(2026) Global, Regional, and National Burden of Myocarditis and Its Impairment, 1990-2023. Journal of the American College of Cardiology. ISSN 1558-3597 (Electronic) 0735-1097 (Linking)
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Abstract
BACKGROUND: The impact of recent trends in the burden of myocarditis has not been reported in detail. OBJECTIVES: This study aims to estimate the global, regional, and national burden of myocarditis from 1990 to 2023, using data from the GBD (Global Burden of Disease, Injuries, and Risk Factors Study) 2023. METHODS: As part of the GBD 2023, the authors used all available administrative health facility and vital registration data to estimate myocarditis prevalence, incidence, disability-adjusted life years (DALYs), mortality, and mortality-to-incidence ratio (MIR) for every country, stratified by age, sex, and quintiles of a Socio-demographic Index (SDI). The MIR represents the relative mortality burden compared with disease incidence at the population level. The prevalence of heart failure attributable to myocarditis was estimated using a model-based attribution approach. RESULTS: In 2023, the global age-standardized rates of prevalence, incidence, DALY, and mortality of myocarditis were 4.84 (95 uncertainty interval UI: 3.98-5.80), 12.46 (95% UI: 9.86-15.70), 8.41 (95% UI: 5.63-12.59) and 0.21 (95% UI: 0.14-0.29) per 100,000 population, respectively. Although global age-standardized prevalence and incidence rates remained stable from 1990 to 2023, the absolute number of incident cases increased by 54.28% from 0.67 million (95% UI: 0.52-0.85 million) to 1.04 million (95% UI: 0.83-1.32 million). Age-standardized DALYs and mortality rates decreased by 62.48% and 60.00%, respectively, over the same period. The MIR decreased across all age groups from 1990 to 2023 and remained highest among the youngest and oldest populations, with the ratio in those <5 years of age declining from 17.82% in 1990 to 6.32% in 2023. Across SDI strata, incidence rates remained stable from 1990 to 2023, while mortality rates declined in all quintiles and remained lowest in high SDI regions, whereas the MIR decreased from 2.33 in 1990 to 1.30 in 2023. In 2023, prevalence was highest in the high SDI quintile (6.30 95% UI: 5.15-7.48 per 100,000 population) and lowest in the low-middle SDI quintile (4.10 95% UI: 3.38-5.02), reflecting disparities aligned with health resource availability. Age-standardized prevalence rates of heart failure attributable to myocarditis declined from 2.33 (95% UI: 1.90-2.90) per 100,000 population in 1990 to 1.76 (95% UI: 1.41-2.29) in 2023, with a U-shaped distribution across age groups showing the highest burden in those <5 years of age and >75 years of age in 2023. CONCLUSIONS: Although age-adjusted DALYs and mortality rates of myocarditis decreased globally from 1990 to 2023, incidence and prevalence remained stable, suggesting potential improvements in outcomes over time. However, absolute burden has grown due to population growth and aging, and important disparities persist across age groups and SDI strata. These findings highlight the need for targeted strategies to improve early diagnosis and reduce the burden of myocarditis, particularly in vulnerable populations and lower-resource settings, while being interpreted in the context of evolving diagnostic and coding practices.
