Prevalence, incidence, and survival of pulmonary arterial hypertension: A systematic review for the global burden of disease 2020 study

Abstract

Pulmonary arterial hypertension (PAH) is characterized by increased resistance in the pulmonary arterioles as a result of remodeled blood vessels. We sought all available epidemiologic data on population-based prevalence, incidence, and 1-year survival of PAH as part of the Global Burden of Disease Study. We performed a systematic review searching Global Index Medicus (GIM) for keywords related to PAH between 1980 and 2021 and identified population-representative sources of prevalence, incidence, and mortality for clinically diagnosed PAH. Of 6772 articles identified we found 65 with population-level data: 17 for prevalence, 17 for incidence, and 58 reporting case fatality. Reported prevalence ranged from 0.37 cases/100,000 persons in a referral center of French children to 15 cases/100,000 persons in an Australian study. Reported incidence ranged from 0.008 cases/100,000 person-years in Finland, to 1.4 cases/100,000 person-years in a retrospective chart review at a clinic in Utah, United States. Reported 1-year survival ranged from 67% to 99%. All studies with sex-specific estimates of prevalence or incidence reported higher levels in females than males. Studies varied in their size, study design, diagnostic criteria, and sampling procedures. Reported PAH prevalence, incidence, and mortality varied by location and study. Prevalence ranged from 0.4 to 1.4 per 100,000 persons. Harmonization of methods for PAH registries would improve efforts at disease surveillance. Results of this search contribute to ongoing efforts to quantify the global burden of PAH.

Keywords: population health; pulmonary arterial hypertension; survival.

Figure 1

PRISMA diagram. Results of the systematic review, including number of hits from each data source, number of articles included after title/abstract review, and number of articles included

Figure 2

Reported prevalence of pulmonary arterial hypertension in 17 studies identified in systematic review x‐axis text: Prevalence per 100,000. Reported prevalence of pulmonary arterial hypertension per 100,000 as identified by echocardiography, right heart catheterization, echocardiography + right heart catheterization, or electronic data capture. Studies identified by first author and date of publication. Data represent reported prevalence and 95% confidence interval. When a confidence interval was not reported, we used cases and sample size to estimate a standard error using Wilson's score

Figure 3

Reported incidence of pulmonary arterial hypertension in 17 studies identified in systemic review x‐axis text: Incidence per 100,000. Reported incidence of pulmonary arterial hypertension per 100,000 as identified by echocardiography or right heart catheterization. Studies identified by first author and date of publication. Data represent reported incidence and 95% confidence interval. When a confidence interval was not reported, we used cases and sample size to estimate a standard error using Wilson's score

Figure 4

Reported 1‐year survival of pulmonary arterial hypertension in 58 studies identified in systematic review x‐axis text: Percent surviving 1 year. Reported 1‐year survival of pulmonary arterial hypertension per 100,000 as identified by echocardiography, right heart catheterization, echocardiography + right heart catheterization, or electronic data capture. Studies identified by first author and date of publication. Data represent reported incidence and 95% confidence interval. When a confidence interval was not reported, we used cases and sample size to estimate a standard error using Wilson's score