{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T19:54:46Z","timestamp":1765828486705,"version":"build-2065373602"},"reference-count":14,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Rheumatic heart disease (RHD) shows significant sex differences in disease burden. This study assesses these differences using data from the Global Burden of Disease Study 2021 (GBD 2021).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We extracted sex-specific indicators for RHD from the GBD database, including disability-adjusted life years (DALYs), mortality, and prevalence. Trends were analyzed using estimated annual percentage change (EAPC), and sex differences were assessed via female-by-male ratios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 1990 to 2021, females consistently had higher age-standardized DALYs (ASDR), mortality (ASMR), and prevalence rates (ASPR) than males. These differences were particularly pronounced in specific regions and age groups. In 2021, female ASDR and ASMR in Andorra were over three times higher than males, while in the Cook Islands, they were less than half of males\u2019 rates. In the United States Virgin Islands, females aged 10\u201319 had an ASMR only 0.01 times that of males, whereas in the United Arab Emirates, females aged 70\u201389 had ASDR and ASMR five times higher than males. Overall, the female-by-male ratios in ASDR, ASMR, and ASPR have shown a yearly decline. However, these ratios are positively correlated with the Sociodemographic Index (SDI), with correlation coefficients of 0.1 for ASDR, 0.22 for ASMR, and 0.47 for ASPR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study reveals a persistent global sex disparity in RHD burden from 1990 to 2021, with females generally experiencing a heavier burden. These findings underscore the need for sex-specific approaches in RHD prevention and treatment and further research into the underlying factors driving these disparities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0334914","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T17:41:52Z","timestamp":1761154912000},"page":"e0334914","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sex difference in the burden of rheumatic heart disease: Insights from the Global Burden of Disease Study 2021"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1541-7888","authenticated-orcid":true,"given":"Shushu","family":"Jiang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiakai","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Menghao","family":"Shi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yin","family":"Dong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhaohui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7185-2671","authenticated-orcid":true,"given":"Cheng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"issue":"20","key":"pone.0334914.ref001","doi-asserted-by":"crossref","DOI":"10.1161\/CIR.0000000000000921","article-title":"Contemporary 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gender and migration on epidemiology and management","volume":"50","author":"RK Mutagaywa","year":"2020","journal-title":"Eur J Clin Invest"},{"issue":"8","key":"pone.0334914.ref007","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1056\/NEJMoa1603693","article-title":"Global, Regional, and National Burden of Rheumatic Heart Disease, 1990-2015","volume":"377","author":"DA Watkins","year":"2017","journal-title":"N Engl J Med"},{"issue":"10","key":"pone.0334914.ref008","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1093\/eurjpc\/zwac044","article-title":"Global burden of rheumatic heart disease and its association with socioeconomic development status, 1990-2019","volume":"29","author":"M Lv","year":"2022","journal-title":"Eur J Prev Cardiol"},{"issue":"10","key":"pone.0334914.ref009","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1139\/cjpp-2023-0390","article-title":"Impact of biological sex on valvular heart disease, interventions, and outcomes","volume":"102","author":"EJ Wiens","year":"2024","journal-title":"Can J Physiol Pharmacol"},{"issue":"10440","key":"pone.0334914.ref010","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"403","author":"GBD 2021 Diseases and Injuries Collaborators","year":"2024","journal-title":"Lancet"},{"issue":"1","key":"pone.0334914.ref011","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1186\/s12872-023-03552-w","article-title":"Analysis and comparison of the trends in burden of rheumatic heart disease in China and worldwide from 1990 to 2019","volume":"23","author":"L Shi","year":"2023","journal-title":"BMC 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and Control","volume":"18","author":"J Zhang","year":"2021","journal-title":"Int J Environ Res Public Health"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0334914","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T17:41:55Z","timestamp":1761154915000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0334914"}},"subtitle":[],"editor":[{"given":"Sadaf 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