Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990-2017

Abstract

Non-rheumatic valvular heart diseases (NRVDs) are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease (GBD) 2017 study, mortality, prevalence, and disability-adjusted life years (DALYs) for calcific aortic valve disease (CAVD), degenerative mitral valve disease (DMVD), and other NRVD were estimated for 195 countries and territories from 1990 to 2017.

Methods

Vital registration data, epidemiological survey data, and administrative hospital data were used to estimate disease burden using the GBD modeling framework, which ensures comparability across locations. Geospatial statistical methods were used to estimates disease for all countries, as data on NRVD are extremely limited for some regions of the world, such as sub-Saharan Africa and South Asia. Results accounted for estimated level of disease severity as well as the estimated availability of valve repair or replacement procedures. DALYs and other measures of health-related burden were generated for each sex, five-year age group, location, and year from 1990 to 2017.

Results

Globally, CAVD and DMVD caused 102,700 (95% uncertainty interval [UI] 82,700 to 107,900) and 35,700 (95% UI 30,500 to 42,500) deaths, and had 12.6 million (95% UI 11.4 million to 13.8 million) and 18.1 million (95% UI 17.6 million to 18.6 million) prevalent cases in 2017, respectively. 1.5 million (95% UI 1.4 million to 1.6 million) DALYs were estimated as due to NRVD, globally, representing 0.26% (95% UI 0.22% to 0.27%) of total lost health from all diseases in 2017. The number of DALYs increased for CAVD and DMVD between 1990 and 2017, by 123% (95% UI 101% to 137%) and 64% (95% UI 50% to 75%), respectively. There is significant geographic variation in the prevalence, mortality rate, and overall burden of these diseases, with highest age-standardized DALY rates of CAVD estimated for high-income countries.

Conclusion

These global and national estimates demonstrate that CAVD and DMVD are important causes of disease burden among older adults. Efforts to better understand modifiable risk factors and improve access to valve interventions are necessary if progress is to be made toward reducing, and eventually eliminating, the burden of these highly treatable diseases.