Data_Sheet_1_National, regional, and global cardiomyopathy burden from 1990 to 2019.pdf

ObjectiveTo examine the incidence of cardiomyopathy including both alcoholic cardiomyopathy (AC) and other cardiomyopathy (OC) in 204 nations and regions over the 1990–2019 period.
MethodsThe present study was conducted using data derived from the GBD 2019 study coordinated by the Institute for Health Metrics and Evaluation (IHME). The GBD 2019 study included epidemiological data pertaining to 369 diseases/injuries, 286 causes of death, and 87 risk factors in 204 nations and regions. For this study, we adopt published estimates pertaining to the prevalence rates, mortality rates, and disability-adjusted life years (DALYs) associated with cardiomyopathy. The Bayesian mixed-effects DisMod-MR 2.1 meta-regression tool, which was designed to analyze GBD data, was used to estimate the prevalence of OC and AC. The GBD data are subdivided into 21 global regions based on characteristics such as geographical proximity and epidemiological similarity. The overall burden of cardiomyopathy was assessed by combining AC- and OC-related data, 95% confidence intervals were calculated based on standardized error values determined based upon the width of the 95% UI divided by 1.96 × 2.
ResultsGlobally, there were an estimated 0.71 million (95% UI: 0.55–0.92) AC cases and 3.73 million (95% UI: 2.92–4.72) OC cases in 2019. The age-standardized cardiomyopathy, AC, and OC prevalence rates (per 100,000 persons) in 2019 were 56.0 (95% CI: 43.82–71.17), 8.51 (95% UI: 6.6–11.01), and 47.49 (95% UI: 37.22–60.16), respectively. In total, the respective numbers of global deaths attributed to AC and OC were 0.07 million (95% UI: 0.06–0.08) and 0.24 million (95% UI: 0.19–0.26). The age-standardized mortality rate for cardiomyopathy in 2019 was 3.97 (95% CI: 3.29–4.39), with respective mortality rates of 0.86 (95% UI: 0.72–0.99) and 3.11 (95% UI: 2.57–3.4) for AC and OC. At the global level in 2019, 2.44 million (95% UI: 2.04–2.78) DALYs were attributed to AC, while 5.72 million (95% UI: 4.89–6.33) DALYs were attributed to OC. From 1990 to 2019, cardiomyopathy age-standardized prevalence rates declined by −0.49% (95% CI: −0.57 to −0.41), with those for AC and OC having respectively declined by −0.32% (95% UI: −0.36 to −0.28) and −0.17% (95% UI: −0.21 to −0.13). The age-standardized AC and OC mortality rates declined by −0.36% (95% UI: −0.5 to −0.26) and −0.39% (95% UI: −0.44 to −0.29), despite 24.8 and 30.2% increases, respectively, in the numbers of AC- and OC-related deaths during the same period.
ConclusionPrevious studies have estimated the risk factors that influence the burden of multiple cardiovascular diseases (CVD). Among them, some studies related to the GBD database on cardiomyopathy data suggest that alcohol intake, gender are factors in the development of AC, and the burden of AC and OC is not limited to developed or less developed countries. Otherwise, this study mainly focused on cardiomyopathy, and analyzed multiple indicators from national, regional, and age-standard dimensions to identify potential risk factors including prevalence, deaths, years lived with Disability-adjusted life years (DALYs) that influence the development of AC and OC. To our knowledge, this study is the first to have systematically assessed the burden of AC and OC as of 2019 at the national, regional, and global levels and calculated DALYs to achieve a better evaluation of disease risk and quality of life of the population. The number of cases, deaths and DALYs of cardiomyopathy showed an overall increasing trend and obvious geographical differences in the past three decades. The burden of cardiomyopathy remains a persistent threat to global public health. These results provide an epidemiological foundation that can guide public health efforts and policymakers.

研究目的：本研究旨在考察1990年至2019年间，全球204个国家和地区中，包括酒精性心肌病（alcoholic cardiomyopathy, AC）及其他心肌病（other cardiomyopathy, OC）在内的心肌病的发病情况。
研究方法：本研究采用由健康指标与评估研究所（Institute for Health Metrics and Evaluation, IHME）牵头的2019年全球疾病负担研究（Global Burden of Disease 2019, GBD 2019）的数据开展。GBD 2019研究涵盖了全球204个国家和地区的369种疾病/损伤、286种死亡原因以及87种危险因素的流行病学数据。本研究采用已发表的与心肌病相关的患病率、死亡率及伤残调整寿命年（disability-adjusted life years, DALYs）估算值。本研究采用专为分析GBD数据而设计的贝叶斯混合效应DisMod-MR 2.1元回归工具，对OC和AC的患病率进行估算。GBD数据根据地理毗邻性、流行病学相似性等特征被划分为21个全球区域。本研究通过合并AC与OC相关数据评估心肌病的整体疾病负担，并基于95%不确定区间（uncertainty interval, UI）宽度除以1.96×2得到的标准误值计算95%置信区间（confidence interval, CI）。
研究结果：2019年全球范围内，估计AC患者约71万例（95% UI：0.55~0.92万），OC患者约373万例（95% UI：2.92~4.72万）。2019年，心肌病、AC及OC的年龄标化患病率（每10万人）分别为56.0（95% CI：43.82~71.17）、8.51（95% UI：6.6~11.01）和47.49（95% UI：37.22~60.16）。全球范围内，AC和OC所致的死亡人数分别约为7万例（95% UI：0.06~0.08万）和24万例（95% UI：0.19~0.26万）。2019年，心肌病的年龄标化死亡率为3.97（95% CI：3.29~4.39），其中AC和OC的年龄标化死亡率分别为0.86（95% UI：0.72~0.99）和3.11（95% UI：2.57~3.4）。2019年全球范围内，AC所致伤残调整寿命年约为244万（95% UI：2.04~2.78万），OC所致伤残调整寿命年约为572万（95% UI：4.89~6.33万）。1990年至2019年，心肌病的年龄标化患病率下降了0.49%（95% CI：-0.57~-0.41），其中AC和OC的年龄标化患病率分别下降了0.32%（95% UI：-0.36~-0.28）和0.17%（95% UI：-0.21~-0.13）。尽管同期AC和OC相关死亡人数分别增长了24.8%和30.2%，但AC和OC的年龄标化死亡率分别下降了0.36%（95% UI：-0.5~-0.26）和0.39%（95% UI：-0.44~-0.29）。
结论：既往研究已明确了影响多种心血管疾病（cardiovascular diseases, CVD）负担的危险因素。其中，部分基于GBD数据库心肌病数据的研究表明，饮酒量、性别是AC发生的危险因素，且AC和OC的疾病负担并非仅局限于发达国家或欠发达国家。本研究聚焦于心肌病，从国家、区域及年龄标化维度分析多项指标，以明确影响AC和OC发生的潜在危险因素，包括患病率、死亡数及伤残调整寿命年。据我们所知，本研究首次在国家、区域及全球层面系统评估了截至2019年AC和OC的疾病负担，并计算了伤残调整寿命年，以更精准地评估人群的疾病风险与生活质量。过去三十年间，心肌病的病例数、死亡数及伤残调整寿命年整体呈上升趋势，且存在显著的地域差异。心肌病的疾病负担仍是全球公共卫生面临的持续威胁。本研究结果为公共卫生实践及政策制定提供了流行病学依据。