Global, Regional and National Time Trends in Mortality for Congenital Heart Disease, 1990-2019: An Age-Period-Cohort Analysis for the GBD 2019

2021 
Background: Congenital heart disease (CHD) is the leading cause of morbidity and mortality from birth defects worldwide. We report an overview of trends in CHD mortality in 204 countries and territories over the past 30 years and associations with age, period, and birth cohort.  Methods: Cause-specific CHD mortality estimates were derived from the Global Burden of Disease study 2019. We utilized an age-period-cohort model to estimate overall annual percentage changes in mortality (net drifts), annual percentage changes from 0-4 to 65-69 years (local drifts), period and cohort relative risks (period/cohort effects) between 1990 and 2019. This approach allows for the examination and differentiation of age, period and cohort effects in the mortality trends, with the potential to identify disparities and treatment gaps in cardiac care.  Findings: CHD is the leading cause of deaths from non-communicable diseases in those under 20 years. Global CHD deaths in 2019 were 217,000 (95% uncertainty interval: 177,000, 262,000).There were 129 countries with at least 50 deaths. India, China, Pakistan and Nigeria had the highest mortality accounting for 39.7% of deaths globally. Between 1990 and 2019, the reduction in CHD all-age mortality ranged from –71.3% [–74.7 to –64.6] in high-sociodemographic index (SDI) countries to –42.1% [–61.9 to 12.1] in low-SDI countries. Globally, there was an emerging transition in the age distribution of deaths from pediatric to adult population, except for an increasing trend of mortality in 10~34 years in Mexico and Pakistan. During the past 30 years, favorable mortality reductions were generally found in most high-SDI countries like South Korea (net drift = –4.0% [95% confidence interval: –4.8 to –3.1] per year) and United States (–2.3% [–2.5 to –2.0]), and also in many middle-SDI countries like Brazil (–2.7% [–3.1 to 2.4]) and South Africa (–2.5% [–3.2 to –1.8]) and a few low-SDI countries like Ethiopia (–2.3% [–3.0 to –1.6]). However, 52 out of 129 countries had either increasing trends (net drifts≥0.0%) or stagnated reductions (≥–0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts among high- and high-middle SDI countries with the exceptions of Saudi Arabia and Kazakhstan. Fourteen middle-SDI countries such as Ecuador and Mexico, and sixteen low-middle-SDI countries including India and twenty low-SDI countries including Pakistan, had unfavorable or worsening risks for recent periods and birth cohorts.  Interpretation: CHD mortality is an accessible metric that can be used to track trends and levels in the provision of congenital cardiac care for low- and middle-income countries. Improvements in the treatment of CHD should reduce the risk for successively younger cohorts and shift the risk for all age groups over time. Although there were gains in CHD mortality globally over the past three decades, unfavorable period and cohort effects were found in many countries, raising questions about adequacy of their health care for CHD patients across all age-groups. These failings carry significant implications for the likelihood of achieving the Sustainable Development Goals in this domain.  Funding Information: National Natural Science Foundation of China, Shanghai Outstanding Medical Academic Leader program, and Collaborative Innovation Program of Shanghai Municipal Health Commission. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The GBD study uses deidentified data and a waiver of informed consent was approved by the University of Washington Institutional Review Board.
    • Correction
    • Source
    • Cite
    • Save
    • Machine Reading By IdeaReader
    0
    References
    0
    Citations
    NaN
    KQI
    []