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The global burden of pediatric infective endocarditis (5-14 years): epidemiological patterns from 1990 to 2021 and
Ying Xiao1, Yin Li2, YuLing Hou2
1Department of Cardiology, Kunming Children's Hospital, Kunming City, Yunnan, China.
Insights
Pediatric infective endocarditis (IE) incidence and mortality decreased globally from 1990-2021, but significant regional disparities persist. Future trends may stabilize or slightly increase, emphasizing the need for equitable care and surveillance.
Area of Science:
- Global health
- Epidemiology
- Pediatric cardiology
Background:
- Pediatric infective endocarditis (IE) is a rare, life-threatening condition in children.
- Global burden, trends, and disparities of pediatric IE are not well understood despite advances in cardiac care.
Purpose of the Study:
- To analyze the global burden, temporal trends, and regional disparities of pediatric IE.
- To forecast future trends of pediatric IE through 2035.
Main Methods:
- Utilized the Global Burden of Disease (GBD) 2021 dataset for children aged 5-14 years.
- Estimated incidence, mortality, and DALYs from 1990-2021 across 204 countries.
- Applied an ARIMA model for trend forecasting through 2035, with stratification by sex, region, and SDI.
Main Results:
- Global pediatric IE incidence and mortality declined by 27.6% and 21.4% respectively between 1990-2021.
- Significant disparities observed, with high-SDI regions showing greatest reductions, while sub-Saharan Africa and Eastern Europe showed stagnation or increases.
- Projected stabilization or slight rebound in global pediatric IE burden by 2035, particularly in girls.
Conclusions:
- Despite progress, substantial geographic and socio-demographic inequalities in pediatric IE burden persist.
- Urgent need for strengthened early detection, prevention, and equitable cardiac care access, especially in low- and middle-income countries.
- Enhanced surveillance and data collection are crucial for monitoring trends and improving interventions.
Background:
Pediatric infective endocarditis (IE) remains a rare but life-threatening condition, with substantial morbidity and mortality among children worldwide. Despite advances in cardiac care and infection control, the global burden, temporal trends, and regional disparities of pediatric IE remain poorly characterized.
Methods:
We conducted a comprehensive analysis of pediatric IE burden among children aged 5-14 years using the Global Burden of Disease (GBD) 2021 dataset. Annual incidence, mortality, and disability-adjusted life years (DALYs) attributable to IE were estimated across 204 countries and territories from 1990 to 2021. Analyses were stratified by sex, region, and socio-demographic index (SDI). An autoregressive integrated moving average (ARIMA) model was applied to forecast pediatric IE trends through 2035.
Results:
Globally, the incidence of pediatric IE declined by 27.6% (95% UI, -30.9% to -24.9%) and mortality by 21.4% (95% UI, -35.2% to -0.8%) between 1990 and 2021, with an estimated annual percentage change (EAPC) of -1.37% (95% CI, -1.49% to -1.24%) and -0.64% (95% CI, -0.75% to -0.54%), respectively. DALYs decreased by 19.2% (95% UI, -33.2% to 1.9%). Marked disparities persisted, with high-SDI regions, notably China, achieving the greatest reductions in burden, while sub-Saharan Africa and Eastern Europe exhibited stagnant or increasing rates. The ARIMA model projected a potential stabilization or slight rebound in the global pediatric IE burden by 2035, particularly among girls, although wide confidence intervals highlight the uncertainty of long-term forecasts.
Conclusions:
While significant progress has been made in reducing the global burden of pediatric IE, major geographic and socio-demographic inequalities persist. Sustained efforts to strengthen early detection, risk stratification, prevention (including rheumatic heart disease control and antibiotic prophylaxis), and equitable access to cardiac care are urgently required-especially in low- and middle-income countries. Enhanced surveillance and data collection will be crucial to monitor trends, evaluate interventions, and achieve further reductions in pediatric IE morbidity and mortality.
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