Abstract
BACKGROUND: Myocarditis, a condition associated with an elevated risk of heart failure and sudden cardiac death, has been linked to low-environmental temperature exposure. Despite its significant health implications, there has been very limited research to examine the global burden of myocarditis and its association with cold environmental temperatures. This study aimed to comprehensively analyze the impact of low environmental temperatures on myocarditis-related mortality and disability-adjusted life years (DALYs) over a 30-year period, providing evidence to inform global public health strategies. METHODS: Data from the 2021 Global Burden of Disease (GBD) database were used to evaluate deaths, DALYs, age-standardized mortality rate (ASMR), age-standardized DALYs rate (ASDR), and estimated annual percentage change (EAPC) with 95% uncertainty intervals (95% UI) for low environmental temperature-related myocarditis. Analyses were conducted at global, regional, and national levels from 1990 to 2021 and stratified by sex, age, sociodemographic index (SDI), region, and country. The frontier analyses assessed the impact of epidemiological drivers and SDI on the burden. The nordpred model validated the predictions. RESULTS: From 1990 to 2021, deaths attributable to low environmental temperature-related myocarditis increased by 32%, rising from 1,405 (95% UI, 1056–1818) in 1990 to 1,855 (95% UI, 1288–2438) in 2021. China reported the highest number of deaths and DALYs, while Romania exhibited the highest ASMR and ASDR. Males were disproportionately affected, and the burden was most pronounced in regions with high-middle and middle SDI. Deaths among individuals over 30 years increased significantly, whereas the ASMR for individuals aged 85 years and above exhibited an inverted V-shaped trend. It is projected that by 2046. Males are expected to experience a greater burden of disability and a higher ASDR compared to females. CONCLUSION: Low-environmental temperature exposure contributes significantly to myocarditis-related mortality and DALYs. Targeted interventions to mitigate the effects of cold exposure, particularly in high-burden regions and vulnerable populations, are essential to improve public health outcomes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-025-05209-2.