Trends and Burden of Pulmonary Arterial Hypertension at Global, Regional, and National Levels from 1990 to 2021: Findings from the 2021 Global B urden of Disease Study

Objectives: Pulmonary arterial hypertension (PAH) is a chronic vascular disorder characterized by elevated pulmonary artery pressure and pulmonary vascular resistance, which can ultimately result in right ventricular failure. This condition imposes a substantial economic burden and significant health challenges on both healthcare systems and patients. The objective of this study was to conduct a comprehensive analysis of the global burden of PAH, evaluating factors such as gender, age, region, country, and sociodemographic variables, utilizing data from the Global Burden of Disease Study (GBD) 2021. Methods: This study leverages the most recent data from the Global Burden of Disease (GBD) 2021 to evaluate the global, regional, and national burden and trends of pulmonary arterial hypertension (PAH). The analysis is based on age-standardized prevalence, mortality, and disability-adjusted life years (DALYs), employing decomposition analysis, health inequality analysis, and frontier analysis. Additionally, the study investigates period and cohort effects from 1990 to 2021 using age-period-cohort (APC) modeling and projects the futuredisease burden of PAH through Bayesian APC (BAPC) modeling. Results: In 2021, the prevalence and mortality rates of pulmonary arterial hypertension (PAH) were notably higher compared to previous years, whereas disability-adjusted life years (DALYs), age-standardized prevalence rates (ASPR), age-standardized mortality rates (ASMR), and age-standardized death rates (ASDR) exhibited a declining trend. The disease burden was generally greater among females and the elderly population compared to males and other age groups. Low Socio-Demographic Index (SDI) regions consistently bore a disproportionately higher burden of mortality and DALYs. Decomposition analyses revealed that population growth and aging were significant contributors to the overall PAH disease burden. Age-period-cohort effects indicated that the risk of disease was broadly positively correlated with age. Bayesian age-period-cohort (BAPC) modeling projections suggest that the global burden of PAH is expected to decrease by 2035. Conclusions: Global, national, and regional progress in reducing the disease burden of pulmonary arterial hypertension (PAH) during the study period was relatively limited, particularly among women and older age groups. Diagnosis, treatment, and prevention strategies for PAH remain insufficient in low- and middle-income countries. Therefore, the proactive development of health policies tailored to the disease burden of PAH and aligned with the economic development levels of different countries and regions represents a crucial approach to tackling this significant public health challenge.