Rheumatic Heart Disease Burden and Sex Differences in China and ASEAN Countries, 1990–2030: A Comparative Analysis from the Global Burden of Disease Study 2023

Junning Liu,1,2,* Yangxi Zeng,2,* Hao Chi,3 Yang Luo,2 Rui Zeng,2 Chao Yang,2 Juyi Wan,2 Peidong Li11Department of Cardiovascular Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong, Sichuan, People’s Republic of China; 2Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China; 3Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA*These authors contributed equally to this workCorrespondence: Juyi Wan, Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China, Email [email protected]; Peidong Li, Department of Cardiovascular Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong, Sichuan, People’s Republic of China, Email [email protected]: Rheumatic heart disease (RHD) remains a major public health concern in low‑ and middle‑income countries. Systematic comparisons between China and the ten ASEAN member states examining sex disparities are scarce.Methods: Using Global Burden of Disease Study 2023 data, we analyzed RHD burden in China and ten ASEAN countries from 1990 to 2023. Key measures included age‑standardized prevalence (ASPR), mortality (ASMR), and disability‑adjusted life‑years rates (ASDR). Temporal trends were assessed via estimated annual percentage changes (EAPCs) and joinpoint regression. Decomposition analysis quantified contributions of population aging, growth, and epidemiological change. Age‑period‑cohort modeling and ARIMA forecasting (2024‑2030) were applied.Results: From 1990 to 2023, China achieved steeper declines in ASDR (EAPC: − 7.03 vs − 2.40) and ASMR (− 7.07 vs − 2.87) than ASEAN. In 2023, Cambodia, Myanmar, and Laos had the highest burdens; Singapore, Brunei, and Thailand were comparable to China. Females consistently had higher rates than males across all indicators, with wider sex disparity in ASEAN (female‑to‑male ASDR ratio 1.6 vs 1.1 in China). Decomposition analysis showed that China’s female DALY decline was driven by epidemiological improvement (189.7%), whereas in ASEAN population growth largely offset gains (− 145.9%). Joinpoint analysis revealed that China’s female ASDR and ASMR plateaued after 2020, while ASEAN’s female ASPR increased in 2021– 2023 (APC: 0.22). Projections suggested that by 2030 China’s female ASMR would fall below the ASEAN average, potentially positioning China as a regional low‑burden benchmark for all three female indicators.Conclusion: China has made remarkable progress in reducing female RHD burden, outpacing ASEAN. However, the observed post‑2020 plateau in China and the recent rise in female prevalence in ASEAN demand renewed efforts. Persistent sex disparities underscore the urgent need for targeted secondary prophylaxis and regional cooperation, particularly for women of childbearing age in high‑burden countries.Keywords: rheumatic heart disease, global burden of disease, China, ASEAN, age-period-cohort analysis