of countries in 2019 from (A) to (C), and the cases of CAVD in 2019 from (D) to (I). The r indices and p values presented were derived from Pearson correlation analysis. Abbreviations: CAVD, calcific aortic valve disease; EAPC, estimated annual percentage change; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASDR, age-standardized deaths rate; SDI: socio-demographic index.; ASR, age standardized rate.