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| Keywords: | Daly Global Burden of Disease, Injuries, and Risk Factors Study impairment incidence mortality myocarditis prevalence Foundation. This analysis was supported by the Ministry of Science and ICT (IITP-2026-RS-2026-25617111 and RS-2026-25495984 to DKY) and the Ministry of Health and Welfare (RS-2025-02220492 to DKY), Republic of Korea. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors had full access to the study data and had final responsibility for the decision to submit for publication. Dr Ahmad has received grants or contracts from the University of Sharjah outside of the submitted work. Dr Al-Tawfiq has leadership or fiduciary roles in other board, society, committee, or advocacy group, paid or unpaid as member-at large, Board of Directors, or International Society of Infectious Disease outside of the submitted work. Dr Ammirati has received grants or contracts from European Union, NextGenerationEU-Mission 6/Component 2/Investment 2.1/PNRR - CUP H43C21000150006 has received consulting fees from Lexeo has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Hotgen participates on a Data Safety Monitoring Board or Advisory Board with ICON/Tenax outside of the submitted work. Dr Baltatu has received support for the present manuscript from National Council for Scientific and Technological Development (CNPq) Fellowship and from Anima Institute (AI) Research Professor Fellowship leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid as managing partner, VividiWise Analytics, and as Biotech Advisory Board Member, Sao Jose dos Campos Technology Park-CITE outside of the submitted work. Dr Bhaskar has received grants or contracts from Japan Society for the Promotion of Science (JSPS), Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT) (Grant-in-Aid for Scientific Research KAKENHI grant ID: 23KF0126) and from JSPS and the Australian Academy of Science (JSPS International Fellowship grant ID: P23712) has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Japan Stroke Society, Japan (honoraria for invited keynote presentation at the 50th Annual Meeting of the Japan Stroke Society, Osaka, Japan), and from Semey Medical University, Kazakhstan (honorarium for invited professorship and teaching course in neurocardiovascular therapy, Semey Medical University, Kazakhstan) has received support for attending meetings and/or travel from Japan Stroke Society, Japan (travel award for invited keynote presentation at the 50th annual meeting of the Japan Stroke Society, Osaka, Japan) and from Asialink, The University of Melbourne, Australia (travel support for opening invited keynote at 31st Asialink Leaders Foundation Week Program 2026, Melbourne, Australia) leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as District Chair, Diversity, Equity, Inclusion & Belonging, Rotary District 9675, Sydney, Australia as Chair, Founding Member and Manager, Global Health & Migration Hub Community, Global Health Hub Germany, Berlin, Germany and as editorial board member, PLOS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Public Health, Journal of Aging Research,Neurology International, Diagnostics, and BMC Medical Research Methodology as member, College of Reviewers, Canadian Institutes of Health Research (CIHR), Government of Canada and as Director of Research, World Headache Society, Bengaluru, India as expert adviser/reviewer, Cariplo Foundation, Milan, Italy as visiting director, National Cerebral and Cardiovascular Center, Department of Neurology, Division of Cerebrovascular Medicine and Neurology, Suita, Osaka, Japan as member, Scientific Review Committee, Cardiff University Biobank, Cardiff, United Kingdom as chair, Rotary Reconciliation Action Plan and as health care and medical adviser, Japan Connect, Osaka, Japan outside of the submitted work. Dr Cooper has received consulting fees from Cardiol Therapeutics, Moderna, Foresee Pharmaceuticals leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as Stromal Therapeutics and board member with ownership outside of the submitted work. Dr Guha has received grants or contracts from the Department of Defense outside of the submitted work. Dr Jozwiak has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Novartis, Adamed, Amgen, Boehringer Ingelheim, Servier, Novo Nordisc, and MSD (all personal fees) outside of the submitted work. Dr Krishan has received other financial or nonfinancial interests: nonfinancial support from the UGC Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, and RUSA 2.O grant awarded by Ministry of Education to Panjab University, Chandigarh, India, outside of the submitted work. Dr Li has received support for the present manuscript from the National Science and Technology Council, Taiwan (NSTC 113-2314-B-003-002) and the "Higher Education Sprout Project" of National Taiwan Normal University has a leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as technical editor, Journal of the American Heart Association outside of the submitted work. Dr Liu has received other financial or nonfinancial interests as mentor of the National Medical Research Association (NMRA) (United Kingdom) and as member of the British Society for Cardiovascular Research (BSCR) (United Kingdom), Physics and Engineering in Medicine (IPEM) (United Kingdom), and Cardiovascular Analytics Group (CVAG) (HKSAR of China) (NMRA, BSCR, IPEM, and CVAG are