Global Trends, Health Inequalities, and Relationship with Socio-Demographic Index in Congenital Heart Disease: An Analysis from 1990 to 2021

Background: Congenital heart disease (CHD) remains a significant global health concern, with considerable heterogeneity across age groups, genders, and regions. Objective: CHD remains a significant global health concern, with considerable heterogeneity across age groups, genders, and regions. Methods: This study aimed to investigate the global epidemiological patterns, inequalities, and socio-demographic determinants of CHD burden from 1990 to 2021 to inform targeted interventions. Results: CHD burden increased with age, peaking among individuals aged 70 years and older. This does not reflect new-onset disease, but rather the accumulation of late diagnoses, long-term complications, and healthcare encounters in aging individuals with CHD. Males consistently exhibited higher incidence and mortality rates than females. From 1990 to 2010, global age-standardized prevalence and incidence rates increased steadily and declined slightly thereafter. Joinpoint and age-period-cohort analyses revealed inflection points post-2010 and suggested cohort-related effects. Although SII trends indicated rising inequality over time, that disease burden has become more concentrated in low-SDI regions. ARIMA projections estimated a stable or marginally declining CHD burden by 2030. Regional analyses showed that high-SDI countries experienced significant reductions in CHD mortality, whereas low-SDI regions continued to bear a disproportionate burden. Conclusions: CHD burden has shifted in recent decades, influenced by demographic transitions, healthcare access, and socio-economic development. Despite progress, persistent health inequalities remain. Continued investment in early detection, maternal care, and public health infrastructure is essential to reduce CHD disparities globally.