Trend Dynamics of Rheumatic Heart Disease Burden, 1990-2019: Insights From Age-Period-Cohort Modeling and Projections.

Background: Rheumatic heart disease (RHD) is a global autoimmune disease that contributes significantly to cardiovascular mortality. However, a comprehensive investigation into age-specific mortality patterns across diverse regions remains limited. To address this issue, this study aimed to investigate alterations in RHD mortality and disease burden measured by disability-adjusted life years (DALY), and modifiable risk factors across 204 countries and regions during the preceding three decades. Additionally, this study endeavored to forecast the trends for RHD in the coming decade and to explore the associations with the age, period, and birth cohort by analyzing data from the Global Burden of Disease (GBD) 2019. Methods: We present up-to-date mortality and DALY data for RHD sourced from the GBD 2019 data. We employed the age-period-cohort (APC) model to assess local and net drift, as well as the influences of age, period, and birth cohort. Additionally, we examine modifiable risk factors and provide projections for RHD mortality trends in the coming decade. Results: Age-standardized mortality rates for RHD exhibited a net drift ranging from -5.59 (95% confidence interval (CI): -5.84 to -5.34) in high-middle sociodemographic index (SDI) regions, to -2.34 (95% CI: -2.42 to -2.25) in low SDI regions. Comparable trends were observed with DALY. High systolic blood pressure was the major metabolic risk factor in both 1990 and 2019. Projections indicate a global reduction in RHD mortality rates over the coming decade. Nevertheless, individuals in low-SDI regions are projected to bear a substantial mortality burden in both 2019 and 2029, accentuating a widening sex disparity. Conclusions: In summary, this study found that age, period, and birth cohort effects for RHD were positive globally, except for low SDI regions. The widening health disparities between regions indicate an imminent threat of significant disease burden. Thus, this study underscores the imperative requirement for targeted interventions, enhanced healthcare accessibility, and sex-sensitive strategies to alleviate the burden of death and disability associated with RHD, particularly in low SDI regions.