Abstract
BACKGROUND: The increasing survival of individuals with congenital heart disease (CHD) has established developmental intellectual disability (DID) as a major long-term concern, an association supported by extensive evidence. However, the precise global burden of DID in this population remains unquantified. This study therefore aimed to quantify this burden from 1990 to 2021 among children and adolescents with CHD using data from the Global Burden of Disease (GBD) 2021 study. METHODS: Data on prevalence, years lived with disability (YLDs), and DID rates were analyzed by gender, age, location, and severity. Temporal trends were assessed using estimated annual percentage change (EAPC). The study also examined associations with the Socio-Demographic Index (SDI), health inequalities, decomposition, and frontiers analysis to evaluate disparities and developmental influences. RESULTS: In 2021, there were 949,774.9 [95% uncertainty interval (UI): 744,157.7-1,126,344.0] children and adolescents with CHD and DID globally. YLD trends closely followed prevalence patterns, with the highest burden observed in children aged 0-4 years. Borderline DID was the most common form, comprising nearly 70% of cases, while profound DID, though less prevalent, contributed to over a quarter of total YLDs. The low-middle SDI regions reported the highest number of cases and YLDs, whereas low SDI regions had the highest prevalence rates. From 1990 to 2021, global prevalence and YLD rates declined, with the most significant reductions in low SDI regions. In contrast, high-middle SDI regions showed non-significant changes. A negative correlation was observed between SDI and disease burden, with persistent inequalities-particularly in low-middle SDI countries such as Afghanistan, where YLD rates were 150-180% higher than the optimal level. CONCLUSIONS: In summary, our findings quantify the significant global comorbidity between CHD and DID from 1990 to 2021. This analysis reveals a substantial and inequitable health burden, which disproportionately impacts young children in resource-limited settings. These results underscore the need for integrated clinical surveillance and resource planning for this vulnerable population.