The global burden of rheumatic heart disease: 1990-2021

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.

This research reported the burden of RHD from 1990 to 2021, utilising data from the Global Burden of Disease (GBD) 2021 study.

Publicly available data were analysed to determine absolute counts, age-standardised rates and percentage changes in prevalence, deaths and disability-adjusted life years (DALYs) from 1990 to 2021.

In 2021, global RHD cases numbered 54,785,119, with an age-standardised prevalence 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). Women exhibited higher prevalence estimates 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 Socio-demographic Index (SDI) and RHD burden was non-linear, peaking at an SDI of 0.42, before declining sharply.

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.