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.
Tags: (all personal fees) outside of the submitted work. Dr Krishan has received other, (HKSAR of China) (NMRA, BSCR, IPEM, and CVAG are nonprofit academic associations), (IITP-2026-RS-2026-25617111 and RS-2026-25495984 to DKY) and the Ministry of, *Myocarditis/epidemiology/mortality, 113-2314-B-003-002) and the "Higher Education Sprout Project" of National Taiwan, 2.1/PNRR - CUP H43C21000150006, 23KF0126) and from JSPS and the Australian Academy of Science (JSPS International, 50th Annual Meeting of the Japan Stroke Society, Osaka, Japan), and from Semey, Adult, Advanced Study, CAS II, awarded to the Department of Anthropology, and RUSA 2.O, American Heart Association outside of the submitted work. Dr Liu has received, and, and as health care and medical adviser, Japan Connect, Osaka, Japan outside of, and board member with ownership outside of the submitted work. Dr, and from Anima Institute (AI) Research Professor Fellowship, and from Asialink, The University of, as Chair, Founding Member and Manager, Global, as chair, Rotary Reconciliation Action Plan, as editorial board member, PLOS One, BMC Neurology, Frontiers in Neurology,, as expert adviser/reviewer, Cariplo Foundation, Milan,, as member, College of Reviewers, Canadian Institutes of Health, as member, Scientific Review Committee, Cardiff University, as visiting director, National Cerebral and Cardiovascular Center,, Biobank, Cardiff, United Kingdom, committee or advocacy group, paid or unpaid as technical editor, Journal of the, contracts from European Union, NextGenerationEU-Mission 6/Component 2/Investment, course in neurocardiovascular therapy, Semey Medical University, Kazakhstan), Daly, Department of Neurology, Division of Cerebrovascular Medicine and Neurology,, Disability-Adjusted Life Years, Disease outside of the submitted work. Dr Ammirati has received grants or, District 9675, Sydney, Australia, Dr Bhaskar has received grants or contracts from Japan Society for the Promotion, Fellowship, Female, fiduciary role in other board, society, committee or advocacy group, paid or, fiduciary role in other board, society, committee, or advocacy group, paid or, financial or nonfinancial interests: nonfinancial support from the UGC Centre of, for Cardiovascular Research (BSCR) (United Kingdom), Physics and Engineering in, Foundation. This analysis was supported by the Ministry of Science and ICT, Frontiers in Stroke, Frontiers in Public Health, Journal of Aging, Global Burden of Disease, Injuries, and Risk Factors Study, Global Burden of Disease/trends, Global Health, grant awarded by Ministry of Education to Panjab University, Chandigarh, India,, grant ID:, grant ID: P23712), Guha has received grants or contracts from the Department of Defense outside of, has, has a leadership or fiduciary role in other board, society,, has received consulting fees from Lexeo, has received payment or honoraria for lectures,, Health & Migration Hub Community, Global Health Hub Germany, Berlin, Germany, Health and Welfare (RS-2025-02220492 to DKY), Republic of Korea. The funder of, Heart Federation Science Committee and as member, GBD Scientific Committee, Humans, impairment, Incidence, interpretation, or writing of the report. All authors had full access to the, Italy, IYW (Ishares U.S. Technologies), and PLTR (Palantir Technologies) outside of the, Japan (travel award for invited keynote presentation at the 50th annual meeting, Japan Stroke Society, Japan (honoraria for invited keynote presentation at the, Leaders Foundation Week Program 2026, Melbourne, Australia), leadership or, leadership or fiduciary role in, Male, manuscript from the National Science and Technology Council, Taiwan (NSTC, manuscript writing, or educational events from Hotgen, Medical University, Kazakhstan (honorarium for invited professorship and teaching, Medicine (IPEM) (United Kingdom), and Cardiovascular Analytics Group (CVAG), Melbourne, Australia (travel support for opening invited keynote at 31st Asialink, Member, Sao Jose dos Campos Technology Park-CITE outside of the submitted work., member-at large, Board of Directors, or International Society of Infectious, Methodology, Middle Aged, mortality, myocarditis, National Council for Scientific and Technological Development (CNPq) Fellowship, Normal University, Novartis, Adamed, Amgen, Boehringer Ingelheim, Servier, Novo Nordisc, and MSD, of Science (JSPS), Japanese Ministry of Education, Culture, Sports, Science and, of the Japan Stroke Society, Osaka, Japan), or stock options in NVDA (Nvidia Corporation), CRWD (Crowdstrike Holdings, Inc),, other board, society, committee or advocacy group, paid or unpaid as chair, World, other board, society, committee or advocacy group, paid or unpaid as Stromal, other financial or nonfinancial interests as mentor of the National Medical, outside of the submitted work. Dr Li has received support for the present, outside of the submitted work. Dr Mensah has a leadership or fiduciary role in, participates on a Data, presentations, speakers bureaus, manuscript writing or educational events from, presentations, speakers bureaus, manuscript writing, or educational events from, Prevalence, Research (CIHR), Government of Canada and as Director of Research, World Headache, Research Association (NMRA) (United Kingdom) and as member of the British Society, Research,Neurology International, Diagnostics, and BMC Medical Research, Safety Monitoring Board or Advisory Board with ICON/Tenax outside of the, Sharjah outside of the submitted work. Dr Al-Tawfiq has leadership or fiduciary, Society, Bengaluru, India, Suita, Osaka, Japan, Technology (MEXT) (Grant-in-Aid for Scientific Research [KAKENHI], Therapeutics, Therapeutics, Moderna, Foresee Pharmaceuticals.
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