Global, regional, and national burden of congenital heart disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Abstract

Background Previous congenital heart disease estimates came from few data sources, were geographically narrow, and did not evaluate congenital heart disease throughout the life course. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, this study aimed to provide comprehensive estimates of congenital heart disease mortality, prevalence, and disability by age for 195 countries and territories from 1990 to 2017. Methods Mortality estimates were generated for aggregate congenital heart disease and non-fatal estimates for five subcategories (single ventricle and single ventricle pathway congenital heart anomalies; severe congenital heart anomalies excluding single ventricle heart defects; critical malformations of great vessels, congenital valvular heart disease, and patent ductus arteriosus; ventricular septal defect and atrial septal defect; and other congenital heart anomalies), for 1990 through to 2017. All available global data were systematically analysed to generate congenital heart disease mortality estimates (using Cause of Death Ensemble modelling) and prevalence estimates (DisMod-MR 2•1). Systematic literature reviews of all types of congenital anomalies to capture information on prevalence, associated mortality, and long-term health outcomes on congenital heart disease informed subsequent disability estimates. Findings Congenital heart disease caused 261 247 deaths (95% uncertainty interval 216 567-308 159) globally in 2017, a 34•5% decline from 1990, with 180 624 deaths (146 825-214 178) being among infants (aged <1 years). Congenital heart disease mortality rates declined with increasing Socio-demographic Index (SDI); most deaths occurred in countries in the low and low-middle SDI quintiles. The prevalence rates of congenital heart disease at birth changed little temporally or by SDI, resulting in 11 998 283 (10 958 658-13 123 888) people living with congenital heart disease globally, an 18•7% increase from 1990 to 2017, and causing a total of 589 479 (287 200-973 359) years lived with disability. Interpretation Congenital heart disease is a large, rapidly emerging global problem in child health. Without the ability to substantially alter the prevalence of congenital heart disease, interventions and resources must be used to improve survival and quality of life. Our findings highlight the large global inequities in congenital heart disease and can serve as a starting point for policy changes to improve screening, treatment, and data collection. Funding Bill & Melinda Gates Foundation.

Newborn Critical Congenital Heart Disease Screening Using Pulse Oximetry: Value and Unique Challenges in Developing Regions

“…Higher birth rates in low- and middle-income countries increase the burden of disease in these parts of the world. The Lancet recently published an analysis investigating the global burden of congenital heart disease (CHD), concluding that CHD is responsible for over 260,000 deaths annually worldwide [ 4 ]. The majority of those deaths occur in infants less than 1 year of age and in countries associated with low or middle Socio-Demographic Index (SDI) quintiles [ 4 , 5 ].…”

“…The Lancet recently published an analysis investigating the global burden of congenital heart disease (CHD), concluding that CHD is responsible for over 260,000 deaths annually worldwide [ 4 ]. The majority of those deaths occur in infants less than 1 year of age and in countries associated with low or middle Socio-Demographic Index (SDI) quintiles [ 4 , 5 ]. Outcomes for CHD improve correspondingly in regions with higher SDI quintiles [ 4 ].…”

“…The majority of those deaths occur in infants less than 1 year of age and in countries associated with low or middle Socio-Demographic Index (SDI) quintiles [ 4 , 5 ]. Outcomes for CHD improve correspondingly in regions with higher SDI quintiles [ 4 ]. Roughly 90% of infants born with CHD are born in regions with limited or no access to care and in areas where mortality remains significantly higher than the 90–95% that survive into adulthood in developed countries [ 4 ].…”

“…Outcomes for CHD improve correspondingly in regions with higher SDI quintiles [ 4 ]. Roughly 90% of infants born with CHD are born in regions with limited or no access to care and in areas where mortality remains significantly higher than the 90–95% that survive into adulthood in developed countries [ 4 ]. This disparity in outcomes was dramatically captured in a recent analysis examining the global burden of disease over the past 15 years.…”

“…This disparity in outcomes was dramatically captured in a recent analysis examining the global burden of disease over the past 15 years. In a list of the top ten causes of death in infants 1 month to 1 year in age in middle socio-demographic index nations, deaths attributed to CHD rose from being the fourth leading cause to the second leading cause just after lower respiratory infections [ 4 , 6 ]. Reasons for this are multi-factorial and include improved global health measures in the areas of vaccination rates, access to safe water, improved maternal education, and a decrease in poverty associated diseases such as diarrheal diseases [ 7 ].…”