Global, regional, and national burden of endocarditis, 1990-2021: a systematic analysis of the GBD 2021 study

Abstract

Background: Endocarditis is a serious cardiovascular infection associated with high mortality and disability. Its global epidemiological patterns and long-term trends have not been comprehensively characterized.

Methods: Data from the Global Burden of Disease (GBD) Study 1990-2021 were used to evaluate the prevalence, incidence, disability-adjusted life years (DALYs), and Deaths of endocarditis across 204 countries and territories. Temporal trends were analyzed using percentage change and estimated annual percentage change (EAPC), stratified by Socio-demographic Index (SDI), region, age, and sex.

Results: Between 1990 and 2021, the absolute number of endocarditis cases increased: prevalence by 14%, incidence by 34%, DALYs by 26%, and Deaths by 29%. Conversely, age-standardized rates declined (EAPCs: -0.58 for prevalence, -0.09 for incidence, -0.33 for DALYs, -0.29 for Deaths). Females had higher prevalence and incidence, while males experienced greater Deaths and DALYs burdens. The burden was concentrated among individuals aged ≥ 65 years, with slight increases observed in children under 5 in low-SDI regions. High-SDI regions showed declining trends in age-standardized metrics, whereas low- and middle-SDI regions exhibited increases. Correlation analysis indicated a moderate association between SDI and prevalence (R = 0.543), a stronger association with incidence (R = 0.770), and a weak correlation with DALYs (R = 0.063).

Conclusions: The absolute burden of endocarditis has increased globally despite declining standardized rates, with older adults and low-SDI populations disproportionately affected. These findings highlight the need for enhanced surveillance and equitable access to care, although limited clinical detail in the GBD framework restricts direct clinical interpretation.

Keywords: DALYs; Disease burden; EAPC; Endocarditis; GBD 2021; SDI.

Fig. 1

Temporal trend of endocarditis burden in global and 5 territories. A Percentage change in cases of prevalence, incidence, DALYs, and Deaths in 1990 and 2021. B The EAPC of prevalence, incidence, DALYs, and Deaths rates from 1990 to 2021. C The rates of prevalence, incidence, DALYs, and Deaths. D The rates of prevalence, incidence, DALYs, and Deaths for male and female

Fig. 2

Temporal trend of endocarditis burden in regions. A-B Prevalence and incidence per 100,000 population in 1990 and 2021. C Percentage change in cases of prevalence, incidence, DALYs, and Deaths in 1990 and 2021. D The EAPC of rates of prevalence, incidence, DALYs, and Deaths from 1990 to 2021

Fig. 3

Temporal trend of endocarditis burden in globally. A-D Percentage change in prevalence cases of prevalence, incidence, DALYs, and Deaths across 204 countries in 1990 and 2021. E-H The EAPC of prevalence, incidence, DALYs and Deaths rates across 204 countries in 1990 and 2021

Fig. 4

Temporal trend of endocarditis burden by age pattern in different regions. A Prevalence cases of 20 age groups (15-year intervals) from 1990 to 2021 globally and in 5 territories (low to high SDI). B The distribution of prevalence cases across 20 age groups as percentages globally, in 5 territories, and 21 GBD regions in 1990 and 2021. C Percentage change in prevalence cases of 20 age groups globally and in 5 territories in 1990 and 2021. D The EAPC of prevalence rates of 20 age groups globally and in 5 territories from 1990 to 2021

Fig. 5

The associations between the SDI and prevalence, incidence, DALYs and Deaths rates per 100,000 population of endocarditis burden in 21 GBD regions. A Prevalence shows a moderate positive correlation with SDI (R = 0.543). B Incidence shows a strong positive correlation with SDI (R = 0.770). C DALYs have a very weak correlation with SDI (R = 0.063). D Deaths rate shows a moderate positive correlation with SDI (R = 0.538).