Global, regional, and national burden of non-rheumatic calcific aortic valve disease, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Non-rheumatic calcific aortic valve disease (NRCAVD) has emerged as a critical global health challenge, intensified by aging populations and persistent sociodemographic disparities. Existing studies inadequately address its specific disease burden and associated health inequities. This study aims to comprehensively evaluate the global, regional, and national burden of NRCAVD from 1990 to 2021 to inform equitable public health policies and resource allocation strategies. Materials and Methods: Utilizing the Global Burden of Disease (GBD) 2021 dataset, we quantified NRCAVD burden through age-standardized incidence rates (ASIR), mortality (ASDR), disability-adjusted life years (DALYs), and sociodemographic index (SDI). Key drivers of burden trends were identified via age-sex decomposition, age-period-cohort (APC) modeling. Health inequalities and TAVR penetration were assessed through disparity metrics, while Bayesian age-period-cohort (BAPC) models projected future trajectories to 2041. Results: Between 1990 and 2021, global NRCAVD burden increased significantly, with males and populations in high-SDI regions experiencing disproportionately higher burdens. While women showed lower disease incidence, they faced higher mortality rates. Health disparities worsened primarily due to aging and population growth. Higher penetration of TAVR is associated with a decrease in ASDR of NRCAVD, which was observed in multinational registries. Incidence peaked at ages 75–79, whereas mortality and DALYs were highest at 85–89 years. Projections indicate declining age-standardized rates (ASIR: -2.88%, ASDR: -0.69%, DALYs: -7.54% by 2041), though reductions lagged in males compared to females. Conclusion: Global NRCAVD burden remains unequal, particularly in high-SDI regions where mortality rates are disproportionately high. Addressing widening inequalities requires sex-specific interventions for aging populations, expanded access to cost-effective valvular therapies, and strengthened health systems in underserved regions. Multinational collaboration to standardize NRCAVD surveillance and share best practices in lifecycle management is imperative to achieve health equity in an aging world.