Global, Regional, and National Trends in Pulmonary Arterial Hypertension Burden, 1990-2021: Findings from the Global Burden of Disease Study 2021

Objectives: Pulmonary arterial hypertension (PAH) is a severe and life-threatening condition. This study systematically examines the global epidemiology of PAH, focusing on trends in incidence, mortality, and disability-adjusted life years (DALYs) over the past 32 years to inform evidence-based policy and healthcare strategies.Methods: Data from the Global Burden of Disease (GBD) 2021 study was used to analyze PAH incidence, mortality, and DALYs globally, regionally, and nationally from 1990 to 2021. Age-standardized incidence rate (ASIR), death rate (ASMR), disability-adjusted life years rate (ASDR) and estimated annual percentage change (EAPC) were assessed by age, gender, and socio-demographic index (SDI) quintiles. Hierarchical cluster analysis was performed to evaluate the temporal patterns of disease burden changes across GBD regions.Results: Global PAH incident cases increased by 85.6%, from 23,301 in 1990 to 43,251 in 2021. ASIR increased slightly from 0.50 to 0.52 per 100,000 persons (EAPC 0.05%). From 1990 to 2021, PAH-related deaths increased from 14,842 to 22,021, though ASMR decreased (EAPC -0.57%). In 2021, PAH accounted for 642,104 DALYs, with ASDR showing a downward trend (EAPC -1.31%). Regions with low SDI exhibited the highest ASIR, while both ASMR and DALYs decreased across all SDI categories. Southern Sub-Saharan Africa had the highest incidence, while Central Asia saw the largest increases in mortality and DALYs.Conclusions: Over the past 32 years, global ASMR and ASDR for PAH have decreased, while ASIR showed a modest increase. Persistent imbalances in treatment and outcomes remain in certain regions. Enhanced prevention and comprehensive management strategies are needed to diminish the global PAH burden and improve health equity.