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. 2023 Nov 2;9(7):662-672.
doi: 10.1093/ehjqcco/qcac088.

Sex differences in the etiology and burden of heart failure across country income level: analysis of 204 countries and territories 1990-2019

Sunny Wei  1 , J Jamie Miranda  2 , Mamas A Mamas  3 , Liesl J Zühlke  4 , Evan Kontopantelis  5 , Lehana Thabane  6   7   8 , Harriette G C Van Spall  1   6   8   9
Affiliations

Sex differences in the etiology and burden of heart failure across country income level: analysis of 204 countries and territories 1990-2019

Sunny Wei et al. Eur Heart J Qual Care Clin Outcomes. .

Abstract

Background: Heart failure (HF) is a global epidemic.

Objective: To assess global sex differences in HF epidemiology across country income levels.

Methods and results: Using Global Burden of Disease (GBD) data from 204 countries and territories 1990-2019, we assessed sex differences in HF prevalence, etiology, morbidity, and temporal trends across country sociodemographic index or gross national income. We derived age-standardized rates. Of 56.2 million (95% uncertainty interval [UI] 46.4-67.8 million) people with HF in 2019, 50.3% were females and 69.2% lived in low- and middle-income countries; age-standardized prevalence was greater in males and in high-income countries. Ischaemic and hypertensive heart disease were top causes of HF in males and females, respectively. There were 5.1 million (95% UI 3.3-7.3 million) years lived with disability, distributed equally between sexes. Between 1990 and 2019, there was an increase in HF cases, but a decrease in age-standardized rates per 100 000 in males (9.1%, from 864.2 to 785.7) and females (5.8%, from 686.0 to 646.1). High-income regions experienced a 16.0% decrease in age-standardized rates (from 877.5 to 736.8), while low-income regions experienced a 3.9% increase (from 612.1 to 636.0), largely consistent across sexes. There was a temporal increase in age-standardized HF from hypertensive, rheumatic, and calcific aortic valvular heart disease, and a decrease from ischaemic heart disease, with regional and sex differences.

Conclusion: Age-standardized HF rates have decreased over time, with larger decreases in males than females; and with large decreases in high-income and small increases in low-income regions. Sex and regional differences offer targets for intervention.

Keywords: Epidemiology; Female; Global Burden of Disease; Male; Morbidity.

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Conflict of interest statement

None.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Heatmap of global and regional distribution of HF etiologies in 2019. The etiology of HF is ranked according to age-standardized prevalence from 1 (highest) to 16 (lowest) in the regions specified, with males (M) depicted to the left of females (F).
Figure 2
Figure 2
Percentage distribution of HF etiologies across age groups in 2019, stratified by sex. M, males; F, females.
Figure 3
Figure 3
Relative contribution of HF to overall morbidity of the underlying etiology classified according to SDI. Etiologies include (A) ischaemic heart disease, (B) rheumatic heart disease, (C) non-rheumatic valvular heart disease, and (D) congenital heart disease. Females are represented by circles; males by X's. YLD, years lived with disability. Hypertensive heart disease, non-ischaemic cardiomyopathy and myocarditis are not shown as the morbidity from these conditions is entirely linked to heart failure according to GDB classification schemes.
Figure 4
Figure 4
Change in age-standardized HF rate per 100 000 by region and sex 1990–2019. Regions are ordered by % change in HF prevalence in males (left) and females (right). Green represents temporal decreases and red represents increases.
Figure 5
Figure 5
Change in age-standardized HF rate per 100 000 as a function of SDI in 204 countries and territories in males (left) and females (right).
See this image and copyright information in PMC

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