Epidemiological Shifts and Trends From 2009 to 2023 in Hospital Admissions for Ruptured Aortic Aneurysms and Aortic Dissections in Austria: Retrospective, Population-Wide Study

Background: Aortic pathologies in general and acute aortic syndromes in particular are persistent public health concerns worldwide. Continuous efforts to monitor and update incidence rates are necessary for guided public health interventions and health care policy adaptation. Objective: This study aims to evaluate temporal patterns in the incidence and outcomes of hospital admissions for ruptured aortic aneurysms (rAAs) and aortic dissections (ADs) in Austria over a 15-year period, with a focus on population-wide trends. Methods: This study provides a retrospective, population-wide analysis of aortic syndromes using national health care data from 2009 to 2023. The data were provided by a federal data warehouse that stores all recorded in-hospital services in Austria. We analyzed annual and population-adjusted hospital admissions, in-hospital mortality, comorbidities, complications, and demographic characteristics for rAA and AD cases. Temporal patterns were assessed for annual variations. Exploratory forecasts were made until 2030 using exponential smoothing time series models. Subgroup analyses by sex and age strata were incorporated to contextualize epidemiological shifts and assess differential trends across population segments. Results: Corresponding to worldwide trends, the proportion of individuals aged 65 years and older slightly increased in Austria, from 17.4% in 2009 to 19.6% in 2023. Hospital admissions for rAA decreased from 357 in 2009 to 292 in 2023 (-18.2%), with admission rates falling from 4.3 to 3.2 per 100,000 (-25.2%) over the study period. In-hospital mortality among patients with rAA declined from 38.7% (138/357) to 34.6% (101/292), accompanied by a decrease in major comorbidities and recorded in-hospital complications. The incidence of hospital admissions for AD, however, showed a significant increase from 430 to 872 (+102.8%), with population-adjusted incidence rates rising from 5.2 to 9.6 per 100,000 (+85.6%). In-hospital mortality for aggregated AD cases decreased slightly, from 12.1% to 11.0%. Forecasting analyses suggest a continued rise in AD incidence through 2030, whereas rAA rates are expected to remain comparatively stable. Conclusions: While rAA incidence and mortality declined, AD cases showed a substantial increase, potentially due to improved detection, diagnostic advances, or a true epidemiological shift that warrants further investigation. These diverging trends highlight the need for updated surveillance strategies, improved risk stratification, and adaptation of health care resources to a potentially increasing burden of AD.