Global, regional, and national time trends in disability-adjusted life years, mortality, and variable risk factors of non-rheumatic calcified aortic valve disease, 1990-2019: an age-period-cohort analysis of the Global Burden of Disease 2019 study

Zeye Liu; Zhanhao Su; Wenchao Li; Fengwen Zhang; Wenbin Ouyang; Shouzheng Wang; Xiangbin Pan

doi:10.21037/jtd-23-480

Global, regional, and national time trends in disability-adjusted life years, mortality, and variable risk factors of non-rheumatic calcified aortic valve disease, 1990-2019: an age-period-cohort analysis of the Global Burden of Disease 2019 study

J Thorac Dis. 2023 Apr 28;15(4):2079-2097. doi: 10.21037/jtd-23-480. Epub 2023 Apr 25.

Authors

Zeye Liu^{1

2

3

4}, Zhanhao Su⁵, Wenchao Li⁶, Fengwen Zhang^{1

2

3

4}, Wenbin Ouyang^{1

2

3

4}, Shouzheng Wang^{1

2

3

4}, Xiangbin Pan^{1

2

3

4}

Affiliations

¹ Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
² National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China.
³ Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China.
⁴ National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
⁵ Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁶ Department of Pediatric Cardiac Surgery, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Huazhong Fuwai Hospital, Zhengzhou, China.

Abstract

Background: Non-rheumatic heart valve disease (NRVD) is a common cardiovascular disease, whereas calcific aortic valve disease (CAVD) is a type of disease with the fastest-growing mortality and disability-adjusted life years (DALYs). This study presents an overview of the trends noted in the DALY, CAVD mortality, and the modiﬁable risk factors in the last 30 years, across 204 countries and territories, and their relationship with the period, age, and birth cohort.

Methods: Data were obtained from the Global Burden of Disease (GBD) 2019 database. An age-period-cohort (APC) model was used to assess general annual percentage changes in DALYs and mortality over the past 30 years in 204 countries and territories.

Results: In 2019, the age-standardized mortality rate for the entire population in areas with a high socio-demographic index (SDI) was more than 4 times higher than that in low-SDI areas. From 1990 to 2019, the net drift in mortality for the whole population was from -2.1% [95% confidence interval (CI): -2.39% to -1.82%] per year in high-SDI regions to 0.05% (95% CI: -0.13% to 0.23%) per year in low- to medium-SDI regions. The trend of DALYs was similar to that of mortality. The age-wise distribution of deaths exhibited a shift toward older populations in high-SDI regions globally, except for Qatar, Saudi Arabia, and the United Arab Emirates. Over time, in most medium, medium-low, and low SDI regions, there was no significant improvement in the period and birth cohort or even an unfavorable or worsening risk. The main variable risk factors of CAVD death and DALYs lost were high sodium diet, high systolic blood pressure, and lead exposure. Those risk factors only showed a significant downward trend in middle- and high-SDI regions.

Conclusions: Health disparities between regions for CAVD are widening and could lead to a heavy disease burden in the future. Health authorities and policymakers in low SDI areas, in particular, need to consider improving resource allocation, increasing access to medical resources, and controlling variable risk factors to stem the growth of the disease burden.

Keywords: Calcific aortic valve disease (CAVD); Global Burden of Disease (GBD); age-period-cohort analysis (APC analysis); cardiology; variable risk factors.