Geographical Inequalities and Temporal Trends in Pediatric Cardiovascular Diseases in Indonesia: A 32-Year Global Burden of Disease Analysis

Muhammad Iqhrammullah¹Derren DCH Rampengan²Ikhwan Amri³Roy Novri Ramadhan⁴Muhammad Haneef Ghifari⁵Firyal Khansa⁵Novi Kurnia Rizki⁵Starry H Rampengan²Radityo Prakoso^6,7Muhammad Habiburrahman^8,9*

• ¹Universitas Muhammadiyah Aceh, Banda Aceh, Indonesia
• ²Universitas Sam Ratulangi Fakultas Kedokteran, Manado, Indonesia
• ³Universitas Samudra, Langsa, Indonesia
• ⁴Universitas Airlangga Fakultas Kedokteran, Surabaya, Indonesia
• ⁵Universitas Syiah Kuala Fakultas Kedokteran, Banda Aceh, Indonesia
• ⁶Pusat Jantung Nasional, Jakarta, Indonesia
• ⁷Universitas Indonesia Divisi Kardiologi, Central Jakarta, Indonesia
• ⁸Imperial College London Faculty of Medicine, London, United Kingdom
• ⁹Universitas Indonesia Fakultas Kedokteran, Jakarta, Indonesia

Background: Pediatric cardiovascular diseases (CVDs), including congenital heart anomalies (CHAs), rheumatic heart disease (RHD), and related conditions, remain a significant health challenge in Indonesia, especially given the country's diverse geography and disparities in healthcare access. We aim to analyze national and provincial trends in the burden of pediatric CVDs in Indonesia from 1990 to 2023 using Global Burden of Disease (GBD) data. Methods: We conducted a retrospective observational analysis using the GBD 2023 dataset, focusing on the prevalence, mortality, and disability-adjusted life years (DALYs) of pediatric cardiovascular diseases across age groups. Trends were assessed by sex and province. The Estimated Annual Percentage Change (EAPC) was calculated for each CVD subcategory and age group by fitting a log-linear regression model to the natural logarithm of annual rates. To evaluate nonlinear temporal patterns, generalized additive models (GAMs) were applied with penalized smoothing splines for year. Poisson or negative binomial regression models were used to model mortality counts, with the latter selected when overdispersion exceeded 1.5. Results: From 1990 to 2023, Indonesia showed an overall decline in DALY rates for CHAs, decreasing from 120,809.85 to 68,324.17 per 100,000, and for non-congenital CVDs, from 42,118.56 to 29,842.73 per 100,000. The most notable improvements occurred among infants and toddlers, whereas adolescents showed stagnant or rising burdens, particularly for ischemic heart disease (IHD), hypertensive heart disease (HHD), and aortic aneurysm. CHAs remained the leading contributor, with neonatal prevalence and mortality in 2023 reaching 1511.53 and 1341.68 per 100,000, respectively. Despite the overall national decline, positive EAPC values (p < 0.001) were observed for these adult-type cardiovascular conditions within the transitioning adolescent population. Regionally, the eastern provinces showed consistently higher mortality—CHA from 23.20 to 15.58 per 100,000 and noncongenital CVDs from 6.07 to 5.23 per 100,000. Conclusion: CHAs remain the leading cause of pediatric CVD in Indonesia, especially among neonates, while adolescents face rising adult-type cardiovascular conditions. National improvements are uneven, with eastern provinces experiencing higher burdens due to limited access to care. These inequalities highlight the need for targeted prevention, early detection, and strengthened long-term management to ensure equitable and sustainable child cardiovascular health.