nonprofit academic associations) outside of the submitted work. Dr Mensah has a leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as chair, World Heart Federation Science Committee and as member, GBD Scientific Committee stock or stock options in NVDA (Nvidia Corporation), CRWD (Crowdstrike Holdings, Inc), IYW (Ishares U.S. Technologies), and PLTR (Palantir Technologies) outside of the submitted work. Dr Mohammed has received support for the present manuscript from the Gates Foundation outside of the submitted work. Dr Oancea has received support for the present manuscript from UEFISCDI (project PN-IV-P6-6.1-CoEx-2024-0196, contract number 17/2.03.2026) and from MRID (project PNRR-I8 number 842027778, contract number 760096) outside of the submitted work. Dr Sharma has received other financial or nonfinancial interests: support from DFSS (MHA)'s research project (DFSS28(1)2019/EMR/6) at Department of Forensic Science (Formerly Institute of Forensic Science & Criminology), Panjab University, Chandigarh, India, RUSA 2.0 grant to Panjab University and PAIR grant (ANRF/PAIR/2025/000006/PAIR) to Panjab University from ANRF outside of the submitted work. Dr Shin has received support for this work from the Yonsei Fellowship, funded by Lee Youn Jae outside of the submitted work. Dr Singh has received consulting fees from ROMTech, Atheneum, Clearview health care partners, Yale, Hulio, Horizon Pharmaceuticals/DINORA, ANI/Exeltis USA Inc, SOBI Pharmaceuticals, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two labs Inc, Adept Field Solutions, Clinical Care options, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, and Practice Point communications the National Institutes of Health and the American College of Rheumatology (consultant fees paid to Dr Singh for each entity) has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: Dr Singh is on the Speakers Bureau of Simply Speaking (he previously served as a consultant and consultant fees were paid to him) has received support for attending meetings and/or travel from past steering committee member of OMERACT (he previously received support from the organization to attend their meeting every 2 years) participates on a Data Safety Monitoring Board or Advisory Board with the FDA Arthritis Advisory Committee (he served previously as a member no financial support) has a leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as past steering committee member of the OMERACT, an international organization that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies (he previously received support from the organization to attend their meeting every 2 years) has stock or stock options in Atyr pharmaceuticals, Atai Life Sciences, Kintara therapeutics, Intelligent Biosolutions, Acumen pharmaceutical, TPT Global Tech, Vaxart pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics Inc, Seres Therapeutics, Tonix Pharmaceuticals Holding Corporation, Aebona Pharmaceuticals, and Charlotte's Web Holdings, Inc (he owns stock options), and in Amarin, Viking, and Moderna pharmaceuticals (he previously owned stock options) outside of the submitted work. Dr Starnes has participated on a Data Safety Monitoring Board or Advisory Board with Medtronic (has received payment for serving on advisory board for pulse oximetry) outside of the submitted work. Dr Upadhyay has patents planned, issued or pending: a system and method of reusable filters for antipollution mask, a system and method for electricity generation through crop stubble by using microbial fuel cells, a system for disposed personal protection equipment (PPE) into biofuel through pyrolysis and method, a novel herbal pharmaceutical aid for formulation of gel and method thereof, herbal drug formulation for treating lung tissue degenerated by particulate matter exposure, and a method to transform cow dung into the wall paint by using natural materials and composition thereof (all published) and biodegradable packaging composition and method of preparation thereof, eco-friendly bio-shoe polish from banana and turmeric, honey-based polyherbal syrup composition to treat air pollution-induced inflammation and preparation method thereof, process for preparing a caffeine free, antioxidant and nutrient rich beverage, polyherbal oral mist composition for dual relief and method for preparation thereof, and method for fabricating sustainable waterproof material sheets from LDPE plastic wastes (all filed) leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as Former Joint Secretary, Executive Council Member, Indian Meteorological Society, Jaipur Chapter (India) and as member secretary of the DSTPURSE program outside of the submitted work. Dr Weintraub has participated on a Data Safety Monitoring Board or Advisory Board with the VALOR study advisory board (pediatric heart failure drug trial) outside of the submitted work. Dr Zielinska has other financial or nonfinancial interests as an Alexion AstraZeneca Rare Disease employee outside of the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. |
| Journal or Publication Title: | Journal of the American College of Cardiology |
| Journal Index: | Pubmed |
| Identification Number: | https://doi.org/10.1016/j.jacc.2026.07.039 |
| ISSN: | 1558-3597 (Electronic) 0735-1097 (Linking) |
| Depositing User: | خانم ناهید ضیائی |
| URI: | http://eprints.mui.ac.ir/id/eprint/34443 |
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