The Global Burden of Rheumatic Heart Disease: 1990-2021

INTRODUCTION: Rheumatic heart disease (RHD) arises from acute rheumatic fever (ARF) following group A streptococcal infection. While its prevalence has declined in high-income regions, it remains a major health burden in low-resource settings. OBJECTIVE: This research investigated the burden of RHD from 1990 to 2021, utilizing data from the Global Burden of Disease (GBD) 2021 study. METHODS: Publicly available data were analysed to determine absolute counts, age-standardised rates, and percentage changes in prevalence, disability-adjusted life years (DALYs), and deaths from 1990 to 2021. RESULTS: In 2021, global RHD cases numbered 54,785,119, with an age-standardised prevalence rate of 684.2 per 100,000, reflecting a 12.6% increase since 1990. Deaths totalled 373,345, with an age-standardised rate of 4.5 per 100,000, marking a 56.2% decline over the period. In 2021, Eritrea (1,865.4) had the highest prevalence rate and Finland (17.4) the lowest. In 2021, Micronesia reported the highest death rate (9.6 per 100,000), and Guatemala the lowest (0.2). Females exhibited higher prevalence rates across all ages, peaking in the 25-29 age range. Although prevalence declined with age, it remained higher in females than among males. The relationship between the Sociodemographic Index (SDI) and RHD burden was non-linear, peaking at an SDI of 0.42, before declining sharply. CONCLUSION: RHD remains a major public health challenge, characterised by rising prevalence and significant health and economic impacts. Despite reductions in mortality and DALY rates, the increasing prevalence underscores the urgent need for improved prevention and management strategies.