Burden of Rheumatic Heart Disease in Chinese Children and Adolescents versus Adults: An Analysis from the "Global Burden of Disease" Study

Introduction: Rheumatic heart disease (RHD) is a globally important public health issue. China, as a populous country, has daunting challenges posed by RHD-related morbidity and mortality in the public health system. Evaluating and comparing the differences in the RHD burden of children and adolescents versus adults in China not only helps optimize domestic prevention and control strategies but also provides a reference for regional practices in RHD control. Methods: Open data from the 2021 Global Burden of Disease database were utilized to analyze the characteristics of the RHD burden of children, adolescents, and adults in China, including changes in morbidity and mortality. Joinpoint was utilized to calculate the average annual percentage change (AAPC). A comprehensive comparative analysis was undertaken on the differences in RHD burden in Chinese children, adolescents, and adults from multiple dimensions such as age, gender, and time. Results: From 1990 to 2021, the number of deaths of RHD in children and adolescents in China exhibited a declining trend compared to that in adults. In terms of the number of incidences, all age groups showed a declining trend except for those aged 55 and above, which manifested an upward trend. The crude incidence and crude mortality rates both declined during the same period, with their AAPC being -0.53 (95% CI: -0.61, -0.46) and -8.13 (95% CI: -8.65, -7.61) for those aged under 20 years, and -1.92 (95% CI: -2.05, -1.80) and -2.98 (95% CI: -3.18, -2.79) for those aged 20 years and above. The incidence and mortality rates had a bearing on patient age, with higher incidence rates observed in children and adolescents and higher mortality rates observed in adults. According to the analysis of gender differences, the incidence of children and adolescents was higher in men, while women always had a higher crude incidence rate (CIR) and mortality rate (CDR) than men (CIR in 2021: 21.31/100,000 for women vs. 20.08/100,000 for men; CDR: 0.05/100,000 for women vs. 0.06/100,000 for men). The mortality rate of adult women was particularly prominent. The number of cases in children and adolescents exhibited a "W-shaped" fluctuation, while the adult group showed an "M-shaped" trend. The overall CIR and CDR both exhibited a downward trend. Conclusion: The burden of RHD is linked to age and gender, with a high incidence in young people and a high mortality rate in adults. Women are more prone to develop the disease and have a higher risk of mortality. Given China's large and aging population, RHD remains a major public health challenge in China. Effective prevention and control strategies should be underscored.