Trends and global comparisons of non-rheumatic degenerative mitral valve disease burden in China from 1990 to 2023_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Junning ¹ , LI Peidong ¹ , LU Qilin ¹ , XU Kanglin ¹ , LU Ziao ¹ , LEI Yong ¹ , ZHU Guiying ¹ ,  ZHANG Haibo ^1,2

1. Department of Cardiovascular Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University & Nanchong Central Hospital, Nanchong, 637000, Sichuan, P. R. China;
2. Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing, 100020, P. R. China;

Corresponding?author：

ZHANG Haibo, Email: Zhanghb2318@163.com

Keywords：

Non-rheumatic degenerative mitral valve disease; disease burden; trend analysis; Joinpoint regression; decomposition analysis; prediction

DOI：

10.7507/1007-4848.202603040

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Objective To analyze the disease burden trend of non-rheumatic degenerative mitral valve disease (NR-DMVD) in China from 1990 to 2023 and compare it with global levels and those in the United States and India. Methods Based on the Global Burden of Disease (GBD) 2023 database, data on incidence, mortality, prevalence, and disability-adjusted life years (DALYs) for NR-DMVD were extracted. Joinpoint regression, decomposition analysis, and autoregressive integrated moving average model (ARIMA) were used to analyze trends, drivers, and project burden to 2040. Results In 2023, China's age-standardized DALY rate (2.56/100 000) and mortality rate (0.037/100 000) for NR-DMVD were significantly lower than those in the United States, India, and globally, while its age-standardized incidence rate (10.39/100 000) and prevalence rate (126.03/100 000) showed slow increases. From 1990 to 2023, the estimated annual percentage changes (EAPC) for China's age-standardized DALY rate and mortality rate were –2.11% [95%CI (–2.25%, –1.98%)] and –4.54% [95%CI (–4.92%, –4.16%)], respectively, while the incidence rate and prevalence rate continued to rise; India showed increasing trends in all burden indicators. Decomposition analysis indicated that population aging was the primary driver of the increase in DALYs and prevalence cases, while epidemiological improvement was the key factor that led to the reduction in the number of deaths. Joinpoint analysis showed that China's age-standardized DALY rate declined most rapidly between 2000 and 2013, while the age-standardized mortality rate decreased fastest between 2007 and 2013. ARIMA models projected that China's prevalence rate would continue to rise and mortality rate would continue to decline through 2040. Conclusion NR-DMVD in China exhibits a dual-track pattern of "declining mortality but rising prevalence", driven by population aging. A tiered prevention and control system focusing on the elderly and high-risk male groups is needed.

Citation： LIU Junning, LI Peidong, LU Qilin, XU Kanglin, LU Ziao, LEI Yong, ZHU Guiying, ZHANG Haibo. Trends and global comparisons of non-rheumatic degenerative mitral valve disease burden in China from 1990 to 2023. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(9): 1439-1447. doi: 10.7507/1007-4848.202603040 Copy

