Global and Chinese trends in the burden of infective endocarditis from 1990 to 2021

Abstract Objective To compare trends in the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of infective endocarditis in China and worldwide from 1990 to 2021, assessing potential associations with major health system reforms in China, including the 2015 Community-Oriented Risk Management Project for cardiovascular disease. Methods We performed a comparative ecological analysis using data from the Global Burden of Disease (GBD) 2021 study. Age-standardized rates (ASRs) and crude counts for endocarditis from 1990 to 2021 were extracted. Trend analyses covered 1990–2019 to avoid pandemic-related artifacts, while 2021 estimates are reported to reflect the latest burden. Joinpoint regression was used to quantify trends via the average annual percentage change (AAPC). Results Between 1990 and 2021, incident cases increased in both China (97.45%) and globally (135.03%), and prevalent cases rose by 78.87% in China compared to 199.99% worldwide. However, China achieved substantial reductions in mortality (-44.98%; ASMR AAPC: -4.09% [95% CI: -4.32 to -3.86]) and disability-adjusted life years (DALYs) (-70.58%; ASDR AAPC: -4.88% [-5.20 to -4.57]). In contrast, global mortality increased by 111.06% (ASMR AAPC: -0.02% [-0.13 to 0.10]) and DALYs rose by 55.67% (ASDR AAPC: -0.33% [-0.43 to -0.23]). The burden shifted from younger populations (< 5 years) to older adults (≥ 65 years) in both settings, with males disproportionately affected across all metrics. Conclusion China’s pronounced decline in endocarditis mortality and disability coincides temporally with its nationwide healthcare reforms. In contrast, rising global mortality and DALYs highlight persistent challenges related to aging populations, sex disparities, and antimicrobial resistance. These findings underscore the potential impact of integrated health policies on severe infections and emphasize the need for targeted, equity-focused strategies to mitigate the global burden of endocarditis.