Abstract
Objective: To estimate the burden of myocarditis (MC), alcoholic cardiomyopathy (AC), and other cardiomyopathy (OC) for 195 countries and territories from 1990 to 2017.Methods: We collected detailed information on MC, AC, and OC between 1990 and 2017 from the Global Burden of Disease study 2017, which was designed to provide a systematic assessment of health loss due to diseases and injuries in 21 regions, covering 195 countries and territories. Estimates of MC, AC, and OC burden were produced using a standard Cause of Death Ensemble model and a Bayesian mixed-effects meta-regression tool, and included prevalence, deaths, years lived with disability (YLDs), and years of life lost (YLLs). All estimates were presented as counts, age-standardized rates per 100,000 people and percentage change, with 95% uncertainty intervals (UIs).Results: Worldwide, there were 1.80 million (95% UI 1.64–1.98) cases of MC, 1.62 million (95% UI 1.37–1.90) cases of AC and 4.21 million (95% UI 3.63–4.87) cases of OC, contributing to 46,486 (95% UI 39,709–51,824), 88,890 (95% UI 80,935–96,290), and 233,159 (95% UI 213,677–248,289) deaths in 2017, respectively. Furthermore, globally, there were 131,376 (95% UI 90,113–183,001) YLDs and 1.26 million (95% UI 1.10–1.42) YLLs attributable to MC, 139,087 (95% UI 95,134–196,130) YLDs and 2.84 million (95% UI 2.60–3.07) YLLs attributable to AC, and 353,325 (95% UI 237,907–493,908) YLDs and 5.51 million (95% UI 4.95–5.99) YLLs attributable to OC in 2017. At the national level, the age-standardized prevalence rates varied by 10.4 times for MC, 252.6 times for AC and 38.1 times for OC; the age-standardized death rates varied by 43.9 times for MC, 531.0 times for AC and 43.3 times for OC; the age-standardized YLD rates varied by 12.4 times for MC, 223.7 times for AC, and 34.1 times for OC; and the age-standardized YLL rates varied by 38.4 times for MC, 684.8 times for AC, and 36.2 times for OC. Between 1990 and 2017, despite the decreases in age-standardized rates, the global numbers of prevalent cases, deaths, YLDs, and YLLs have increased for all the diseases.Conclusion: Accurate assessment of the burden of MC, AC, and OC is essential for formulating effective preventative prevention and treatment programs and optimizing health system resource allocation. Our results suggest that MC, AC, and OC remain important global public health problems with increasing numbers of prevalent cases, deaths, YLDs, and YLLs over the past decades, and there are significant geographic variations in the burden of these diseases. Further research is warranted to expand our knowledge of potential risk factors and to improve the prevention, early detection and treatment of these diseases.
Highlights
Cardiovascular disease (CVD) is the largest single contributor to global mortality and morbidity, imposing a severe burden in terms of lost productivity and disability in adults [1]
The age-standardized prevalence rate of AC was significantly higher in males than females [27.7 (95% uncertainty intervals (UIs) 23.4–32.4) vs. 12.6 (95% UI 10.6–14.7) per 100,000 people], whereas the age-standardized prevalence rates of MC and OC were similar between males and females (Table 1)
In addition to extreme age groups, the numbers of MC prevalent cases were stable across different age groups in both sexes
Summary
Cardiovascular disease (CVD) is the largest single contributor to global mortality and morbidity, imposing a severe burden in terms of lost productivity and disability in adults [1]. Among CVD, myocarditis (MC) represents an often-underdiagnosed cause of several life-threatening conditions, including acute heart failure, dilated cardiomyopathy, and sudden death [2, 3]. The incidence and specific causes of MC vary considerably across the globe, depending on the geographical area and the selected population [4, 5]. Together with MC, cardiomyopathy is another often fatal disease contributing to about half of patients dying suddenly in childhood or adolescence or needing to undergo cardiac transplantation [7]. Several types of cardiomyopathy exist, with new ones having been discovered and added recently and MC having been reclassified by some scholars as “inflammatory cardiomyopathy” [7, 8]
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