Thirty-year Trend of Non-rheumatic Valvular Heart Disease: A Comparison of Pakistan with South Asia and Global Scenario

Abstract

Background: Improved prophylaxis has shifted valvular heart disease (VHD) from rheumatic to non-rheumatic causes globally, with rheumatic VHD nearly eradicated in high-income countries. However, non-rheumatic VHD remains a major health issue in low-to-middle-income countries like those in South Asia. This study examines non-rheumatic VHD trends in Pakistan compared to South Asia and global figures. Objective: To evaluate non-rheumatic VHD trends in Pakistan from 1990 to 2019 using Global Burden of Disease (GBD) data. Methods: The study extracted data on prevalence, deaths, disability-adjusted life years (DALYs), and age-standardized death rate (ASDR) from the GBD study. An ecological design analyzed data using Excel and R-Studio. Poisson regression assessed the 30-year ASDR trend at global, South Asian, and national levels, calculating percentage changes with incidence rate ratios (IRR) and 95% confidence intervals. Results: From 1990 to 2019, Pakistan's non-rheumatic VHD prevalence increased by 14.1% (6.4 to 7.3 per 100,000), and ASDR rose by 12.9% (1.32 to 1.49), with an IRR of 1.102 (95% CI: 1.002-1.198). Global ASDR slightly decreased (IRR: 0.997, 95% CI: 0.971-1.024), and South Asia’s IRR was 0.996 (95% CI: 0.959-1.034). Deaths in Pakistan rose by 1.1% (0.59 to 0.60 per 100,000), and DALYs increased by 17% (14.1 to 16.5 per 100,000), with significant rises in Sindh (30.3%), Baluchistan (23.7%), and Azad Jammu & Kashmir (23.9%). Conclusion: GBD data show a significant increase in non-rheumatic VHD burden in Pakistan over 30 years, necessitating policy and interventions to address this growing health issue.