Global, Regional, and National Burden of Valvular Heart Disease, 1990 to 2021

Abstract

Background: Valvular heart disease poses an escalating global health challenge with an increasing impact on mortality and disability. This study aims to comprehensively analyze the global burden of valvular heart disease.

Methods and results: Using the Global Burden of Disease 2021 data, we analyzed the prevalence and disability-adjusted life years, examining implications across demographics and geographic regions. In 2021, an estimated 54.8 million (95% uncertainty interval [UI], 43.3-67.6) cases of rheumatic heart disease, 13.3 million (95% UI, 11.4-15.2) cases of nonrheumatic calcific aortic valve disease (CAVD), and 15.5 million (95% UI, 14.5-16.7) cases of nonrheumatic degenerative mitral valve disease (DMVD) were reported globally. Despite the rising prevalence, disability-adjusted life years declined between 1991 and 2021. Among individuals aged 70 years or older, the age-standardized prevalences were 1803.6 per 100 000 (95% UI, 1535.5-2055.7) for CAVD and 2148.9 per 100 000 (95% UI, 2001.4-2310.1) for DMVD. Sub-Saharan Africa had the highest age-standardized prevalence for rheumatic heart disease; Conversely, high-income regions led in CAVD and DMVD prevalence. Rheumatic heart disease had the highest age-standardized prevalence of 1184.2 per 100 000 (95% UI, 932.4-1478.2) in low Socio-Demographic Index (SDI) regions, whereas CAVD peaked at 349.8 per 100 000 (95% UI, 303.6-395.8) in high SDI regions. The most substantial increases in age-standardized prevalences of CAVD from 1990 to 2021 occurred in the middle SDI and low-middle SDI regions. A parallel trend was noted for DMVD.

Conclusions: Rheumatic heart disease remains a significant burden in low SDI regions, whereas CAVD and DMVD pose challenges in high SDI regions with aging populations.

Keywords: Global Burden of Disease Study; nonrheumatic calcific aortic valve disease; nonrheumatic degenerative mitral valve disease; rheumatic heart disease; valvular heart disease.

Figure 1. Global burden of age‐standardized prevalence (cases per 100 000 people) of valvular heart disease across 204 countries and territories in 2021.

A, RHD; B, CAVD; C, DMVD. Median estimate and 95% uncertainty intervals are shown. CAVD indicates nonrheumatic calcific aortic valve disease; DMVD, nonrheumatic degenerative mitral valve disease; and RHD, rheumatic heart disease.

Figure 2. Global burden of age‐standardized prevalence (cases per 100 000 people) of VHD by age and sex in 2021.

A, RHD; B, CAVD; C, DMVD. Median estimate and 95% uncertainty intervals are shown. CAVD indicates nonrheumatic calcific aortic valve disease; DMVD, nonrheumatic degenerative mitral valve disease; RHD, rheumatic heart disease; and VHD, valvular heart disease.

Figure 3. Global burden of VHD across GBD regions in 2021.

A, Prevalence number; B, Age‐standardized prevalence (cases per 100 000 people); C, DALY number; D, Age‐standardized DALY (cases per 100 000 people). Median estimate and 95% uncertainty intervals are shown. CAVD indicates nonrheumatic calcific aortic valve disease; DALYs, disability‐adjusted life‐years; DMVD, nonrheumatic degenerative mitral valve disease; GBD, Global Burden of Disease; RHD, rheumatic heart disease; and VHD, valvular heart disease.

Figure 4. Temporal trends of age‐standardized prevalence (cases per 100 000 people) of VHD by SDI regions from 1990 to 2021.

Median estimate and 95% uncertainty intervals are shown. CAVD indicates nonrheumatic calcific aortic valve disease; DMVD, nonrheumatic degenerative mitral valve disease; RHD, rheumatic heart disease; SDI, Socio‐Demographic Index; and VHD, valvular heart disease.

Figure 5. Relationship between age‐standardized prevalence (cases per 100 000 people) of VHD and SDI across regions from 1990 to 2021.

A, RHD; B, CAVD; C, DMVD. CAVD indicates nonrheumatic calcific aortic valve disease; DMVD, nonrheumatic degenerative mitral valve disease; RHD, rheumatic heart disease; SDI, Socio‐Demographic Index; and VHD, valvular heart disease.