Abstract Body (Do not enter title and authors here): Introduction:
Pulmonary arterial hypertension (PAH) is a rare yet progressive condition marked by elevated pulmonary vascular resistance, leading to right heart failure and increased mortality.
Aim:
To evaluate the global, regional, and sex-specific trends in the burden, prevalence, incidence, and mortality of PAH over a 32-year period using the Global Burden of Disease (GBD) 2021 database.
Methods:
We conducted a secondary analysis of the Global Burden of Disease Study 2021, focusing on PAH-related mortality, prevalence, incidence, and disability-adjusted life years (DALYs) from 1990 to 2021. Data were stratified by sex and socio-demographic index (SDI) regions. Temporal trends were assessed using age-adjusted percentage changes and average annual percentage changes (AAPC) with corresponding 95% confidence intervals (CIs).
Results:
Globally, deaths due to PAH increased by 0.23% (95% CI: 0.05, 0.41), with a significant increase among females only (AAPC: 0.34; 95% CI: 0.17, 0.51). Despite rising mortality, incidence rates showed a minor overall decline (-0.01%). Prevalence increased slightly, with greater rises noted among males. The sharpest rise in mortality was observed among females in H-SDI regions (AAPC: 0.9; 95% CI: 0.68, 1.12), followed by those in L-SDI regions (AAPC: 0.66; 95% CI: 0.51, 0.82). Among SDI regions, only H-SDI showed an overall increase in death rates (AAPC: 0.61; 95% CI: 0.42, 0.8). Conversely, the steepest decline was recorded in L-SDI males (AAPC: -0.52; 95% CI: -0.62, -0.43), followed by LM-SDI (-0.39%) and HM-SDI males (-0.15%). DALY trends mirrored mortality patterns, with significant increases in females from L-SDI (AAPC: 0.33; 95% CI: 0.22, 0.44) and H-SDI (AAPC: 0.22; 95% CI: 0.01, 0.42). Notably, despite rising mortality and DALYs, both L-SDI and H-SDI regions observed a decline in PAH incidence among females (AAPC: -0.3% and -0.14%, respectively). Prevalence rates also declined in these regions, potentially reflecting higher associated death rates.
Conclusion:
Over the past three decades, the global burden of PAH has evolved with complex regional and sex-specific patterns. While overall incidence has declined, mortality and DALYs—particularly among females in high- and low-SDI regions—have increased. These findings highlight the need for improved diagnostic access, tailored interventions, and enhanced disease surveillance systems to reduce PAH-related mortality and disability, especially in vulnerable populations.