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4.	Aluru J, Barsouk A, Saginala K, et al. Valvular heart disease epidemiology[J]. Med Sci (Basel), 2022, 10(2): 32.
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10.	Kim H, Fay M, Feuer E, et al. Permutation tests for joinpoint regression with applications to cancer rates[J]. Stat Med, 2000, 19(3): 335-351.
11.	Gammie J, Chikwe J, Badhwar V, et al. Isolated mitral valve surgery: the Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis[J]. Ann Thorac Surg, 2018, 106(3): 716-727.
12.	Romano M, McCarthy P, Baldridge A, et al. Should mitral valve replacement age guidelines be lowered due to better bioprosthetic mitral valve durability[J]? J Thorac Cardiovasc Surg, 2024, 168(5): 1448-1458.
13.	Stone G, Lindenfeld J, Abraham W, et al. Transcatheter mitral-valve repair in patients with heart failure[J]. N Engl J Med, 2018, 379(24): 2307-2318.
14.	Almuzainy S, Lemine M, Aljubeh R, et al. Comparative efficacy and safety of transcatheter mitral valve repair versus mitral-valve surgery in elderly patients with mitral regurgitation: a systematic review and meta-analysis[J]. J Saudi Heart Assoc, 2024, 36(4): 316-334.
15.	McDonagh T, Metra M, Adamo M, et al. 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur Heart J, 2023, 44(37): 3627-3639.
16.	Kreutz R, Brunstr?m M, Burnier M, et al. 2024 European Society of Hypertension clinical practice guidelines for the management of arterial hypertension[J]. Eur J Intern Med, 2024, 126: 1-15.
17.	d'Arcy J, Coffey S, Loudon M, et al. Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study[J]. Eur Heart J, 2016, 37(47): 3515-3522.
18.	Maciorowska M, Zhang L, Tokhi B, et al. Transthoracic and transesophageal echocardiography in the diagnosis and management of mitral regurgitation[J]. Curr Cardiol Rep, 2025, 27(1): 165.
19.	Small A, Yutzey K, Binstadt B, et al. Unraveling the mechanisms of valvular heart disease to identify medical therapy targets[J/OL]. Circulation, 2024, 150(6): e109-e128. DOI: 10.1161/CIR.000000000000125.
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22.	Remenyi B, ElGuindy A, Smith S, et al. Valvular aspects of rheumatic heart disease[J]. Lancet, 2016, 387(10025): 1335-1346.
23.	Zühlke L, Engel M, Karthikeyan G, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study)[J]. Eur Heart J, 2015, 36(18): 1115-1122.
24.	Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: current epidemiology and future directions[J]. Circulation, 2016, 133(16): 1605-1620.
25.	DesJardin J, Chikwe J, Hahn R, et al. Sex differences and similarities in valvular heart disease[J]. Circ Res, 2022, 130(4): 455-473.
26.	Woodward H, Zhu D, Hadoke P, et al. Regulatory role of sex hormones in cardiovascular calcification[J]. Int J Mol Sci, 2021, 22(9): 4620.
27.	Delwarde C, Capoulade R, Mérot J, et al. Genetics and pathophysiology of mitral valve prolapse[J/OL]. Front Cardiovasc Med, 2023, 10: 1077788. DOI: 10.3389/fcvm.2023.1077788.
28.	Consoli L, Majeed M, Cetinel E, et al. Sex-based differences in outcomes of mitral valve surgery: a meta-analysis of propensity score-matched studies with reconstructed time-to-event data[J/OL]. Am Heart J Plus, 2026, 61: 100682. DOI: 10.1016/j.ahjo.2025.100682.
29.	Fan J, Chen J, Wang L, et al. The global burden and attributable risk factor analysis of cardiovascular disease between females and males, 1990-2021: findings from the 2021 Global Burden of Disease Study[J]. Int J Surg, 2026, 112(1): 239-249.
30.	Roth G, Mensah G, Johnson C, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 Study[J]. J Am Coll Cardiol, 2020, 76(25): 2982-3021.
31.	Li W, Xiong S, Yin S, et al. Prevalence and risk factors of mitral, tricuspid, and aortic regurgitation: a population-based study from rural northeast China[J]. Am J Cardiol, 2023, 209: 156-162.
32.	Si K, Hou Y, Wang J, et al. The global, regional, and national burden of non-rheumatic degenerative mitral valve disease from 1990 to 2021 and forecast for 2050[J/OL]. Front Cardiovasc Med, 2026, 13: 1583290. DOI: 10.3389/fcvm.2026.1583290.

