Global, regional, and national burden of endocarditis, 1990-2021: a systematic analysis of the GBD 2021 study

Endocarditis is a serious cardiovascular infection associated with high mortality and disability. Its global epidemiological patterns and long-term trends have not been comprehensively characterized.

Data from the Global Burden of Disease (GBD) Study 1990-2021 were used to evaluate the prevalence, incidence, disability-adjusted life years (DALYs), and Deaths of endocarditis across 204 countries and territories. Temporal trends were analyzed using percentage change and estimated annual percentage change (EAPC), stratified by Socio-demographic Index (SDI), region, age, and sex.

Between 1990 and 2021, the absolute number of endocarditis cases increased: prevalence by 14%, incidence by 34%, DALYs by 26%, and Deaths by 29%. Conversely, age-standardized rates declined (EAPCs: -0.58 for prevalence, -0.09 for incidence, -0.33 for DALYs, -0.29 for Deaths). Females had higher prevalence and incidence, while males experienced greater Deaths and DALYs burdens. The burden was concentrated among individuals aged ≥ 65 years, with slight increases observed in children under 5 in low-SDI regions. High-SDI regions showed declining trends in age-standardized metrics, whereas low- and middle-SDI regions exhibited increases. Correlation analysis indicated a moderate association between SDI and prevalence (R = 0.543), a stronger association with incidence (R = 0.770), and a weak correlation with DALYs (R = 0.063).

The absolute burden of endocarditis has increased globally despite declining standardized rates, with older adults and low-SDI populations disproportionately affected. These findings highlight the need for enhanced surveillance and equitable access to care, although limited clinical detail in the GBD framework restricts direct clinical interpretation.