Sex-specific patterns in global burden of nonrheumatic degenerative mitral valve disease during 1990–2021: Results from the Global Burden of Disease Study 2021

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Objectives: Considerable sex-specific differences regarding etiology, pathophysiology, and outcomes across valvular heart diseases exist. This study aimed to explicitly describe sex-specific and worldwide patterns in the nonrheumatic degenerative disease burden. Methods: Using the Global Burden of Disease 2021, incidence, prevalence, deaths, and disability-adjusted life years were adopted to assess the burden of nonrheumatic degenerative disease. Global, regional, national, and age-period-cohort analyses, focusing on sex-specific sub-analysis, were performed between 1990 and 2021. Results: Globally, significantly higher age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) in 2021 were observed in males. Both ASIR and ASPR remained relatively stable or slowly declining, but both the age-standardized mortality rate and age-standardized disability-adjusted life year rate rapidly declined (net drift < −1.0%) during 1990–2021. More reduction and more rapid decline of ASIR and ASPR were noted in females. Regionally, males had higher ASIR and ASPR across sociodemographic index quintiles, except in the low sociodemographic index region. In females, more reductions with more rapid decline were observed in middle and low-middle regions regarding the age-standardized mortality rate, and observed in high, high-middle, middle, and low-middle regions regarding the age-standardized disability-adjusted life year rate. Nationally, significant sex-specific differences between four age-standardized rates and net drifts were found in many countries, such as Norway, Grenada, Ethiopia, and American Samoa. The sex-specific age patterns of the four indicators also varied, commonly heavier in the middle-aged elderly male population. In the age-period-cohort model, males showed poorer performance in the age, period, and cohort effects. Conclusion: Various and heterogeneous sex-specific patterns in nonrheumatic degenerative disease burden were characterized spatiotemporally in detail. Despite great advancements, the burden remained heavy, particularly in high-income regions or countries and among the elderly. 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.

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