Sex-specific patterns in worldwide burden of non-rheumatic degenerative mitral valve disease between 1990 and 2021, results from the Global Burden of Disease Study 2021

Abstract Background This study aimed to provide the updated worldwide burden of NRDMVD and associations with age, period, and birth cohort, particularly in their sex-specific patterns. Methods Data were sourced from the Global Burden of Disease Study 2021. Incidence, prevalence, deaths, and disability-adjusted life years (DALYs) as well as their age-standardized rates (ASRs) per 100,000 population were adopted to assess the burden of NRDMVD. Global, regional, national, and age-period-cohort analyses, focusing on sex-specific sub-analysis, were performed between 1990 and 2021. Results Globally, there were 1162.56 thousand incident cases, 15494.65 thousand prevalent cases, 36.84 thousand death cases, and 943.26 thousand DALYs cases in 2021. Significantly higher age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) in 2021 were observed in males compared with females. Both ASIR and ASPR remained stable but both the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) declined during 1990–2021. More reduction and more rapid decline of ASIR and ASPR were noted in females over the past 3 decades. Regionally, males have a heavier burden on ASIR and ASPR in 2021 across each region except in the low SDI region. In females, more reductions with more rapid decline were observed in middle and low-middle regions regarding the ASMR and observed in high, high-middle, middle, and low-middle regions regarding ASDR. Nationally, the most significant sex-specific differences of four ASRs could be identified in Norway (female ASIR, 28.1%, ASPR, 352.67% vs. male ASIR, 114.72%, ASPR, 1486.34% per year) and Grenada (female ASMR, 0.53%, ASDR, 14.15% vs. male ASMR, 1.94%, ASDR, 53.5% per year). The sex-specific age patterns of the four indicators also varied, commonly heavier in the males and elderly. In the age-period-cohort model, age effects revealed similar peaking patterns of incidence risk across all SDI regions, with the highest incidence in the 65–69 age group. The risks were higher in males approximately over 50 years old. In addition, risks of prevalence and DALYs increased with age, with an increasingly higher burden in males. The relative risk of four indicators had a declining trend over the study period and successively younger birth cohorts. Conclusion Incidence, prevalence, death, and DALYs of NRDMVD from 1990 to 2021 were described comprehensively, showing significant heterogeneity of sex-specific patterns. The burden remained heavy, particularly in the males and the elderly, albeit with improvements over the past three decades. These findings would be beneficial for healthcare professionals, policymakers, and researchers to precisely refine strategies on management and healthcare source allocation targeting sex-specific patterns.Sex-specific patterns in NRDMVD burden