Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population-based study

Abstract

Background: Relevant studies focusing on epidemiological of profiles hypertensive disorders of pregnancy from global data that report the cause-specific prevalence and trends of hypertensive disorders of pregnancy at global, regional and national levels from 1990 to 2019 by age and sociodemographic index are still limited.

Methods: For hypertensive disorders of pregnancy, point prevalence, annual incidence, and years lived with disability numbers and age standardized rates per 100,000 population were compared at regional and national levels by age and sociodemographic index using data from the global Burden of Disease 2019 Study, covering populations from 204 countries and territories. Estimates are reported with uncertainty intervals to exhibit the changing trends during a specific period.

Results: The incidence of hypertensive disorders of pregnancy increased from 16.30 million to 18.08 million globally, with a total increase of 10.92 % from 1990 to 2019. The age-standardized incidence rate decreased, with an estimated annual percent change of -0.68 (95 % confidence interval [CI] -0.49 to -0.86). The number of deaths due to hypertensive disorders of pregnancy was approximately 27.83 thousand in 2019, representing a 30.05 % decrease from 1990. Based on the incidence and prevalence, the number of deaths and years lived with disability were highest in the group aged 25-29 years, followed by the groups aged 30-34 and 20-24 years, while the lowest estimated incidence rate was observed in the group aged 25-29 years and higher incidence rates were observed in the youngest and oldest groups. Positive associations between incidence rates and the sociodemographic index and human development index were found for all countries and regions in 2019. Age-standardized incidence rates were higher in countries/regions with lower sociodemographic indices and human development indices.

Conclusions: Our study provides a comprehensive overview of the global burden of hypertensive disorders of pregnancy. The death and incidence rates are decreasing in most countries and all regions except for those with low sociodemographic and human development indexes. This difference is mainly due to the increasing attention to prenatal examinations and health education. Further investigations should focus on forecasting the global disease burden of specific hypertensive disorders of pregnancy and modifiable risk factors.

Keywords: Burden of disease; Human development index; Hypertensive disorders of pregnancy; Sociodemographic index.

Fig. 1

Overview of HDP by country and region for both sexes combined. a The prevalence of HDP in 2019. b The ASIR of HDP per 100,000 population in 2019. c The EAPC in the ASDR of HDP from 1990 to 2019. The map depicted in this figure is our own. ASIR, age-standardized incidence rate; ASDR, age-standardized death rate; EAPC, estimated annual percentage change; HDP, hypertensive disorders of pregnancy

Fig. 2

Global number of cases and ASRs per 100,000 population stratified by age in 2017. aThe global number of deaths and ASDRs. b The global number of deaths and eASDR. c The global number of incident cases and ASIR. d The global number of incident cases and eASIR. e The global number of prevalence cases and ASPR. f The global number of prevalent cases and eASPR. g The global number of YLDs and ASR of YLDs. h The global number of YLDs and eASR of YLDs. ASIR, age-standardized incidence rate; eASIR, estimated age-standardized incidence rate according to the number of pregnant women; ASDR, age-standardized death rate; eASDR, estimated age-standardized death rate according to the number of pregnant women; ASPR, age-standardized prevalence rate; eASPR, estimated age-standardized prevalence rate according to the number of pregnant women; ASR, age-standardized rate; eASR, estimated age-standardized rate according to the number of pregnant women; YLDs, years lived with disability

Fig. 3

ASIRs of HDP by country and region and (a) SDIs (with 204 countries and regions) and (b) HDIs (with 187 countries and regions) in 2019. Each point shows the observed ASIR for a specified country or region in 2019. The red circle includes the 10 countries or regions with the highest ASIRs. The blue circle includes the 10 countries or regions with the lowest ASIRs. ASIR, age-standardized incidence rate; HDP, hypertensive disorders of pregnancy; HDI, human development index; SDI, sociodemographic index