Global, Regional, and National Burden of Myocarditis From 1990 to 2017: A Systematic Analysis Based on the Global Burden of Disease Study 2017

Abstract

Objective: The global trends in myocarditis burden over the past two decades remain poorly understood and might be increasing during the coronavirus disease 2019 (COVID-19) worldwide pandemic. This study aimed to provide comprehensive estimates of the incidence, mortality, and disability-adjusted life years (DALYs) for myocarditis globally from 1990 to 2017. Methods: Data regarding the incidence, mortality, DALY, and estimated annual percentage change (EAPC) between 1990 and 2017 for myocarditis worldwide were collected and calculated from the 2017 Global Burden of Disease study. We additionally calculated the myocarditis burden distribution based on the Socio-Demographic Index (SDI) quintile and Human Development Index (HDI). Results: The incidence cases of myocarditis in 2017 was 3,071,000, with a 59.6% increase from 1990, while the age-standardized incidence rate (ASIR) was slightly decreased. The number of deaths due to myocarditis increased gradually from 27,120 in 1990 to 46,490 in 2017. The middle SDI quintile showed the highest number of myocarditis-related deaths. On the contrary, the global age-standardized death rate (ASDR) decreased with an overall EAPC of -1.4 [95% uncertainty interval (UI) = -1.8 to -1.0]. Similar to ASDR, the global age-standardized DALY rate also declined, with an EAPC of -1.50 (95% UI = -2.30 to -0.8) from 1990 to 2017. However, there was a 12.1% increase in the number of DALYs in the past 28 years; the middle SDI and low-middle SDI quintiles contributed the most to the DALY number in 2017. We also observed significant positive correlations between the EPAC of age-standardized rate and HDI for both death and DALY in 2017. Conclusions: Globally, the ASIR, ASDR, and age-standardized DALY rate of myocarditis decreased slightly from 1990 to 2017. The middle SDI quintile had the highest level of ASIR, ASDR, and age-standardized DALY rate, indicating that targeted control should be developed to reduce the myocarditis burden especially based on the regional socioeconomic status. Our findings also provide a platform for further investigation into the myocarditis burden in the era of COVID-19.

Keywords: Global Burden of Disease; death; disability-adjusted life years; incidence; myocarditis.

Figure 1

The global incidence burden of myocarditis in 195 countries and territories. (A) The absolute number of myocarditis incidence cases in 2017. (B) The ASIR of myocarditis in 2017. (C) The EAPC of myocarditis ASIRs between 1990 and 2017. ASIR, age-standardized incidence rate; EAPC, estimated annual percentage change.

Figure 2

The proportion of the three age groups (15–49 years, 50–69 years and 70+ years) for myocarditis incidences (A), deaths (B), and DALY (C) cases globally and in five SDI quintiles between 1990 and 2017. SDI, Socio-Demographic Index; DALY, disability-adjusted life year.

Figure 3

The trends of ASIR change (A), ASDR (B), and age-standardized DALY rate (C) (per 100,000 persons) globally and among different SDI quintiles between 1990 and 2017. ASIR, age-standardized incidence rate; ASDR, age-standardized death rate; DALY, disability-adjusted life year; SDI, Socio-Demographic Index.

Figure 4

Correlation between the EAPC of incidences/deaths/DALYs and (A,C,E) the corresponding ASRs in 1990 and (B,D,F) HDI in 2017. The size of the circle is increased with the number of incidence, death, and DALY cases of myocarditis. ASR, age-standardized rate; ASIR, age-standardized incidence rate; ASDR, age-standardized death rate; DALY, disability-adjusted life year; EAPC, estimated annual percentage change; HDI, Human Development Index.

Figure 5

The proportion of the three age groups (15–49, 50–69, and 70+ years) for myocarditis incidence (A,D), deaths (B,E), and DALYs (C,F) in 21 GBD regions between 1990 and 2017. DALY, disability-adjusted life year; GBD, Global Burden of Disease.

Figure 6

The global burden of myocarditis in both genders and different age groups in 2017. (A) The absolute number of incidence cases. (B) The absolute number of death cases. (C) The absolute number of DALYs. DALY, disability-adjusted life year.