Global, Regional, and National Burden of Myocarditis and Its Impairment, 1990-2023.
Abstract
Background
The impact of recent trends in the burden of myocarditis has not been reported in detail.
Objectives
This study aims to estimate the global, regional, and national burden of myocarditis from 1990 to 2023, using data from the GBD (Global Burden of Disease, Injuries, and Risk Factors Study) 2023.
Methods
As part of the GBD 2023, the authors used all available administrative health facility and vital registration data to estimate myocarditis prevalence, incidence, disability-adjusted life years (DALYs), mortality, and mortality-to-incidence ratio (MIR) for every country, stratified by age, sex, and quintiles of a Socio-demographic Index (SDI). The MIR represents the relative mortality burden compared with disease incidence at the population level. The prevalence of heart failure attributable to myocarditis was estimated using a model-based attribution approach.
Results
In 2023, the global age-standardized rates of prevalence, incidence, DALY, and mortality of myocarditis were 4.84 (95% uncertainty interval [UI]: 3.98-5.80), 12.46 (95% UI: 9.86-15.70), 8.41 (95% UI: 5.63-12.59) and 0.21 (95% UI: 0.14-0.29) per 100,000 population, respectively. Although global age-standardized prevalence and incidence rates remained stable from 1990 to 2023, the absolute number of incident cases increased by 54.28% from 0.67 million (95% UI: 0.52-0.85 million) to 1.04 million (95% UI: 0.83-1.32 million). Age-standardized DALYs and mortality rates decreased by 62.48% and 60.00%, respectively, over the same period. The MIR decreased across all age groups from 1990 to 2023 and remained highest among the youngest and oldest populations, with the ratio in those <5 years of age declining from 17.82% in 1990 to 6.32% in 2023. Across SDI strata, incidence rates remained stable from 1990 to 2023, while mortality rates declined in all quintiles and remained lowest in high SDI regions, whereas the MIR decreased from 2.33 in 1990 to 1.30 in 2023. In 2023, prevalence was highest in the high SDI quintile (6.30 [95% UI: 5.15-7.48] per 100,000 population) and lowest in the low-middle SDI quintile (4.10 [95% UI: 3.38-5.02]), reflecting disparities aligned with health resource availability. Age-standardized prevalence rates of heart failure attributable to myocarditis declined from 2.33 (95% UI: 1.90-2.90) per 100,000 population in 1990 to 1.76 (95% UI: 1.41-2.29) in 2023, with a U-shaped distribution across age groups showing the highest burden in those <5 years of age and >75 years of age in 2023.
Conclusions
Although age-adjusted DALYs and mortality rates of myocarditis decreased globally from 1990 to 2023, incidence and prevalence remained stable, suggesting potential improvements in outcomes over time. However, absolute burden has grown due to population growth and aging, and important disparities persist across age groups and SDI strata. These findings highlight the need for targeted strategies to improve early diagnosis and reduce the burden of myocarditis, particularly in vulnerable populations and lower-resource settings, while being interpreted in the context of evolving diagnostic and coding practices.