Global pulmonary arterial hypertension trends and projections to 2046: a multi-method analysis of epidemiologic and demographic drivers using GBD 2021.

Background: Pulmonary arterial hypertension (PAH) is a progressive disease that affects millions of individuals worldwide. This investigation predicted PAH burden pattern and temporal trends to provide epidemiologic evidence. Methods: Data on prevalence, mortality and disability-adjusted life years (DALYs) was extracted from the Global Burden of Diseases (GBD) 2021. Subgroup analyses were performed based on sex, geographical regions, and socio-demographic index (SDI). Joinpoint model, Bayesian age-period-cohort (BAPC) model, age-period-cohort analysis, decomposition methodology and frontier analysis were employed to evaluate the temporal trends from 1992 to 2021, forecast the disease burden up to 2046 and decompose prevalence, mortality and DALYs by population age structure, population growth and epidemiologic changes. Results: From 1992 to 2021, the worldwide prevalence of PAH remained steady, while mortality and DALYs associated with PAH declined. There were substantial disparities in the PAH burden and trends across sex, age and SDI regions. Population aging and growth were key factors driving the increase in PAH prevalence, while epidemiological changes affected DALYs differently across regions. Frontier analysis indicated that countries or regions with a higher SDI quintile tend to have greater improvement potential. Predictions suggested that from 2022 to 2046, global PAH prevalence, mortality, and DALYs were expected to decline, with persisting but decreasing gender differences. Conclusions: The study provided a comprehensive global assessment of the PAH burden. Socioeconomic factors significantly influence PAH outcomes, highlighting the need for equitable access to healthcare access. Future projections indicate ongoing improvements in PAH management, underscoring the importance of continued research and policy development.