LIU Mei 1,2 , WANG Qing 2 , XIONG Shiwen 2 , ZHANG Changdong 3 , SHANG Xiaoke 1,2,3
  • 1. Department of Clinical Nutrition, Wuhan No.1 Hospital, Wuhan, 430022, P. R. China;
  • 2. Laboratory of Cardiac Dynamics and Assistive Technology, School of Life Sciences and Health Engineering, Hubei University of Technology, Wuhan, 430068, P. R. China;
  • 3. Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, P. R. China;
SHANG Xiaoke, Email: 14236338@qq.com
Valvular heart disease; rheumatic heart disease; non-rheumatic valvular disease; non-rheumatic calcific aortic valve disease; incidence; mortality; disease burden; epidemiology
10.7507/1007-4848.202509022
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Objective  To systematically analyze the disease burden, long-term trends, and age-sex distribution of major valvular heart disease (VHD) subtypes—rheumatic heart disease (RHD), non-rheumatic valvular disease (NRVD), and non-rheumatic calcific aortic valve disease (CAVD)—in global, Chinese, and US populations from 1990 to 2021, providing evidence for public health strategies and clinical resource allocation. Methods  Based on publicly available data from the Global Burden of Disease (GBD) Study 2021, we extracted incidence, mortality, and disability-adjusted life years (DALYs) for VHD from 1990 to 2021. Age-standardized rates (ASRs) were calculated using the GBD 2021 global standard population, and the estimated annual percentage change (EAPC) with its 95% uncertainty interval (UI) was computed for the period. Data from the US Healthcare Cost and Utilization Project (HCUP), the European Society of Cardiology (ESC)/Eurostat surveys, and Chinese national registries were used for trend triangulation and contextual background. Results  From 1990 to 2021, the ASR and disease burden of RHD significantly decreased globally and in China (EAPC for DALYs in China: -2.15%, 95% UI: -2.28% to -2.02%). In contrast, the burden of NRVD and CAVD has been steadily increasing in aging populations like those in China and the US, with a higher burden observed in older adults and males. In 2021, the incidence of NRVD and CAVD peaked in individuals aged ≥65 years, with rates being significantly higher in men than in women. RHD burden was concentrated in low Socio-demographic Index (SDI) regions, whereas NRVD/CAVD burden was strongly associated with high-SDI regions. Conclusion The global VHD epidemiological landscape is transitioning from an RHD-dominant to an NRVD/CAVD-dominant pattern. China faces a dual challenge of a residual RHD burden and a rapidly growing burden of degenerative valvular diseases. Developing tailored screening, prevention, and treatment strategies for different disease subtypes and populations is crucial.

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