Global Burden of Pediatric Pulmonary Arterial Hypertension, 1990-2021: A Systematic Analysis from the Global Burden of Disease Study 2021.

Pediatric pulmonary arterial hypertension (PAH) remains a critical global health threat characterized by disparities in burden driven by sociodemographic factors, with persistent gaps in early screening and equitable healthcare access despite therapeutic advances. Leveraging Global Burden of Disease 2021 data including 204 countries and territories from 1990 to 2021, this study analyzed trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) using joinpoint regression to discern temporal patterns, inequality metrics to quantify disparities, and decomposition and frontier analyses to investigate DALY change drivers and health system inefficiencies. Globally, pediatric PAH incidence increased by 20.1% from 1990 to 2021, while deaths and DALYs decreased significantly by 57.7 and 57.9%, respectively. Low-middle socio-demographic index (SDI) regions reported the highest incidence and deaths, whereas high-SDI regions achieved the most substantial mortality reductions. Neonates faced the highest mortality risk (4.86 per 100,000 population). Females demonstrated higher incidence and prevalence, while males under 10 years had elevated mortality and DALYs-a trend reversing in adolescence. Low-SDI regions experienced increasing burdens due to demographic shifts, and frontier analysis revealed inefficiencies even in resource-rich high-SDI countries. Addressing persistent inequities necessitates tailored regional strategies: optimizing resource allocation in high-SDI settings and expanding low-cost screening and treatment in low-SDI regions, alongside prioritizing neonatal care and risk mitigation to achieve global health equity in pediatric PAH.