Burden of non-rheumatic valvular heart disease globally and in China from 1990 to 2021: a systematic analysis for the global burden of disease study 2021.

Background: Non-rheumatic valvular heart disease (NRVHD), driven by aging populations and epidemiological transitions, has become the dominant form of valvular heart disease globally, yet its burden trends and demographic disparities remain undercharacterized. This study quantifies the global and Chinese burden of NRVHD from 1990 to 2021, analyzing age-sex disparities and temporal trends. Methods: Using data from the Global Burden of Disease (GBD) 2021 Study. First, the number of incidence, prevalence, deaths, and disability-adjusted life years (DALYs) cases, along with their corresponding age-standardized rates (ASRs), were reported globally and in China, stratified by different sub-types in 2021. These sub-types included sex and age groups. Second, to explore the temporal trend of the disease burden, data from 1990 to 2021 were analyzed both globally and by sub-types. The estimated annual percentage change (EAPC) value was calculated using a linear regression model. Results: In 2021, NRVHD caused 2,206,928 global incidence cases (ASR: 25.0/100,000) and 28.4 million prevalence cases (ASR: 335.3/100,000), with 181,078 deaths (ASR: 2.31/100,000) and 3.24 million DALYs (ASR: 39.7/100,000). China accounted for 292,215 incidence cases (ASR: 12.8/100,000) and 3.28 million prevalence cases (ASR: 156.2/100,000), demonstrating lower deaths cases (ASDR: 0.13 vs. global 2.31/100,000) but accelerated burden growth. From 1990 to 2021, global incidence rose 129%, while China's surged 220%. Age-standardized deaths rate declined globally and in China, contrasting with rising prevalence. Males bore higher burdens globally and in China, with elderly populations disproportionately affected. Conclusion: NRVHD burden has escalated globally, characterized by rising morbidity amid declining mortality, a paradox amplified in China. While therapeutic advances and hypertension control contributed to mortality reductions, persistent sex-age disparities and rural-urban inequities demand targeted strategies. China's rapid epidemiological transition underscores the urgency of integrating primary prevention, equitable technology access, and enhanced surveillance to address aging-related valvulopathies.