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

AimsTo 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. MethodsWe 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. ResultsBetween 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. ConclusionIE 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 SummaryThis study explores how the global burden of infective endocarditis has changed over time and highlights persistent inequalities across countries with different development levels. Key findings* 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.