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N Engl J Med. 2017 Aug 24;377(8):713-722. doi: 10.1056/NEJMoa1603693.

Global, Regional, and National Burden of Rheumatic Heart Disease, 1990-2015.

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From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.).



Rheumatic heart disease remains an important preventable cause of cardiovascular death and disability, particularly in low-income and middle-income countries. We estimated global, regional, and national trends in the prevalence of and mortality due to rheumatic heart disease as part of the 2015 Global Burden of Disease study.


We systematically reviewed data on fatal and nonfatal rheumatic heart disease for the period from 1990 through 2015. Two Global Burden of Disease analytic tools, the Cause of Death Ensemble model and DisMod-MR 2.1, were used to produce estimates of mortality and prevalence, including estimates of uncertainty.


We estimated that there were 319,400 (95% uncertainty interval, 297,300 to 337,300) deaths due to rheumatic heart disease in 2015. Global age-standardized mortality due to rheumatic heart disease decreased by 47.8% (95% uncertainty interval, 44.7 to 50.9) from 1990 to 2015, but large differences were observed across regions. In 2015, the highest age-standardized mortality due to and prevalence of rheumatic heart disease were observed in Oceania, South Asia, and central sub-Saharan Africa. We estimated that in 2015 there were 33.4 million (95% uncertainty interval, 29.7 million to 43.1 million) cases of rheumatic heart disease and 10.5 million (95% uncertainty interval, 9.6 million to 11.5 million) disability-adjusted life-years due to rheumatic heart disease globally.


We estimated the global disease prevalence of and mortality due to rheumatic heart disease over a 25-year period. The health-related burden of rheumatic heart disease has declined worldwide, but high rates of disease persist in some of the poorest regions in the world. (Funded by the Bill and Melinda Gates Foundation and the Medtronic Foundation.).

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