Non-rheumatic calcific aortic valve disease in China: findings from the Global Burden of Disease study 2021

Over the past 30 years, rapid population aging has made non-rheumatic calcific aortic valve disease (NR-CAVD) a growing public health concern in China. However, its long-term epidemiological trends and future disease burden remain unclear. This study aimed to comprehensively assess temporal trends in NR-CAVD in China from 1990 to 2021 and to predict its disease burden over the next 30 years from the Global Burden of Disease (GBD) 2021 data.

Data on the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of NR-CAVD were retrieved from the GBD 2021 database, and estimated annual percentage changes (EAPCs) were calculated. Temporal patterns were evaluated using an age-period-cohort (APC) model, while Joinpoint regression was applied to identify key inflection points. Future trends were projected through a Bayesian APC (BAPC) model based on integrated nested Laplace approximation.

From 1990 to 2021, the age-standardized prevalence and incidence of NR-CAVD in China increased significantly (EAPC for prevalence: 2.33%, incidence: 2.03%), whereas mortality (EAPC $=$ $-$ 1.34%) and DALYs (EAPC $=$ $-$ 1.06%) showed a continuous decline. In 2021, adults aged $\ge$ 65 years accounted for more than two-thirds of total cases, with men showing higher age-standardized rates than women. Joinpoint analysis revealed an accelerated increase after 2005, and BAPC projections indicated that incidence will continue to rise through 2050, particularly among individuals aged 70-74 years.

Although mortality and DALYs associated with NR-CAVD have gradually declined in China, the overall disease burden continues to increase due to population aging. Preventive strategies should prioritize adults over 50 years of age and integrate early screening alongside targeted interventions to reduce future cardiovascular risks.