Global burden of pulmonary arterial hypertension and health inequality in women of childbearing age from 1990 to 2021, with projections up to 2040: the global burden of disease 2021 study

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Objective: To assess the global burden, trends, and inequalities of pulmonary arterial hypertension (PAH) among women of childbearing age (WCBA) from 1990 to 2021, projecting future trends to 2040. Methods: Using Global Burden of Disease (GBD) 2021 data, we analyzed PAH mortality, incidence, prevalence, and disability-adjusted life years (DALYs) among WCBA aged 15 to 49. Trends were assessed via age-standardized rates (ASR), estimated annual percentage change (EAPC), joinpoint regression, decomposition, and inequality analyses. Future burden was projected using Bayesian age-period-cohort, auto-regressive moving average, and exponential smoothing models. Results: The absolute number of PAH cases among WCBA increased globally from 1990 to 2021. Critically, the global age-standardized incidence rate (ASIR) showed a neglected upward trend (EAPC = 0.12), while mortality and DALY rates declined. Significant inequalities were observed, with the ASIR highest in low-middle SDI regions and prevalence highest in high SDI regions. Decomposition analysis identified population growth as the primary driver of increasing burden in low-resource settings. Projections indicate a continued rise in incidence by 2040, alongside declining mortality. Conclusion: This study demonstrated a persistent and growing PAH burden among WCBA, marked by significant inequalities. The rising incidence, particularly in low-resource settings, coupled with the cumulative prevalence in high-income regions, underscores an urgent need for targeted public health actions. Region-specific interventions are vital, including integrating PAH screening into maternal health programs in resource-poor settings and optimizing long-term management in high-income countries.

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