The burden of non-rheumatic valve disease among China, the United States, India, and Central Africa from 1990 to 2021 and projections to 2040

Background: Non-rheumatic valvular heart disease (NRVD) is a leading cause of cardiovascular disease among older adults and poses a significant public health burden worldwide. This study reviewed the trends in the burden of NRVD from 1990 to 2021 in China, the United States, India, and globally, and provides projections up to 2040. These countries were selected not only for their large population sizes but also to represent diverse levels of economic development, stages of epidemiological transition, and variations in healthcare systems.

Methods: Data on the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for NRVD were sourced from the Global Burden of Disease (GBD) 2021 study. The uncertainty of all estimates was quantified using 95% uncertainty interval (UI), calculated as the 2.5th and 97.5th percentiles of the ordered estimate values. Age-standardized rate (ASR) and the average annual percentage change (AAPC) were applied to assess trends in the disease burden. Key temporal inflection points in these trends were identified using Joinpoint regression analysis. Furthermore, a Bayesian age-period-cohort (BAPC) model was employed to project the evolution of the NRVD burden from 2022 to 2040.

Results: Globally, the age-standardized mortality rate (ASMR) and disability-adjusted life year rate (ASDR) for NRVD declined from 1990 to 2021. The ASMR fell from 2.65 (95% UI: 2.40–2.83) to 2.31 (1.96–2.50) per 100,000, and the age-standardized DALYs rate from 52.00 (48.10–57.26) to 43.21 (39.42–48.50) per 100,000. In contrast, the incidence of calcific aortic valve disease (CAVD) rose from 10.16 (8.48–11.85) to 12.02 (10.43–13.56) per 100,000, while that of degenerative mitral valve disease (DMVD) decreased from 13.73 (12.68–14.76) to 12.97 (12.10–13.89) per 100,000. During this period, mortality and DALYs burden related to NRVD increased in India but decreased in the United States, China, and the Central African Republic. China experienced the steepest declines, with an AAPC of −1.76% (−1.94% to −1.58%) in ASMR and −1.21% (−1.39% to −1.04%) in ASDR. Additionally, in China, the United States, and the Central African Republic, males had higher incidence and DALYs than females. However, with advancing age, females gradually surpassed males in both DALYs and mortality. Age-stratified analysis showed the peak incidence of the disease occurred in individuals aged 65–69 years. Projections to 2040 indicate a continued global decline in age-standardized incidence and mortality for NRVD. An exception is expected in incidence rates, which are projected to rise in China and India.

Conclusions: The global burden of NRVD remains significant. While its age-standardized mortality and disability rates are declining in countries like China and the United States, they continue to rise in India. This divergence necessitates evidence-based, country-specific strategies to manage NRVD effectively.