National, regional and provincial prevalence of peripheral artery disease in Chinese adults in 2023: an updated systematic review and modelling study

Background: Peripheral artery disease (PAD), a common atherosclerotic condition characterised by the narrowing or obstruction of peripheral arteries, has become a substantial public health concern in China. However, its prevalence across the country at the provincial level has never been quantified. Through an updated systematic review and modelling study, we aimed to estimate the national, regional, and provincial prevalence of PAD among Chinese individuals aged 30-89 years in 2023. Methods: We conducted an updated literature search in PubMed, Embase, MEDLINE, the China National Knowledge Infrastructure, Wanfang, and the Chinese Science and Technology Journal Database to identify studies published between 4 March 2017 and 12 August 2024 reporting on the prevalence of PAD in the general Chinese population. We also identified and included studies from previous systematic reviews. We then used a multilevel mixed-effects meta-regression model to generate the age- and sex-specific prevalence estimates of PAD among individuals aged 30-89 years at the national level. We calculated pooled odds ratios (ORs) for factors associated with PAD using a random-effects meta-analysis and incorporated them into an 'associated factor-based model' to estimate regional and provincial prevalence. Results: We included 54 articles from all searches. Model-based estimates indicated that the overall prevalence of PAD among Chinese adults aged 30-89 years in 2023 was 5.47% (95% confidence interval (CI) = 4.64-6.44), equivalent to 49.90 million (95% CI = 42.32-58.73) affected individuals. Prevalence increased progressively with age, ranging from 4.23% (95% CI = 3.58-5.00) among individuals aged 30-34 years to 18.37% (95% CI = 15.90-21.13) among those aged 85-89 years. The overall prevalence was higher in females (6.19%; 95% CI = 5.25-7.27) than males (4.76%; 95% CI = 4.03-5.61). Regionally, Northeast China had the highest prevalence of PAD at 5.87% (95% CI = 4.98-6.91), while Central China had the lowest at 5.26% (95% CI = 4.46-6.19). At the provincial level, the prevalence of PAD was the highest in Beijing (6.40%; 95% CI = 5.43-7.53) and lowest in Tibet (4.35%; 95% CI = 3.68-5.12). Female sex, current smoking, hypertension, diabetes, coronary heart disease, and stroke were identified as factors significantly associated with PAD. Conclusions: We found that PAD is prevalent in China, with pronounced age-related trends, sex differences, and regional disparities. These findings could inform targeted public health initiatives and appropriate resource allocation. Registration: PROSPERO: CRD420251118923.