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Ojha U, Marshall DC, Salciccioli JD, Al-Khayatt BM, Hammond-Haley M, Goodall R, Borsky KL, Crowley CP, Shalhoub J, Hartley A. Temporal trend analysis of rheumatic heart disease burden in high-income countries between 1990 and 2019. Eur Heart J Qual Care Clin Outcomes 2024; 10:108-120. [PMID: 36477873 PMCID: PMC10904725 DOI: 10.1093/ehjqcco/qcac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/29/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022]
Abstract
AIMS To assesses trends in rheumatic heart disease (RHD) burden in high-income, European Union 15+ (EU15+) countries between 1990 and 2019. METHODS AND RESULTS Cross-sectional analysis of the incidence and mortality of RHD was conducted using data from the Global Burden of Disease (GBD) Study database. Age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) were extracted for EU15+ countries per sex for each of the years from 1990 to 2019, inclusive, and mortality-to-incidence indices (MII) were computed. Joinpoint regression analysis was used for the description of trends. Over 29 years, an overall declining trend in RHD incidence and mortality across EU 15+ nations were observed. There was significant variability in RHD incidence and mortality rates across high-income countries. However, both RHD incidence and mortality were higher among females compared with males across EU15+ countries over the observed period. The most recent incidence trend, starting predominantly after 2014, demonstrated a rise in RHD incidence in most countries for both sexes. The timing of this RHD resurgence corresponds temporally with an influx of migrants and refugees into Europe. The recent increasing RHD incidence rates ranged from +0.4% to +24.7% for males, and +0.6% to +11.4% for females. CONCLUSION More than half of EU15+ nations display a recent increase in RHD incidence rate across both sexes. Possible factors associated with this rise are discussed and include increase in global migration from nations with higher RHD prevalence, host nation factors such as migrants' housing conditions, healthcare access, and migrant health status on arrival.
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Affiliation(s)
- Utkarsh Ojha
- Royal Brompton & Harefield Hospitals, Heart and Lung Division, Hill End Rd, Harefield, Uxbridge, UB9 6JH, UK
- Chelsea and Westminster Hospital, Department of Medicine, London SW10 9NH, UK
| | - Dominic C Marshall
- Department of Respiratory, National Heart and Lung Institute, Guy Scadding Building, Cale Street, London, SW3 6LY, UK
| | - Justin D Salciccioli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA
| | - Becker M Al-Khayatt
- Department of Cardiology, East Surrey Hospital, Surrey and Sussex NHS Trusts, UK
| | - Matthew Hammond-Haley
- Department of Cardiology, King's College Hospital, British Heart Foundation Centre of Research Excellence, London, WC2R 2LS, UK
| | - Richard Goodall
- St Andrews Centre for Plastic Surgery and Burns, Chelmsford, CM1 7ET, UK
| | - Kim L Borsky
- Department of Plastic Surgery, Stoke Mandeville Hospital, Mandeville Rd, Aylesbury, HP21 8AL, UK
| | - Conor P Crowley
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, 41 Burlington Mall Rd, Burlington, MA, USA
| | - Joseph Shalhoub
- Imperial College London and Imperial College Healthcare NHS Trust, Imperial Vascular Unit, Mary Stanford Wing, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Adam Hartley
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, London, SW7 2BX, UK
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Hammond-Haley M, Hartley A, Al-Khayatt BM, Delago AJ, Ghajar A, Ojha U, Marshall DC, Salciccioli JD, Prendergast BD, Shalhoub J. Trends in the incidence and mortality of infective endocarditis in high-income countries between 1990 and 2019. Int J Cardiol 2023; 371:441-451. [PMID: 36179905 DOI: 10.1016/j.ijcard.2022.09.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Infective endocarditis (IE) remains a life-threatening disease with high morbidity and mortality. OBJECTIVES To describe temporal trends in IE incidence, mortality and survival over the last 30 years. METHODS Nineteen high-income countries (the 'EU 15+') were included. Age-standardised and sex-stratified incidence rates (ASIRs) and mortality rates (ASMRs) for IE were extracted from the Global Burden of Disease (GBD) database between 1990 and 2019, and mortality to incidence ratios (ASMIRs) were calculated. Trends were analysed using Joinpoint regression analysis. RESULTS ASIRs were higher in males than females and increased in both sexes in all countries between 1990 and 2019. A recent steep rise in ASIRs was noted in several countries including the UK, the USA and Germany. ASMRs increased for both sexes in all countries except Finland and Austria. The largest increase in ASMR was observed in females in Italy (+246%). ASMIRs were generally higher in females compared to males, with large increases in ASMIRs (indicating worsening survival) at the end of the 20th century, but more recent stabilisation or decline across the study cohort. CONCLUSIONS While the incidence and mortality of IE have increased over the last 30 years, recent data suggest that these trends have plateaued or reversed in most countries studied. However, a recent surge in incidence in several countries (including the USA and UK) is of concern, while unfavourable outcomes in females also merit attention. More encouragingly, this analysis provides the first indication of improving IE survival at population level, supporting recent advances in diagnosis and treatment.