1. Delling FN, Vasan R. Epidemiology and pathophysiology of mitral valve prolapse: new insights into disease progression, genetics, and molecular basis[J]. Circulation, 2014, 129(21): 2158-2170.
2. Delgado V, Ajmone Marsan N, Bonow R, et al. Degenerative mitral regurgitation[J]. Nat Rev Dis Primers, 2023, 9(1): 70.
3. Coffey S, Roberts-Thomson R, Brown A, et al. Global epidemiology of valvular heart disease[J]. Nat Rev Cardiol, 2021, 18(12): 853-864.
4. Aluru J, Barsouk A, Saginala K, et al. Valvular heart disease epidemiology[J]. Med Sci (Basel), 2022, 10(2): 32.
5. Otto C, Nishimura R, Bonow R, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J/OL]. Circulation, 2021, 143(5): e35-e71. DOI: 10.1161/cir.0000000000000960.
6. Wang C, Song M, Chen H, et al. Global epidemiologic trends and projections to 2030 in non-rheumatic degenerative mitral valve disease from 1990 to 2019: an analysis of the Global Burden of Disease Study 2019[J]. Rev Cardiovasc Med, 2024, 25(7): 269.
7. 付宏利, 閆昱名, 關禮春, 等. 1993—2023 年中國與全球老年非風濕性鈣化性主動脈瓣疾病負擔的年齡-時期-隊列分析及未來趨勢預測[J]. 中國心血管病研究, 2025, 23(12): 1141-1149.Fu HL, Yan YM, Guan LC, et al. Age-period-cohort analysis and future trend projections of the burden of non-rheumatic calcific aortic valve disease in older adults in China and worldwide, 1993-2023[J]. Chin J Cardiovasc Res, 2025, 23(12): 1141-1149.
8. 尹光嬌, 祖木熱提古麗·牙克甫, 王紫薇, 等. 1990—2019 年中國與全球風濕性心臟病疾病負擔分析[J]. 武漢大學學報 (醫學版), 2023, 44(7): 841-847.Yin GJ, Zumratgul Y, Wang ZW, et al. Disease burden analysis on rheumatic heart disease in China and the world from 1990 to 2019[J]. Med J Wuhan Univ, 2023, 44(7): 841-847.
9. GBD 2023 Disease and Injury and Risk Factor Collaborators. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023[J]. Lancet, 2025, 406(10513): 1873-1922.
10. Kim H, Fay M, Feuer E, et al. Permutation tests for joinpoint regression with applications to cancer rates[J]. Stat Med, 2000, 19(3): 335-351.
11. Gammie J, Chikwe J, Badhwar V, et al. Isolated mitral valve surgery: the Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis[J]. Ann Thorac Surg, 2018, 106(3): 716-727.
12. Romano M, McCarthy P, Baldridge A, et al. Should mitral valve replacement age guidelines be lowered due to better bioprosthetic mitral valve durability[J]? J Thorac Cardiovasc Surg, 2024, 168(5): 1448-1458.
13. Stone G, Lindenfeld J, Abraham W, et al. Transcatheter mitral-valve repair in patients with heart failure[J]. N Engl J Med, 2018, 379(24): 2307-2318.
14. Almuzainy S, Lemine M, Aljubeh R, et al. Comparative efficacy and safety of transcatheter mitral valve repair versus mitral-valve surgery in elderly patients with mitral regurgitation: a systematic review and meta-analysis[J]. J Saudi Heart Assoc, 2024, 36(4): 316-334.
15. McDonagh T, Metra M, Adamo M, et al. 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure[J]. Eur Heart J, 2023, 44(37): 3627-3639.
16. Kreutz R, Brunstr?m M, Burnier M, et al. 2024 European Society of Hypertension clinical practice guidelines for the management of arterial hypertension[J]. Eur J Intern Med, 2024, 126: 1-15.
17. d'Arcy J, Coffey S, Loudon M, et al. Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study[J]. Eur Heart J, 2016, 37(47): 3515-3522.
18. Maciorowska M, Zhang L, Tokhi B, et al. Transthoracic and transesophageal echocardiography in the diagnosis and management of mitral regurgitation[J]. Curr Cardiol Rep, 2025, 27(1): 165.
19. Small A, Yutzey K, Binstadt B, et al. Unraveling the mechanisms of valvular heart disease to identify medical therapy targets[J/OL]. Circulation, 2024, 150(6): e109-e128. DOI: 10.1161/CIR.000000000000125.
20. Yang J, Bai R, Wang L, et al. A projection of life expectancy based on the Global Burden of Disease Study 2019: China, 1990-2030[J]. China CDC Wkly, 2023, 5(2): 40-44.
21. Center for Cardiovascular Diseases the Writing Committee of the Report on Cardiovascular Health and Diseases in China, Hu SS. Report on cardiovascular health and diseases in China 2023: an updated summary[J]. Biomed Environ Sci, 2024, 37(9): 949-992.
22. Remenyi B, ElGuindy A, Smith S, et al. Valvular aspects of rheumatic heart disease[J]. Lancet, 2016, 387(10025): 1335-1346.
23. Zühlke L, Engel M, Karthikeyan G, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study)[J]. Eur Heart J, 2015, 36(18): 1115-1122.
24. Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: current epidemiology and future directions[J]. Circulation, 2016, 133(16): 1605-1620.
25. DesJardin J, Chikwe J, Hahn R, et al. Sex differences and similarities in valvular heart disease[J]. Circ Res, 2022, 130(4): 455-473.
26. Woodward H, Zhu D, Hadoke P, et al. Regulatory role of sex hormones in cardiovascular calcification[J]. Int J Mol Sci, 2021, 22(9): 4620.
27. Delwarde C, Capoulade R, Mérot J, et al. Genetics and pathophysiology of mitral valve prolapse[J/OL]. Front Cardiovasc Med, 2023, 10: 1077788. DOI: 10.3389/fcvm.2023.1077788.
28. Consoli L, Majeed M, Cetinel E, et al. Sex-based differences in outcomes of mitral valve surgery: a meta-analysis of propensity score-matched studies with reconstructed time-to-event data[J/OL]. Am Heart J Plus, 2026, 61: 100682. DOI: 10.1016/j.ahjo.2025.100682.
29. Fan J, Chen J, Wang L, et al. The global burden and attributable risk factor analysis of cardiovascular disease between females and males, 1990-2021: findings from the 2021 Global Burden of Disease Study[J]. Int J Surg, 2026, 112(1): 239-249.
30. Roth G, Mensah G, Johnson C, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 Study[J]. J Am Coll Cardiol, 2020, 76(25): 2982-3021.
31. Li W, Xiong S, Yin S, et al. Prevalence and risk factors of mitral, tricuspid, and aortic regurgitation: a population-based study from rural northeast China[J]. Am J Cardiol, 2023, 209: 156-162.
32. Si K, Hou Y, Wang J, et al. The global, regional, and national burden of non-rheumatic degenerative mitral valve disease from 1990 to 2021 and forecast for 2050[J/OL]. Front Cardiovasc Med, 2026, 13: 1583290. DOI: 10.3389/fcvm.2026.1583290.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Trends and global comparisons of non-rheumatic degenerative mitral valve disease burden in China from 1990 to 2023

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