Trends and projections of the global burden of pulmonary arterial hypertension (1990–2050): An observational trend study

By using the global burden of disease 2021 database, this study systematically analyze the current status and trends of the global pulmonary arterial hypertension (PAH) disease burden from 1990 to 2021, projecting to 2050. The study data were derived from the global burden of disease 2021 project's estimates of PAH, covering 204 countries and territories worldwide, and the morbidity, mortality, and disability-adjusted life years (DALYs) of PAH were analyzed from 1990 to 2021, broken down by sex, age, and sociodemographic index (SDI) subdistricts. Long-term trends in PAH disease burden were assessed by calculating age-standardized rate (ASR) and estimated annual percentage change. Linear trends in ASR were assessed using Joinpoint regression analysis, quantified using annual percentage change; and the Bayesian age-period-cohort model was used to project the global PAH disease burden in 2050. Data were organized and visualized using R statistical software (version 4.3.3). As of 2021, despite a slight increase in global PAH age-standardized incidence rate, age-standardized mortality rate (ASMR) and ASR of DALYs showed a decreasing trend, indicating a reduction in the overall disease burden. Older age groups have a high incidence of PAH. The incidence and mortality rates of PAH were generally higher in women than in men, but the ASMR declined more rapidly in men. PAH burden varies significantly across regions, lower SDIs are associated with higher ASMR and ASR of DALYs. By 2050, PAH incidence may increase slightly, but mortality and DALYs rates will continue to decline. The study reveals global PAH burden dynamics, noting regional disparities, particularly in lower SDI countries with higher PAH prevalence. Incidence is prominent in older adults, predominantly women. Projections indicate a gradual rise in PAH incidence but a sustained decline in mortality and DALYs. Findings will significantly inform global health policies, resource distribution, and research priorities.