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. 2023 Oct;11(10):e1553-e1565.
doi: 10.1016/S2214-109X(23)00355-8.

Global burden of peripheral artery disease and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

GBD 2019 Peripheral Artery Disease Collaborators
Collaborators

Global burden of peripheral artery disease and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

GBD 2019 Peripheral Artery Disease Collaborators. Lancet Glob Health. 2023 Oct.

Abstract

Background: Peripheral artery disease is a growing public health problem. We aimed to estimate the global disease burden of peripheral artery disease, its risk factors, and temporospatial trends to inform policy and public measures.

Methods: Data on peripheral artery disease were modelled using the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2019 database. Prevalence, disability-adjusted life years (DALYs), and mortality estimates of peripheral artery disease were extracted from GBD 2019. Total DALYs and age-standardised DALY rate of peripheral artery disease attributed to modifiable risk factors were also assessed.

Findings: In 2019, the number of people aged 40 years and older with peripheral artery disease was 113 million (95% uncertainty interval [UI] 99·2-128·4), with a global prevalence of 1·52% (95% UI 1·33-1·72), of which 42·6% was in countries with low to middle Socio-demographic Index (SDI). The global prevalence of peripheral artery disease was higher in older people, (14·91% [12·41-17·87] in those aged 80-84 years), and was generally higher in females than in males. Globally, the total number of DALYs attributable to modifiable risk factors in 2019 accounted for 69·4% (64·2-74·3) of total peripheral artery disease DALYs. The prevalence of peripheral artery disease was highest in countries with high SDI and lowest in countries with low SDI, whereas DALY and mortality rates showed U-shaped curves, with the highest burden in the high and low SDI quintiles.

Interpretation: The total number of people with peripheral artery disease has increased globally from 1990 to 2019. Despite the lower prevalence of peripheral artery disease in males and low-income countries, these groups showed similar DALY rates to females and higher-income countries, highlighting disproportionate burden in these groups. Modifiable risk factors were responsible for around 70% of the global peripheral artery disease burden. Public measures could mitigate the burden of peripheral artery disease by modifying risk factors.

Funding: Bill & Melinda Gates Foundation.

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Conflict of interest statement

Declaration of interests S W Lee reports support for the present manuscript from a National Research Foundation grant funded by the Ministry of Education, South Korea (NRF2021R1I1A2059735). S Bhaskar reports leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with Rotary District 9675 as a chair of Diversity, Equity, and Inclusion; the Rotary Club of Sydney as a board director and chair of Youth, Global Health and Migration; and the Global Health Hub Germany as a founding member and chair; all outside the submitted work. K Krishan reports other non-financial support from the UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India; all outside the submitted work. S Lorkowski reports grants or contracts from Akcea Therapeutics Germany; consulting fees from Danone, Novartis Pharma, Swedish Orphan Biovitrum, and Upfield; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Akcea Therapeutics Germany, AMARIN Germany, Amedes Holding, Amgen, Berlin-Chemie, Boehringer Ingelheim Pharma, Daiichi Sankyo Deutschland, Danone, Hubert Burda Media Holding, Janssen-Cilag, Lilly Deutschland, Novartis Pharma, Novo Nordisk Pharma, Roche Pharma, Sanofi-Aventis, SYNLAB Holding Deutschland, and SYNLAB Akademie; support for attending meetings or travel from Amgen; participation on a data safety monitoring board or advisory board with Akcea Therapeutics Germany, Amgen, Daiichi Sankyo Deutschland, Novartis Pharma, and Sanofi-Aventis; all outside the submitted work. A-F A Mentis reports grants or contracts from MilkSafe (a novel pipeline to enrich formula milk using omics technologies), research co-financed by the European Regional Development Fund of the EU and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH–CREATE–INNOVATE (project code T2EDK-02222), as well as from ELIDEK (Hellenic Foundation for Research and Innovation, MIMS-860); payment for expert testimony from serving as an external peer reviewer for Fondazione Cariplo, Italy; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid as an editorial board member for Systemic Reviews and Annals of Epidemiology, and as associate editor for Translational Psychiatry; stocks in a family winery; other financial or non-financial support from the BGI group as a scientific officer; outside the submitted work. A Radfar reports support for the present manuscript from Avicenna Medical and Clinical Research Institute. J A Singh reports consulting fees from Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM, Trio Health, Medscape, WebMD, and Practice Point Communications, and the National Institutes of Health and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from the speakers bureau of Simply Speaking; support for attending meetings or travel from the steering committee of OMERACT; participation on a data safety monitoring board or advisory board as a member of the FDA Arthritis Advisory Committee; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid as a steering committee member of OMERACT, with the Veteran Affairs Rheumatology Field Advisory Committee as a chair, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as an editor; stock or stock options in Atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals and Charlotte's Web, and previously owned stock options in Amarin, Viking, and Moderna Pharmaceuticals; all outside the submitted work. J Sundström reports stock or stock options as a shareholder in Anagram Kommunication and Symptoms Europe, outside the submitted work. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Geographical distribution of age-standardised rates of peripheral artery disease in 2019 DALY=disability-adjusted life-year.
Figure 2
Figure 2
Total numbers and rates of peripheral artery disease, 1990–2019 (A) Total number of DALYs, deaths, prevalent cases, incident cases, YLDs, and YLLs of peripheral artery disease at the global level. (B) Rates (per 100 000 population) of age-standardised and all-age DALYs, deaths, prevalent cases, incident cases, YLDs, and YLLs of peripheral artery disease at the global level. Shaded regions indicate 95% uncertainty intervals. DALY=disability-adjusted life-year. YLD=year lived with disability. YLL=year of life lost.
Figure 3
Figure 3
Numbers and age-standardised rates (per 100 000 population) of prevalence, incidence, DALYs, and deaths from peripheral artery disease at the global level by age group and sex, 2019 Error bars and shaded regions indicate 95% uncertainty intervals. DALY=disability-adjusted life-year.
Figure 4
Figure 4
DALYs, mortality, prevalence, and incidence rates (per 100 000 persons) of peripheral artery disease for both sexes at the World Bank income level, by age group, 2019 DALY=disability-adjusted life-year. HIC=high-income country. UMIC=upper-middle-income country. LMIC=lower-middle-income country. LIC=low-income country.
Figure 5
Figure 5
Age-standardised DALYs rate (per 100 000 persons) of peripheral artery disease attributed to risk factors in 2019
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