Sex difference in the burden of rheumatic heart disease: Insights from the Global Burden of Disease Study 2021

Introduction: Rheumatic heart disease (RHD) shows significant sex differences in disease burden. This study assesses these differences using data from the Global Burden of Disease Study 2021 (GBD 2021). Methods: We extracted sex-specific indicators for RHD from the GBD database, including disability-adjusted life years (DALYs), mortality, and prevalence. Trends were analyzed using estimated annual percentage change (EAPC), and sex differences were assessed via female-by-male ratios. Results: From 1990 to 2021, females consistently had higher age-standardized DALYs (ASDR), mortality (ASMR), and prevalence rates (ASPR) than males. These differences were particularly pronounced in specific regions and age groups. In 2021, female ASDR and ASMR in Andorra were over three times higher than males, while in the Cook Islands, they were less than half of males’ rates. In the United States Virgin Islands, females aged 10–19 had an ASMR only 0.01 times that of males, whereas in the United Arab Emirates, females aged 70–89 had ASDR and ASMR five times higher than males. Overall, the female-by-male ratios in ASDR, ASMR, and ASPR have shown a yearly decline. However, these ratios are positively correlated with the Sociodemographic Index (SDI), with correlation coefficients of 0.1 for ASDR, 0.22 for ASMR, and 0.47 for ASPR. Conclusion: Our study reveals a persistent global sex disparity in RHD burden from 1990 to 2021, with females generally experiencing a heavier burden. These findings underscore the need for sex-specific approaches in RHD prevention and treatment and further research into the underlying factors driving these disparities.