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Affiliation(s)
- Matthew Hammond-Haley
- King's College Hospital NHS Foundation Trust, London, UK; Medical Data Research Collaborative, UK.
| | - Adam Hartley
- Medical Data Research Collaborative, UK; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - Becker M Al-Khayatt
- Medical Data Research Collaborative, UK; Department of Cardiology, Croydon University Hospital, 530 London Road, London CR7 7YE, UK
| | - Augustin J Delago
- Medical Data Research Collaborative, UK; Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Alireza Ghajar
- Medical Data Research Collaborative, UK; Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Utkarsh Ojha
- Medical Data Research Collaborative, UK; Royal Brompton & Harefield Hospitals, UB9 6JH, UK
| | - Dominic C Marshall
- Medical Data Research Collaborative, UK; National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK
| | - Justin D Salciccioli
- Medical Data Research Collaborative, UK; Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | - Joseph Shalhoub
- Medical Data Research Collaborative, UK; Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
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Al-Khayatt BM, Salciccioli JD, Marshall DC, Krahn AD, Shalhoub J, Sikkel MB. Paradoxical impact of socioeconomic factors on outcome of atrial fibrillation in Europe: trends in incidence and mortality from atrial fibrillation. Eur Heart J 2021; 42:847-857. [PMID: 33495788 DOI: 10.1093/eurheartj/ehaa1077] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/01/2020] [Accepted: 12/16/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS The aim of this study was to understand the changing trends in atrial fibrillation (AF) incidence and mortality across Europe from 1990 to 2017, and how socioeconomic factors and sex differences play a role. METHODS AND RESULTS We performed a temporal analysis of data from the 2017 Global Burden of Disease Database for 20 countries across Europe using Joinpoint regression analysis. Age-adjusted incidence, mortality, and mortality-to-incidence ratios (MIRs) to approximate case fatality rate are presented. Incidence and mortality trends were heterogenous throughout Europe, with Austria, Denmark, and Sweden experiencing peaks in incidence in the middle of the study period. Mortality rates were higher in wealthier countries with the highest being Sweden for both men and women (8.83 and 8.88 per 100 000, respectively) in 2017. MIRs were higher in women in all countries studied, with the disparity increasing the most over time in Germany (43.6% higher in women vs. men in 1990 to 74.5% higher in women in 2017). CONCLUSION AF incidence and mortality across Europe did not show a general trend, but unique patterns for some nations were observed. Higher mortality rates were observed in wealthier countries, potentially secondary to a survivor effect where patients survive long enough to suffer from AF and its complications. Outcomes for women with AF were worse than men, represented by higher MIRs. This suggests that there is widespread healthcare inequality between the sexes across Europe, or that there are biological differences between them in terms of their risk of adverse outcomes from AF.
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Affiliation(s)
- Becker M Al-Khayatt
- Cardiothoracic Intensive Care, Department of Intensive Care Medicine, St George's University Hospital, 1st Floor, Atkinson Morley Wing, Blackshaw Road, London SW17 0QT, UK
| | | | - Dominic C Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Joseph Shalhoub
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK.,Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Markus B Sikkel
- Division of Cardiology, University of British Columbia, Vancouver, Canada.,Royal Jubilee Hospital, Vancouver, Canada.,Division of Medical Sciences, University of Victoria, Victoria, Canada
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