Development-adjusted inequities and temporal trends in rheumatic heart disease burden across ASEAN countries,...

Although health indicators have improved across ASEAN, RHD burden remains uneven and its decline relative to socioeconomic development is unclear. This study aimed to assess temporal trends, burden typologies, and development-adjusted inequities in RHD across ASEAN countries from 2000 to 2023.

Data from the Global Burden of Disease (GBD) 2023 study including age-standardised rates of RHD-attributable disability-adjusted life years (DALYs), deaths, and prevalence were used for 11 ASEAN countries from 2000 to 2023. Average annual percentage change (AAPC), derived from generalised additive model (GAM) predictions, was used as the primary trend metric to summarise nonlinear trajectories. Estimated annual percentage change (EAPC) was additionally reported as a uniform log-linear measure for cross-country clustering. Socio-demographic Index (SDI) frontier analysis was performed using a GAM with a country-level random-effect term to evaluate development-adjusted performance.

Across ASEAN, the age-standardised RHD DALY rate declined by 41.0%, from 185.20 [95% uncertainty interval (UI): 126.22-260.25] in 2000 to 109.27 (95% UI: 72.17-159.80) per 100,000 in 2023. Age-standardised death rates fell by 46.6%, from 3.42 to 1.83 per 100,000, while prevalence declined only marginally by 2.1%, indicating persistent prevalent burden despite reductions in mortality and DALYs. GAM-derived AAPCs ranged from -1.80% in Timor-Leste to -4.63% in Cambodia, while EAPCs ranged from -0.95% to -4.67%. Joint EAPC-DALY clustering identified Cambodia and Singapore as less concerning, Brunei Darussalam, Indonesia, Malaysia, the Philippines, Thailand, and Viet Nam as moderately concerning, and Lao People's Democratic Republic (PDR), Myanmar, and Timor-Leste as highly concerning. In the SDI-adjusted analysis, the largest higher-than-expected DALY burdens were observed in Myanmar (+80.6 DALYs per 100,000) and Lao PDR (+76.2), whereas Thailand showed the largest lower-than-expected burden (-77.1). In 2023, the highest DALY rates were observed in Lao PDR (298.12 per 100,000), Timor-Leste (281.03), and Myanmar (238.76).

All ASEAN countries made substantial progress in reducing RHD burden, with most showing nonlinear declining trajectories. However, progress remained uneven and major disparities persisted. Countries classified as highly concerning require prioritised investment in primary prevention, early detection, secondary prophylaxis, and long-term RHD care.