Kong Youjin, Zhao Yan, Chen Tingting, Xie Lingling, Mao Wei
The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Zhejiang Key Laboratory of Integrative Chinese and Western Medicine for Diagnosis and Treatment of Circulatory Diseases, Zhejiang Hospital (Affiliated Zhejiang Hospital, Zhejiang University School of Medicine), Hangzhou, Zhejiang, China.
BMJ Open. 2025 Sep 14;15(9):e104086. doi: 10.1136/bmjopen-2025-104086.
This study aimed to assess the global, regional and national burden of non-rheumatic degenerative mitral valve disease (nrDMVD) from 1990 to 2021 using data from the global burden of disease (GBD) Study 2021, focusing on trends in incidence, prevalence, mortality and disability-adjusted life-years (DALYs). The analysis evaluated disparities by age, sex and sociodemographic index (SDI).
This was a systematic analysis leveraging GBD 2021 data and employing decomposition and frontier analyses to quantify the contributions of ageing, population growth and epidemiological transitions. Age-standardised rates (ASRs) and absolute case numbers were analysed across 204 countries and territories.
Global, regional and national data spanning 1990 to 2021, stratified by SDI quintiles (low to high), 21 GBD regions and age-sex groups.
Individuals diagnosed with nrDMVD, with data representing global populations categorised by age, sex and SDI.
Primary outcomes included incidence, prevalence, mortality and DALYs. Secondary outcomes encompassed age-standardised rates (ASR) (age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR), age-standardised mortality rate (ASMR) and age-standardised DALYs rate (ASDR)) and temporal trends.
In 2021, there were 15.49 million prevalent cases (ASPR: 182.13 per 100 000 population) and 36 843 deaths (ASMR: 0.46 per 100 000 population) globally. From 1990 to 2021, ASRs for prevalence, mortality and DALYs declined significantly (estimated annual percentage change range: -0.17% to -0.31%), while absolute case numbers increased by 85% due to population ageing. High-SDI regions exhibited the highest ASIR (28.49 per 100 000) and ASPR (364.24 per 100 000), while low-SDI regions showed underdiagnosis. Sex disparities were pronounced, with higher ASIR (16.13 vs 11.38) and ASPR (385.09 vs 241.64) in females. Projections to 2050 indicated continued ASR declines, yet rising absolute cases. Frontier analysis identified Serbia, Georgia and high-SDI countries (eg, the Netherlands) as having the largest gaps between actual and achievable disease burden.
Despite declining ASRs, nrDMVD remains a critical global health challenge, driven by ageing populations and regional inequalities. Targeted interventions addressing gender disparities, ageing-related healthcare and resource allocation in low-SDI regions are urgently needed to mitigate future burdens.
本研究旨在利用2021年全球疾病负担（GBD）研究的数据，评估1990年至2021年非风湿性退行性二尖瓣疾病（nrDMVD）的全球、区域和国家负担，重点关注发病率、患病率、死亡率和伤残调整生命年（DALYs）的趋势。该分析评估了年龄、性别和社会人口学指数（SDI）方面的差异。
这是一项系统分析，利用GBD 2021数据并采用分解分析和前沿分析来量化老龄化、人口增长和流行病学转变的贡献。对204个国家和地区的年龄标准化率（ASRs）和绝对病例数进行了分析。
1990年至2021年的全球、区域和国家数据按SDI五分位数（从低到高）、21个GBD区域以及年龄 - 性别组进行分层。
被诊断患有nrDMVD的个体，数据代表按年龄、性别和SDI分类的全球人群。
主要结局包括发病率、患病率、死亡率和DALYs。次要结局包括年龄标准化率（ASR）（年龄标准化发病率（ASIR）、年龄标准化患病率（ASPR）、年龄标准化死亡率（ASMR）和年龄标准化DALYs率（ASDR））以及时间趋势。
2021年，全球有1549万例患病率病例（ASPR：每10万人口182.13例）和36843例死亡（ASMR：每10万人口0.46例）。从1990年到2021年，患病率、死亡率和DALYs的ASRs显著下降（估计年百分比变化范围：-0.17%至-0.31%），而由于人口老龄化，绝对病例数增加了85%。高SDI地区的ASIR最高（每10万人口28.49例）和ASPR最高（每10万人口364.24例），而低SDI地区存在诊断不足的情况。性别差异明显，女性的ASIR（16.13对11.38）和ASPR（385.09对241.64）更高。到2050年的预测表明ASRs将持续下降，但绝对病例数将上升。前沿分析确定塞尔维亚、格鲁吉亚和高SDI国家（如荷兰）的实际疾病负担与可实现的疾病负担之间差距最大。
尽管ASRs下降，但nrDMVD仍然是一项严峻的全球健康挑战，这是由人口老龄化和区域不平等驱动的。迫切需要针对性的干预措施来解决性别差异、低SDI地区与老龄化相关的医疗保健和资源分配问题，以减轻未来的负担。
