Trends in pediatric rheumatic heart disease in the Indonesia–Malaysia–Thailand Growth Triangle economic sub-region (Indonesia, Malaysia, and Thailand), 1990–2023: A Global burden of disease study

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ABSTRACT Background: The extent to which socio-demographic development translates into reductions in rheumatic heart disease (RHD) burden in the Indonesia–Malaysia–Thailand Growth Triangle (IMT-GT) Economic Sub-Region have not been assessed. This study aimed to assess temporal trends, socio-demographic gradients, and development-adjusted performance of pediatric RHD from 1990 to 2023. Methods: Data from the Global Burden of Disease Study 2023 for Indonesia, Malaysia, and Thailand were analyzed. Age-specific incidence, mortality, and disability-adjusted life years (DALYs) were estimated by the sex. Temporal trends were assessed using generalized additive models to estimate average annual percentage changes (AAPC). The association between DALY rates and the socio-demographic index (SDI) was evaluated using elasticity analysis and performance relative to SDI-based expectations was quantified as the gap between observed and expected DALY rates. Results: Between 1990 and 2023, the burden of RHD declined across the IMT-GT sub-region, with substantial cross-country variation. AAPCs indicated modest declines in DALYs and mortality in all countries, whereas incidence showed no consistent long-term decrease. Higher SDI was significantly associated with lower DALY rates across all pediatric age groups (P < 0.001). SDI-benchmarked comparisons indicate that Indonesia has not achieved the level of DALY reduction expected for its development status, whereas Thailand has exceeded these expectations and Malaysia has remained on the predicted trajectory. Conclusions: The burden of pediatric RHD has declined in the IMT-GT Economic Sub-region over the past three decades, driven primarily by reductions in mortality. Sociodemographic development was strongly associated with lower DALY rates, but substantial cross-country differences in development-adjusted performance persist.

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