The global, regional, and national burden of endocarditis from 1990 to 2021: an analysis of the global burden of disease study 2021

Background Infective endocarditis (IE) persists as a major public health challenge, shaped by demographic shifts and healthcare disparities. However, comprehensive analyses of its spatiotemporal epidemiological patterns and their linkage to structural inequities remain limited. Objective This study aimed to systematically quantify the global, regional, and national burden of IE from 1990 to 2021, evaluate socioeconomic inequalities, and forecast disease trajectories through 2035. Methods Utilizing Global Burden of Disease (GBD) 2021 data spanning 204 countries, we conducted decomposition analysis to disentangle disability-adjusted life years (DALYs) into demographic (aging, population growth) and epidemiological components, assessed socioeconomic disparities using Slope and Concentration Indices, and projected trends via Bayesian Age-Period-Cohort modeling. Results Global IE incidence surged by 135% between 1990 and 2021, with males disproportionately affected (1.37 times higher DALYs). High-income regions exhibited paradoxical elevation in incidence, while mortality rates declined (annual DALY reduction: −0.34%). Socioeconomic disparities moderated (Concentration Index: −0.20 to − 0.12), yet 40% of DALYs persisted in low-income populations. Decomposition identified population growth (87.9%) and aging (38.9%) as primary drivers. Projections indicated a 9.5% rise in incidence by 2035, contrasting with a projected 6.1% decline in mortality rates. Conclusions The escalating burden of IE is shaped by accelerating demographic pressures and entrenched healthcare inequities. Prioritizing context-specific interventions—including geriatric healthcare capacity-building, equitable resource distribution, and enhanced diagnostic access—is imperative to reduce preventable morbidity.