Global Burden of Disease Study based analysis on hypertension-attributable chronic kidney disease: Disease burden and Quality of Care Index across countries, regions, and globally, 1990–2021

BACKGROUND: As populations age and hypertension prevalence rises, the burden of hypertension-attributable chronic kidney disease (CKD) keeps aggregating and varies across regions. A systematic assessment of how disease burden and care quality change over time becomes a prerequisite for sound prevention and control policies. OBJECTIVE: To describe temporal changes and geographical distributions of hypertension-attributable CKD's burden and quality of care across countries, regions, and globally from 1990 to 2021. METHODS: Data were obtained from the Global Burden of Disease Study 2021. Temporal trends in disease burden and Quality of Care Index (QCI) were analyzed using the estimated annual percentage change (EAPC). Spearman correlation analysis and cross-national inequality analysis were conducted to explore QCI health inequality related to the Socio-demographic Index (SDI). RESULTS: From 1990 to 2021, global age-standardized incidence and mortality rates of hypertension-attributable CKD increased by 22.30% and 29.21%, respectively. Age-standardized disability-adjusted life-years rate (ASDR) reached 128.41 per 100,000, up 19.15% over 31 years, whereas the QCI declined. Men had higher ASDR and QCI than women. SDI was negatively correlated with ASDR and positively correlated with QCI. Global health inequalities persisted: low-SDI regions (e.g., sub-Saharan Africa) faced heavier burdens and poorer care quality, whereas high-SDI regions such as Eastern Europe and High-income Asia Pacific displayed lower ASDR and higher QCI, indicating better disease management. CONCLUSIONS: Global burden of hypertension-attributable CKD continues to rise while care quality declines, with low-SDI countries facing the greatest challenges. Enhanced hypertension prevention, improved CKD management, equitable resource allocation, and global health equity initiatives, with a focus on improving global quality of care, are needed.