Can development alone save lives? trends and forecasts of congenital heart anomalies–attributable premature mortality in ASEAN

Background: Congenital heart anomalies (CHAs) are a leading cause of premature childhood mortality and contribute substantially to years of life lost (YLL). Despite overall improvements in child survival in Southeast Asia, progress in reducing CHA-attributed mortality has been uneven. Examining how trends in CHA-related YLL align with socioeconomic development is critical for informing targeted health system investments. This study assesses trends and projections of CHA-attributed premature mortality in ASEAN countries from 2000 to 2030 in relation to development levels. Methods: Data from the Global Burden of Disease Study 2021 were used to extract CHA-attributed YLL rates, including all-age and age-stratified estimates (<5, 5-9, and 10-19 years), alongside Socio-demographic Index (SDI) values from 2000 to 2021. Estimated Annual Percentage Change (EAPC) for YLL and SDI was calculated using log-linear regression, and an efficiency ratio quantified YLL reduction per unit SDI gain. Forecasts up to 2030 were generated using ARIMA and ARIMAX models applied to the natural logarithm-transformed outcome values, with SDI trajectories stratified by recent growth patterns. Results: From 2000 to 2021, all ASEAN countries showed declining CHA-attributed YLL. Singapore achieved the steepest decline (from 104.27 to 26.09 per 100,000) and highest efficiency relative to SDI gains. Children under five consistently bore the greatest burden, with 2021 YLLs ranging from 319 per 100,000 in Singapore to 7,435 per 100,000 in Lao PDR, a more than 23-fold disparity. Under SDI-adjusted projections to 2030, Cambodia, Lao PDR, Myanmar, and Timor Leste were projected to achieve moderate reductions of approximately 16-29% compared with 2021, although their absolute YLL levels remained high (YLLs > 600 per 100,000). The estimated trends in Singapore and Brunei Darussalam exceeded those expected under the SDI-adjusted projections, with projected YLLs of 17.35 and 131.67 per 100,000 population, respectively. Conclusion: CHA-attributed premature mortality is largely preventable but not assured by development alone. Greater YLL reductions occur when investment in pediatric cardiac care keep pace with socioeconomic progress, highlighting the need for targeted interventions in countries with rising SDI but limited mortality reduction.