Abstract
Objective: The global trends in myocarditis burden over the past two decades remain poorly understood and might be increasing during the coronavirus disease 2019 (COVID-19) worldwide pandemic. This study aimed to provide comprehensive estimates of the incidence, mortality, and disability-adjusted life years (DALYs) for myocarditis globally from 1990 to 2017.Methods: Data regarding the incidence, mortality, DALY, and estimated annual percentage change (EAPC) between 1990 and 2017 for myocarditis worldwide were collected and calculated from the 2017 Global Burden of Disease study. We additionally calculated the myocarditis burden distribution based on the Socio-Demographic Index (SDI) quintile and Human Development Index (HDI).Results: The incidence cases of myocarditis in 2017 was 3,071,000, with a 59.6% increase from 1990, while the age-standardized incidence rate (ASIR) was slightly decreased. The number of deaths due to myocarditis increased gradually from 27,120 in 1990 to 46,490 in 2017. The middle SDI quintile showed the highest number of myocarditis-related deaths. On the contrary, the global age-standardized death rate (ASDR) decreased with an overall EAPC of −1.4 [95% uncertainty interval (UI) = −1.8 to −1.0]. Similar to ASDR, the global age-standardized DALY rate also declined, with an EAPC of −1.50 (95% UI = −2.30 to −0.8) from 1990 to 2017. However, there was a 12.1% increase in the number of DALYs in the past 28 years; the middle SDI and low-middle SDI quintiles contributed the most to the DALY number in 2017. We also observed significant positive correlations between the EPAC of age-standardized rate and HDI for both death and DALY in 2017.Conclusions: Globally, the ASIR, ASDR, and age-standardized DALY rate of myocarditis decreased slightly from 1990 to 2017. The middle SDI quintile had the highest level of ASIR, ASDR, and age-standardized DALY rate, indicating that targeted control should be developed to reduce the myocarditis burden especially based on the regional socioeconomic status. Our findings also provide a platform for further investigation into the myocarditis burden in the era of COVID-19.
Highlights
Cardiovascular disease is a major contributor to disease burden and death globally [1]
Myocarditis is a cause of cardiovascular disease that primarily manifests as chest pain, sudden death, and heart failure
Trends of Myocarditis Incidence From 1990 to 2017 Globally, the incidence number of myocarditis was 3,071,000 (95% uncertainty index (UI) = 2,745,000–3,071,000) in 2017, with a 59.6% increase from 1,925,000 (95% UI = 1,741,000–2,164,000) in 1990 (Table 1, Supplementary Table 2, and Figure 1A)
Summary
Cardiovascular disease is a major contributor to disease burden and death globally [1]. Myocarditis is a cause of cardiovascular disease that primarily manifests as chest pain, sudden death, and heart failure. There were 353,700 [95% uncertainty index (UI): 339,500 to 370,600] deaths globally due to myocarditis and cardiomyopathy in 2015, representing a considerable public health problem [2, 3]. It was ranked as the third leading cause of sudden cardiac death in competitive athletes reported by the American Heart Association and the American College of Cardiology, and it was considered the most common known cause of dilated cardiomyopathy in children
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