Global Burden of Pulmonary Arterial Hypertension and Associated Heart Failure: Global Burden of Disease 2021 Analysis.

Abstract

Background: Pulmonary arterial hypertension (PAH) and associated heart failure (HF) are emerging global health challenges.

Objectives: This study aimed to analyze the global, regional, and national burden of PAH and PAH-related HF from 1990 to 2021 with the use of GBD (Global Burden of Disease) 2021 estimates, to observe temporal trends, and to predict future patterns through 2050.

Methods: Data on prevalence, incidence, disability-adjusted life years (DALYs), and deaths were derived from GBD 2021. Joinpoint regression was adopted for analyzing trends and changes, decomposition analysis for quantifying impacts of age structure, population growth, and epidemiologic changes, and the Bayesian age-period-cohort model for predictions.

Results: In 2021, global PAH prevalence was 2.28 per 100,000, slightly down from 1990 (average annual percent change [AAPC]: -0.03; 95% CI: -0.05 to -0.01), and incidence rose to 0.52 per 100,000 (AAPC: 0.10; 95% CI: 0.10-0.11). DALYs fell to 8.24 per 100,000 (AAPC: -1.52; 95% CI: -1.64 to -1.40), and deaths dropped to 0.27 per 100,000 (AAPC: -0.82; 95% CI: -0.95 to -0.68). Increased PAH deaths from aging and growth. Women had higher PAH prevalence and incidence, and by 2021 surpassed men in DALYs and deaths rates. For PAH-related HF, prevalence rose to 191,808 cases and years lived with disability rose from 9,788 to 17,765, although rates declined. These trends are projected to persist through 2050, with cases and deaths rising but rates stable from 2019 to 2021.

Conclusions: The burden of PAH persists due to aging and population growth, despite declining age-standardized rates. Future interventions should address regional and sex disparities in PAH.