Epidemiological Trends in Rheumatic and Non-Rheumatic Valvular Heart Disease in Low- and Middle-Income Countries From 1990 to 2019

Background Valvular heart diseases are a public health problem in low- and middle-income countries (LMICs). However, their epidemiology is understudied as compared to Western countries. The aim of this study was to describe the epidemiological evolution of rheumatic and non-rheumatic heart valve disease (RV and NRVH) from 1990 to 2019 in LMICs. Methods Data on prevalence, incidence, mortality and DALY associated with RVHD and NRVHD were obtained from the Global Burden Disease study from 1990–2019. A comparison analysis of incidence, prevalence, mortality and DALYs was calculated to obtain percentage change for each country. Results A total of 135 LMICs were included, with most located in Africa (40%), followed by Asia, the Americas, and Oceania. The prevalence of RVHD decreased most in low-income countries (–37%), while NRVHD prevalence rose markedly in lower-middle-income countries (+251%). RVHD incidence declined in most LMICs (–7.6%), especially in Eastern Europe, Central Asia, and sub-Saharan Africa. Conversely, NRVHD incidence increased (+16%), particularly in South America, Africa, and South/Southeast Asia. RVHD prevalence showed heterogeneous trends, with declines in Eastern Europe and Latin America but increases in Africa and Asia. An inverse association was found between SDI and RVHD-related DALYs, while no consistent trend was observed for NRVHD. Conclusion The epidemiology of valvular heart disease has shifted markedly since the 1990s, with declining RVHD prevalence but persistently high incidence in many LMICs. NRVHD indicators have been rising, creating a dual burden in resource-limited settings. This underscores the need for intensified research and targeted public health strategies.