Global, regional, and national burden and inequalities of infective endocarditis, 1990–2021: A comprehensive analysis from the Global Burden of Disease Study 2021

Aims To comprehensively assess the global, regional, and national burden of infective endocarditis (IE) from 1990 to 2021, explore socioeconomic inequalities, identify performance gaps across countries, and project future trends through 2036.

We extracted IE-related data from the Global Burden of Disease Study 2021, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Age-standardized rates (ASR) were analyzed across sex, time, and sociodemographic index (SDI) levels. Inequality was quantified using slope and concentration indices. Frontier analysis assessed performance gaps across countries. Decomposition analysis explored contributors to DALY changes, and future trends were projected using a Bayesian age-period-cohort model.

Between 1990 and 2021, global DALYs due to IE increased by 55.67%, mainly driven by population growth (87.92%) and aging (38.91%), while the DALY ASR declined by 9.75%. Marked regional and socioeconomic disparities were observed: high-SDI regions showed rising incidence and prevalence, while low- and middle-SDI regions exhibited decreasing ASRs but persistent burdens. Socioeconomic inequality in IE burden has narrowed over time, yet remains significant. Epidemiological transitions contributed to reduced burden in some settings, but structural disparities continue to affect outcomes. Projections indicate further increases in incidence and prevalence through 2036, despite ongoing declines in deaths and DALYs.

IE remains a growing global health challenge with persistent inequalities. While overall burden has shifted, socioeconomic disparities continue to shape disease patterns. These findings highlight the need for equity-focused, context-specific strategies to reduce the global burden of IE. Lay Summary This study explores how the global burden of infective endocarditis has changed over time and highlights persistent inequalities across countries with different development levels. • Although the age-standardized rate of IE has declined globally, the total number of cases and deaths has risen, mainly due to population growth and aging. • Socioeconomic inequality in IE burden has decreased over time but remains substantial, underscoring the need for more equitable healthcare interventions worldwide. Competing Interest Statement The authors have declared no competing interest. Clinical Trial This is a retrospective analysis of publicly available data from the Global Burden of Disease (GBD) study, which does not meet the definition of a clinical trial. All data used in this study are anonymized and aggregated at the population level. Ethical approval for the use of GBD data was obtained from the University of Washington Institutional Review Board (IRB), and local ethics review was waived as this study did not involve individual patient data. Funding Statement No external funding was received for this study. The authors declare no financial relationships with any third party related to the design, execution, or publication of this work. All data used in this study are publicly available from the Global Burden of Disease (GBD) repository. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by Peking University First Hospital for the use of GBD data. The approval included a waiver of informed consent as the data are de-identified and publicly accessible. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability The data supporting this study are publicly available in the Global Burden of Disease (GBD) repository at https://vizhub.healthdata.org/