Global, Regional, and National Burden of Pulmonary Arterial Hypertension in Children and Adolescents, 1990-2021, and Projections to 2050: A Systematic Analysis for the Global Burden of Disease Study 2021

Background Pulmonary arterial hypertension (PAH) in children and adolescents is a significant global health challenge, leading to a range of severe medical complications and an increased risk of premature death. In this study, we assessed the trends and cross-country disparities in the burden of PAH among children and adolescents from 1990 to 2021, and further predicted its changes to 2050. Results GBD 2021 estimated 5,049 incident cases, 1,972 deaths, and 170,371 DALYs of PAH in children and adolescents globally in 2021. South Asia reported the highest numbers of incident, death, and DALYs cases, while Eastern Sub-Saharan Africa had the highest age-standardized incidence rate (ASIR), and the Caribbean recorded the highest age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR). Between 1990 and 2021, the ASIR in this population showed an overall increasing trend, whereas the ASMR and ASDR demonstrated a consistent decline. The ASIR, ASMR, and ASDR were found to decrease exponentially with rising SDI levels. DALYs were disproportionately concentrated in countries with lower sociodemographic development levels. The ASIR is projected to remain globally stable, while both the ASMR and ASDR are expected to decline annually through 2050. Conclusions The burden of PAH in children and adolescents is concentrated in low-SDI countries. While ASIR has increased, ASMR and ASDR have steadily declined and are projected to continue decreasing through 2050. Strengthening international collaboration, improving healthcare, and targeting high-risk regions are crucial to reducing the disease burden and promoting global health equity.