Global, Regional, and National Burden of Pulmonary Arterial Hypertension, 1990–2021: A Systematic Analysis for the Global Burden of Disease Study 2021

Background Despite advances in diagnosis and treatment, significant gaps remain in understanding the global burden of pulmonary arterial hypertension (PAH), particularly across varying socioeconomic and demographic contexts. Methods Using data from the Global Burden of Disease (GBD) 2021 study, this analysis evaluated trends in PAH incidence, prevalence, disability-adjusted life years (DALYs), and deaths between 1990 and 2021. Disparities based on age, sex, and the Socio-Demographic Index (SDI) were explored. Age–period–cohort and decomposition analyses were conducted to evaluate underlying drivers. Bayesian age-period-cohort (BAPC) modeling was employed to project the future burden of PAH to 2050. Results Over the past 30 years, PAH incidence and prevalence have increased globally, with prevalence rising by 81.5%. The burden, as measured by DALYs, has decreased by 6.59%, reflecting improved survival, particularly in high-SDI regions. However, low-SDI regions continue to experience disproportionately higher deaths and DALYs among younger populations. Females consistently exhibit higher prevalence and incidence rates, while males show higher deaths risks at younger ages. Projections indicate continued increases in global PAH incidence and prevalence, with a shift in burden toward older age groups and persistent sex disparities through 2050. Conclusions This study highlights the evolving and multifaceted nature of the global PAH burden, characterized by demographic shifts, persistent socioeconomic disparities, and rising challenges in low-SDI regions. Addressing these gaps requires coordinated global efforts to enhance early diagnosis, ensure equitable access to care, and implement targeted interventions for vulnerable populations. Clinical trial number: not applicable