Global burden of pulmonary arterial hypertension and health inequality in women of childbearing age from 1990 to 2021, with projections up to 2040: the global burden of disease 2021 study.
To assess the global burden, trends, and inequalities of pulmonary arterial hypertension (PAH) among women of childbearing age (WCBA) from 1990 to 2021, projecting future trends to 2040.
Using Global Burden of Disease (GBD) 2021 data, we analyzed PAH mortality, incidence, prevalence, and disability-adjusted life years (DALYs) among WCBA aged 15 to 49. Trends were assessed via age-standardized rates (ASR), estimated annual percentage change (EAPC), joinpoint regression, decomposition, and inequality analyses. Future burden was projected using Bayesian age-period-cohort, auto-regressive moving average, and exponential smoothing models.
The absolute number of PAH cases among WCBA increased globally from 1990 to 2021. Critically, the global age-standardized incidence rate (ASIR) showed a neglected upward trend (EAPC = 0.12), while mortality and DALY rates declined. Significant inequalities were observed, with the ASIR highest in low-middle SDI regions and prevalence highest in high SDI regions. Decomposition analysis identified population growth as the primary driver of increasing burden in low-resource settings. Projections indicate a continued rise in incidence by 2040, alongside declining mortality.
This study demonstrated a persistent and growing PAH burden among WCBA, marked by significant inequalities. The rising incidence, particularly in low-resource settings, coupled with the cumulative prevalence in high-income regions, underscores an urgent need for targeted public health actions. Region-specific interventions are vital, including integrating PAH screening into maternal health programs in resource-poor settings and optimizing long-term management in high-income countries.
Using Global Burden of Disease (GBD) 2021 data, we analyzed PAH mortality, incidence, prevalence, and disability-adjusted life years (DALYs) among WCBA aged 15 to 49. Trends were assessed via age-standardized rates (ASR), estimated annual percentage change (EAPC), joinpoint regression, decomposition, and inequality analyses. Future burden was projected using Bayesian age-period-cohort, auto-regressive moving average, and exponential smoothing models.
The absolute number of PAH cases among WCBA increased globally from 1990 to 2021. Critically, the global age-standardized incidence rate (ASIR) showed a neglected upward trend (EAPC = 0.12), while mortality and DALY rates declined. Significant inequalities were observed, with the ASIR highest in low-middle SDI regions and prevalence highest in high SDI regions. Decomposition analysis identified population growth as the primary driver of increasing burden in low-resource settings. Projections indicate a continued rise in incidence by 2040, alongside declining mortality.
This study demonstrated a persistent and growing PAH burden among WCBA, marked by significant inequalities. The rising incidence, particularly in low-resource settings, coupled with the cumulative prevalence in high-income regions, underscores an urgent need for targeted public health actions. Region-specific interventions are vital, including integrating PAH screening into maternal health programs in resource-poor settings and optimizing long-term management in high-income countries.
Authors
Li Li, Wang Wang, Chen Chen, Tan Tan, Gao Gao, Chen Chen, Hu Hu, Liu Liu, Zhang Zhang, Jiang Jiang, Bie Bie, Leng Leng
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