Spatiotemporal trends in global burden of rheumatic heart disease and associated risk factors from 1990 to 2019
Introduction
Acute rheumatic fever (ARF) is the result of an autoimmune response to pharyngitis caused by group A streptococcal infection. A severe episode or multiple recurrent episodes of ARF lead to long-term damage to the heart valves, known as rheumatic heart disease (RHD) [1,2]. RHD is one of the most common types of cardiovascular disease. It is preventable and the injection of antibiotics to reduce the risk of streptococcal infection is an effective primary preventive measure [3,4]. RHD has been largely eliminated in developed countries and regions with mature medical care systems and sufficient medical resources [4]. However, RHD is the leading cause of heart failure in children and young adults globally, especially in less-developed countries [5,6], because of the widespread lack of antibiotics, overcrowded living conditions, and poor living conditions and hygiene [7]. In addition, RHD is the most common type of cardiovascular disease in young adults and adolescents requiring cardiac surgery in low- and middle-income countries [8].
In recent years, the attention paid to RHD has continued to increase. Watkins et al. [9] estimated the global prevalence of and mortality due to RHD from 1990 to 2015 and showed that the burden of RHD has decreased globally. However, a high incidence of RHD still exists in Oceania, South Asia and the central region of Sub-Saharan Africa. Using data from the Global Burden of Disease (GBD) 2017 study, Ordunez et al. [10] analyzed regional burdens, trends and inequalities in the burden of RHD in the Americas and showed that the Americas have had a substantially reduced incidence of premature mortality due to RHD since 1990.
On the basis of the abovementioned studies, we used the latest GBD data to update the distribution of RHD burden globally in 2019 and determine the changes from 1990 to 2019. The aim of this study was to identify the countries or regions with the highest burden of RHD or with an increasing burden, to focus more attention on these regions. Further, the distribution and changes in the burden of RHD in countries or regions with different economic levels and in different gender and age groups were compared. In addition, data on the attributed risk factors from the GBD2019 study were used to briefly describe the burden of RHD attributable to risk factors such as lead exposure, high systolic blood pressure and diet high in sodium. A more complete understanding of the distribution and changes in the burden of RHD and its risk factors in the whole population may be of great significance for the prevention and control of RHD globally.
Section snippets
Study data
Data of the mortality and DALYs of RHD in this study were obtained from the GBD 2019, which assesses deaths and health losses from 369 diseases, injuries and impairments and 87 risk factors in 204 countries and regions around the world from 1990 to 2019 [11]. To describe the whole population and identify countries or regions that require special attention, we used the four spatial divisions from the GBD 2019 study. The first division was global, and the second was based on the sociodemographic
The epidemic situation and burden of RHD and its global trends
In 2019, there were 2.7894 million (95%UI, 2.1533 million to 3.4543 million) new RHD patients globally, and there were more than 40.523 million (95%UI, 32.0529 million to 50.0624 million) RHD patients in total. The age-standardized incidence rate (ASIR) and prevalence rate (ASPR) were 37.39/105(95%UI, 28.59/105 to 46.74/105) and 513.68/105 (95%UI, 405.01/105 to 636.25/105), respectively. The number of deaths caused by RHD exceeded 305,600 (95% UI, 259,200 to 340,500), and the number of DALYs
Discussion
In recent years, the prevention, control and elimination of RHD have re-emerged as important public health issues [15]. In 2018, all member states of the World Health Organization signed a joint commitment to put RHD back on the global agenda. Thus, it is necessary to understand the global prevalence of RHD and identify the populations, countries and regions that require attention. In this study, we performed an in-depth analysis of the GBD2019 data to describe the gender, age and geographical
Conclusions
Although the mortality and DALYs rate attributable to RHD are decreasing globally, it remains an important public health problem that needs to be addressed urgently, especially in certain low- and middle-income countries and regions.
The following are the supplementary data related to this article.
CRediT authorship contribution statement
Liang Zhang: Conceptualization, Data curation, Validation, Writing – original draft. Zhuang Tong: Data curation, Software, Supervision. Ruizheng Han: Data curation, Validation. Kaixiang Li: Supervision. Xin Zhang: Conceptualization, Data curation, Writing – review & editing. Ruixia Yuan: Conceptualization, Data curation, Supervision, Writing – review & editing.
Declaration of Competing Interest
The authors declare no conflicts of interest.
Acknowledgements
This work was supported by grants from Medical Science and Technology Research Plan Joint Construction Project of Henan Province (LHGJ20190223).
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This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation