ORIGINAL RESEARCH article
Front. Public Health
Sec. Aging and Public Health
Rheumatic Heart Disease Burden from 1990 to 2021: An Updated Analysis Based on the Global Burden of Disease Study 2021
Provisionally accepted
- 1Department of Cardiothoracic Surgery, Changzhou Wujin People's Hospital, Changzhou, China
- 2Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Rheumatic heart disease (RHD) remains a significant contributor to cardiovascular morbidity and mortality, disproportionately affecting low-and middle-income countries. While global interventions have targeted the control of RHD, its burden and associated inequalities remain substantial. This study aims to evaluate temporal trends, socioeconomic disparities, and future projections of RHD burden across countries stratified by socio-demographic index (SDI). Methods: We analyzed data from the Global Burden of Disease Study spanning 1990 to 2021 to assess RHD incidence, prevalence, deaths, and disability-adjusted life years (DALYs). Inequality was quantified using the concentration index (CI) and slope index of inequality (SII). A decomposition analysis was conducted to attribute changes in RHD burden to population growth, population aging, and epidemiological change. Bayesian age-period-cohort models were used to forecast age-standardized rates of RHD burden through 2050. Results: From 1990 to 2021, the global age-standardized RHD burden declined substantially, particularly in high-SDI countries. However, concentration curves and inequality indices revealed persistent disparities, with low-SDI regions experiencing a disproportionately higher burden of disease. While inequalities in DALYs and mortality have improved modestly, the incidence and prevalence of diseases remain unequally distributed. Decomposition analysis showed that increases in absolute burden in low-SDI countries were primarily driven by population growth and aging, with minimal offset from epidemiological improvements. Future projections indicate continued declines in age-standardized death and DALYs rates, especially in high-SDI regions. In contrast, incidence and prevalence are expected to remain high in low-SDI countries. Conclusions: Despite global progress in reducing the overall burden of RHD, significant socioeconomic inequalities persist and are projected to continue. Strategies to reduce RHD must prioritize prevention, early intervention, and long-term care in low-resource settings.
Keywords: Rheumatic Heart Disease, DALYs, Incidence, Prevalence, Mortality, SDI, healthinequality
Received: 28 Jul 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Zhang, Ren and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Junjie Zhang, zjjnjmu@sina.com
Qiang Zhao, zq11607@rjh.com.cn
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.