Sex-stratified epidemiological trajectories and predictive modeling of aortic aneurysm mortality in South Asia: A global burden of disease analysis (1990–2021) with advanced forecasting to 2050

Aortic aneurysms are a growing public health concern in South Asia due to increasing cardiovascular risk factors and limited healthcare access. With South Asia experiencing rapid aging and limited cardiac care, forecasting aortic aneurysm mortality is critical for resource prioritization. This study analyzes historical mortality trends from 1990 to 2021 and projects future burdens to 2050, using data from 5 South Asian countries (Bangladesh, Bhutan, India, Nepal, and Pakistan), stratified by male and female subgroups, to guide evidence-based interventions. Using Global Burden of Disease 2021 data, age-standardized mortality rates (ASMR) for aortic aneurysms were extracted for South Asia (Bangladesh, Bhutan, India, Nepal, and Pakistan) from 1990 to 2021, stratified by sex. Joinpoint regression calculated average annual percent change (AAPC). Autoregressive integrated moving average models forecasted ASMR to 2030 and 2050. South Asia's ASMR rose (AAPC: 1.9039%, 95% confidence interval [CI]: 1.7297-2.099). Country AAPCs: Bangladesh (1.2885%, 95% CI: 1.0986-1.4865), Bhutan (2.3303%, 95% CI: 2.2462-2.4155), India (2.1206%, 95% CI: 1.8661-2.4155), Nepal (2.2868%, 95% CI: 2.0628-2.5344), and Pakistan (1.5032%, 95% CI: 1.1631-1.8987). Male AAPCs higher (e.g., Nepal: 3.1369%, 95% CI: 2.9941-3.3051 and Bhutan: 3.0672%, 95% CI: 2.9625-3.1859) than female (e.g., Nepal: 1.5482%, 95% CI: 1.2213-1.9275). Peak annual percent change: 2012 to 2015 (South Asia: 4.0211%, 95% CI: 1.9534-4.462). ASMR 2021: South Asia 1.2204 (95% CI: 0.8788-1.7781). Projections 2050: South Asia 1.651 (95% CI: 1.367-1.934), males 2.284 (95% CI: 2.008-2.559), females 0.866 (95% CI: 0.457-1.276); Bhutan males 2.362 (95% CI: 1.1292-3.5942), and India females 0.8289 (95% CI: 0.3399-1.3179). Aortic aneurysm mortality is increasing, with male disparities driven by smoking and hypertension. Female stabilization reflects targeted interventions. Limitations include Global Burden of Disease data variability and forecasting assumptions. Recommendations: enhance diagnostics, male-focused smoking cessation, subnational studies. Policy action is critical by 2050.