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      Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990-2017

      1 , 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 9 , 1 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 5 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 17 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 23 , 37 , 38 , 39 , 1 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 9 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59
      Circulation
      Ovid Technologies (Wolters Kluwer Health)

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          Abstract

          Background: Non-rheumatic valvular heart diseases (NRVDs) are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease (GBD) 2017 study, mortality, prevalence, and disability-adjusted life years (DALYs) for calcific aortic valve disease (CAVD), degenerative mitral valve disease (DMVD), and other NRVD were estimated for 195 countries and territories from 1990 to 2017.

          Methods: Vital registration data, epidemiological survey data, and administrative hospital data were used to estimate disease burden using the GBD modeling framework, which ensures comparability across locations. Geospatial statistical methods were used to estimates disease for all countries, as data on NRVD are extremely limited for some regions of the world, such as sub-Saharan Africa and South Asia. Results accounted for estimated level of disease severity as well as the estimated availability of valve repair or replacement procedures. DALYs and other measures of health-related burden were generated for each sex, five-year age group, location, and year from 1990 to 2017.

          Results: Globally, CAVD and DMVD caused 102,700 (95% uncertainty interval [UI] 82,700 to 107,900) and 35,700 (95% UI 30,500 to 42,500) deaths, and had 12.6 million (95% UI 11.4 million to 13.8 million) and 18.1 million (95% UI 17.6 million to 18.6 million) prevalent cases in 2017, respectively. 1.5 million (95% UI 1.4 million to 1.6 million) DALYs were estimated as due to NRVD, globally, representing 0.26% (95% UI 0.22% to 0.27%) of total lost health from all diseases in 2017. The number of DALYs increased for CAVD and DMVD between 1990 and 2017, by 123% (95% UI 101% to 137%) and 64% (95% UI 50% to 75%), respectively. There is significant geographic variation in the prevalence, mortality rate, and overall burden of these diseases, with highest age-standardized DALY rates of CAVD estimated for high-income countries.

          Conclusion: These global and national estimates demonstrate that CAVD and DMVD are important causes of disease burden among older adults. Efforts to better understand modifiable risk factors and improve access to valve interventions are necessary if progress is to be made toward reducing, and eventually eliminating, the burden of these highly treatable diseases.

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          Author and article information

          Journal
          Circulation
          Circulation
          Ovid Technologies (Wolters Kluwer Health)
          0009-7322
          1524-4539
          March 29 2020
          Affiliations
          [1 ]Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
          [2 ]Department of Cardiology, Dupuytren University Hospital & Institute of Epidemiology, University of Limoges, Limoges, France
          [3 ]College of Medicine, University College Hospital, Ibadan, Ibadan, Oyo, Nigeria
          [4 ]Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
          [5 ]Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
          [6 ]Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN
          [7 ]Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
          [8 ]Health Management and Economics Research Center & Health Economics Department, Iran University of Medical Sciences, Tehran, Tehran, Iran
          [9 ]Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Tehran, Iran
          [10 ]Heart and Vascular Center, Essentia Health, Duluth, MN
          [11 ]Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA
          [12 ]Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Mazandaran, Iran
          [13 ]Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
          [14 ]Applied Molecular Biosciences Unit, Institute of Public Health, University of Porto, Porto, Portugal
          [15 ]Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
          [16 ]School of Medicine, Federal University of Bahia & Medical Board, Roberto Santos General Hospital, Salvador, Bahia, Brazil
          [17 ]Division of Cardiovascular Medicine, University of Louisville, Louisville, KY
          [18 ]Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
          [19 ]REQUIMTE/LAQV, University of Porto, Porto, Portugal
          [20 ]Psychiatry Department, Kaiser Permanente, Fontana, CA & Department of Health Sciences, A.T. Still University, Mesa, AZ
          [21 ]Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH & Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC
          [22 ]School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
          [23 ]Institute for Health Metrics and Evaluation & Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA
          [24 ]Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
          [25 ]Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran
          [26 ]Institute of Family Medicine and Public Health, University of Tartu, Tartu, Tartumaa, Estonia
          [27 ]Hematology-Oncology and Stem Cell Transplantation Research Center & Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Tehran, Iran
          [28 ]Non-communicable Diseases Research Unit, Medical Research Council South Africa Department of Medicine, University of Cape Town, Cape Town, South Africa
          [29 ]Department of Health Management and Health Economics, Kristiania University College, Oslo, Norway & Department of Health Services Policy and Management, University of South Carolina, Columbia, SC
          [30 ]Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
          [31 ]Department of Medicine, Brown University, Providence, RI
          [32 ]Ophthalmology Department, Iran University of Medical Sciences, Tehran, Tehran, Iran & Ophthalmology Department, University of Manitoba, Winnipeg, Manitoba, Canada
          [33 ]Department of Surgery, University of Virginia, Charlottesville, VA
          [34 ]Department of Medicine, University of Cape Town, Cape Town, South Africa & Center for Translation Research and Implementation Science, National Institutes of Health, Bethesda, MD
          [35 ]Faculty of General Medicine, Kyrgyz State Medical Academy & Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
          [36 ]Internal Medicine Department, King Saud University, Riyadh, Riyadh, Saudi Arabia
          [37 ]Anatomy and Embryology Department, Carol Davila University of Medicine and Pharmacy & Department of Cardiology, Cardio-Aid, Bucharest, Bucharest, Romania
          [38 ]Institute for Global Health Innovations, Duy Tan University, Hanoi, Hanoi, Vietnam
          [39 ]Center of Excellence in Behavioral Health, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
          [40 ]Division of Cardiology, University of Washington, Seattle, WA
          [41 ]Department of Medicine, Maimonides Medical Center, Brooklyn, NY
          [42 ]Department of Cardiology, University of Bern, Bern, Switzerland
          [43 ]College of Graduate Health Sciences, A.T. Still University, Mesa, AZ & Medichem, Barcelona, Spain
          [44 ]WHO Collaborating Centre for Public Health Education and Training, Imperial College London & University College London Hospitals, London, United Kingdom
          [45 ]Department of Primary Care and Public Health, Imperial College London & Public Health England, London, United Kingdom
          [46 ]Cardiovascular Medicine, West Virginia University, Morgantown, WV
          [47 ]Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
          [48 ]Faculty of Medicine, Ain Shams University, Cairo, Egypt
          [49 ]Department of Cardiology, Tehran University of Medical Sciences, Tehran, Tehran, Iran
          [50 ]Emergency Department, Manian Medical Centre, ERODE, Tamil Nadu, India
          [51 ]Department of Medicine, University of Cape Town, Cape Town, South Africa
          [52 ]Department of Public Health, Adigrat University, Adigrat, Tigray, Ethiopia
          [53 ]Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
          [54 ]Gomal Center of Biochemistry and Biotechnology, Gomal University, Faisalabad, Punjab & TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan
          [55 ]Heart and Vascular Center, Harvard University, Boston, MA
          [56 ]UKK Institute, Tampere, Finland
          [57 ]School of Population Health & Environmental Sciences, King's College London & Biomedical Research Council, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
          [58 ]Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
          [59 ]Institute for Health Metrics and Evaluation & Department of Health Metrics Sciences, School of Medicine & Division of Cardiology, University of Washington, Seattle, WA
          Article
          10.1161/CIRCULATIONAHA.119.043391
          32223336
          83661893-9bae-4f4e-914c-fd29c9596de8
          © 2020

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