Congenital heart disease: a global public health concern

Congenital heart disease is an important contributor to morbidity and mortality in both children and adults, and large disparities exist throughout the world in access to care and outocomes.1Tchervenkov CI Jacobs JP Bernier PL et al.The improvement of care for paediatric and congenital cardiac disease across the world: a challenge for the World Society for Pediatric and Congenital Heart Surgery.Cardiol Young. 2008; 18: 63-69Crossref PubMed Scopus (62) Google Scholar, 2Hoffman JI The global burden of congenital heart disease.Cardiovasc J Afr. 2013; 24: 141-145Crossref PubMed Scopus (172) Google Scholar Although there have been tremendous advancements in the diagnosis and management of congenital heart disease over the past several decades, much of what is known about congenital heart disease care comes from regions that have a high Socio-demographic Index (SDI).3Gilboa SM Devine OJ Kucik JE et al.Congenital heart defects in the United States: estimating the magnitude of the affected population in 2010.Circulation. 2016; 134: 101-109Crossref PubMed Scopus (272) Google Scholar, 4Triedman JK Newburger JW Trends in congenital heart disease: the next decade.Circulation. 2016; 133: 2716-2733Crossref PubMed Scopus (113) Google Scholar The GBD 2017 Congenital Heart Disease Collaborators' study, as with previous analyses from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), provides important epidemiological data, including trends over time, on contributions to global morbidity and mortality.5Collaborators GBDM Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet. 2018; 392: 1684-1735Summary Full Text Full Text PDF PubMed Scopus (355) Google Scholar, 6Roth GA Abate D Abate KH et al.Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet. 2018; 392: 1736-1788Summary Full Text Full Text PDF PubMed Scopus (2029) Google Scholar, 7GBD 2017 Congenital Heart Disease CollaboratorsGlobal, regional, and national burden of congenital heart disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet Child Adolesc Health. 2020; (published online Jan 21.)https://doi.org/10.1016/S2352-4642(19)30402-XGoogle Scholar The GBD 2017 Congenital Heart Disease Collaborators' study provides new information on the burden of congenital heart disease throughout the world and presents important new epidemiological data not available in previous GBD analyses.7GBD 2017 Congenital Heart Disease CollaboratorsGlobal, regional, and national burden of congenital heart disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet Child Adolesc Health. 2020; (published online Jan 21.)https://doi.org/10.1016/S2352-4642(19)30402-XGoogle Scholar Some of these important findings include a global estimate of nearly 12 million people living with congenital heart disease in 2017, which represents an 18·7% increase from 1990. The number of deaths attributed to congenital heart disease in 2017 was estimated at 261 247, a decline of 34·5% from the estimated number of deaths in 1990. Unsurprisingly, congenital heart disease was a leading cause of infant mortality, ranking 6th globally and 2nd in regions with a high SDI. As top-ranking causes of mortality continue to shift from communicable diseases to non-communicable diseases, the importance of congenital heart disease as a cause of global infant mortality is likely to continue to increase in the years to come. Moreover, as more children are surviving with congenital heart disease and complex forms of congenital heart disease, understanding the comorbidities and potential disabilities faced by individuals living with congenital heart disease is of crucial importance. The estimates of years living with disability from congenital heart disease are another important contribution of this study. Globally, these were estimated to be nearly 600 000 years and they were found not to have significantly changed from 1990 to 2017. Although this important study clearly has many strengths, including the robust data collection and sophisticated modelling, there are some important limitations that merit note and have been acknowledged by the authors. No data on the incidence, prevalence, morbidity, and mortality of congenital heart disease were collected from large parts of the world, including in sub-Sharan Africa (appendix pp 13, 14 of the original Article7GBD 2017 Congenital Heart Disease CollaboratorsGlobal, regional, and national burden of congenital heart disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet Child Adolesc Health. 2020; (published online Jan 21.)https://doi.org/10.1016/S2352-4642(19)30402-XGoogle Scholar). Although the challenges of collecting these data from many parts of the world are vast and not easily overcome, improved data on vital statistics should improve the accuracy of the models and the understanding of the true burden of congenital heart disease. The reported prevalence at birth from eastern sub-Saharan Africa—2670 cases of congenital heart disease per 100 000 individuals—is more than 3 times greater than other contemporary epidemiological studies that have reported global estimates of approximately 910 cases per 100 000.8van der Linde D Konings EE Slager MA et al.Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis.J Am Coll Cardiol. 2011; 58: 2241-2247Crossref PubMed Scopus (1446) Google Scholar Likewise, the estimates of disability come predominately from a systematic review of the literature, with most studies originating from regions with a high SDI. It is unclear how much these results can be extrapolated to other regions with vastly different health-care systems. Although the mathematical modelling used for this study is certainly robust, for parts of the world where there no data are available on the number of children who are born with congenital heart disease, have died from causes related to congenital heart disease, or are currently alive with congenital heart disease, even quite advanced mathematical models are unlikely to provide an accurate description of the current burden of congenital heart disease. These limitations notwithstanding, the GBD 2017 Congenital Heart Disease Collaborators' study does provide the most comprehensive global assessment of congenital heart disease to date. The mission of the Institute of Health Metrics and Evaluation, the organisation that conducts the GBD enterprise, is to improve the health of the world's populations by providing the best information on population health, and this study serves the mission of the organisation well. These data will be used by clinicians, educators, researchers, and policy makers throughout the world in key decisions aimed at improving the lives of all children and adults with congenital heart disease. I report being a consultant for Amgen, Bayer, Novartis, and CSL Behring outside of the submitted work. Global, regional, and national burden of congenital heart disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017Congenital heart disease is a large, rapidly emerging global problem in child health. Without the ability to substantially alter the prevalence of congenital heart disease, interventions and resources must be used to improve survival and quality of life. Our findings highlight the large global inequities in congenital heart disease and can serve as a starting point for policy changes to improve screening, treatment, and data collection. Full-Text PDF Open Access