Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul;80(1):81-88.e1.
doi: 10.1016/j.jvs.2024.02.025. Epub 2024 Feb 24.

Changes in global mortality from aortic aneurysm

Brianna M Krafcik  1 , David H Stone  2 , Ming Cai  3 , Isabel A Jarmel  4 , Mark Eid  3 , Philip P Goodney  5 , Jesse A Columbo  5 , Michael F Mayo Smith  6
Affiliations

Changes in global mortality from aortic aneurysm

Brianna M Krafcik et al. J Vasc Surg. 2024 Jul.

Abstract

Objective: Globally, there has been a marked increase in aortic aneurysm-related deaths between 1990 and 2019. We sought to understand the underlying etiologies for this mortality trend by examining secular changes in both demographics and the prevalence of risk factors, and how these changes may vary across sociodemographic index (SDI) regions.

Methods: We queried the Global Burden of Disease Study (GBD) for aortic aneurysm deaths from 1990 to 2019 overall and by age group. We identified the percentage of aortic aneurysm deaths attributable to each risk factor identified by GBD modeling (smoking, hypertension, lead exposure, and high sodium diet) and their respective changes over time. We then analyzed aneurysm mortality by SDI region.

Results: The number of aortic aneurysm-related deaths have increased from 94,968 in 1990 to 172,427 in 2019, signifying an 81.6% increase, which greatly exceeds the 18.2% increase in all-cause mortality observed over the same time interval. Examination of age-specific mortality demonstrated that the number of aortic aneurysm deaths markedly correlated with advancing age. However, when considering rate of death rather than mortality count, overall age-standardized death rates decreased 18% from 2.72 per 100,000 in 1990 to 2.21 per 100,000 in 2019. Analysis of the specific risk factors associated with aneurysm death revealed that the percentage of deaths attributable to smoking decreased from 45.6% in 1990 to 34.6% in 2019, and deaths attributable to hypertension decreased from 38.7% to 34.7%. Globally, hypertension surpassed smoking as the leading risk factor. The reported rate of death was consistently greater as SDI increased, and this effect was most pronounced among low-middle and middle SDI regions (173.2% and 170.4%, respectively).

Conclusions: Despite an overall increase in the number of aneurysm deaths, there was a decrease in the age-standardized death rate, demonstrating that the observed increased number of aortic aneurysm deaths between 1990 and 2019 was primarily driven by an overall increase in the age of the global population. Fortunately, it appears that the increase in overall aneurysm-related deaths has been modulated by improved risk factor modification, in particular smoking. Given the rise in aneurysm-related deaths, global expansion of vascular specialty capabilities is warranted and will serve to amplify improvements in population-based aneurysm health achieved with risk factor control.

Keywords: Aortic aneurysm; High blood pressure; Public health; Smoking; Socioeconomic factors.

PubMed Disclaimer

Conflict of interest statement

Disclosures None.

Figures

Figure 1.
Figure 1.
Aortic Aneurysm Deaths by Age Group, 1990 and 2019 within the Global Burden of Disease Consortium.
Figure 2.
Figure 2.
Global changes in aortic aneurysm deaths between 1990 and 2019 within the Global Burden of Disease Consortium. (A) Number of deaths (B) Age standardized rate of deaths per 100,000 (C) Total global population
Figure 3.
Figure 3.
Global changes in aortic aneurysm deaths between 1990 and 2019 by sociodemographic index (SDI)*. (A) Aortic aneurysm deaths (B) Age standardized rate of deaths per 100,000 (B) Percent of deaths attributable to smoking by SDI (C) Percent of deaths attributable to high systolic blood pressure by SDI *Socio-Demographic Index is defined by lag-distributed income per capita, fertility rates among women under the age of 25, and mean education for people aged 15 or older
See this image and copyright information in PMC

References

    1. Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet 2020;396(10258):1204–22. Doi: 10.1016/S0140-6736(20)30925-9. - DOI - PMC - PubMed
    1. Wang Z, You Y, Yin Z, Bao Q, Lei S, Yu J, et al. Burden of Aortic Aneurysm and Its Attributable Risk Factors from 1990 to 2019: An Analysis of the Global Burden of Disease Study 2019. Front Cardiovasc Med 2022;9:901225. Doi: 10.3389/fcvm.2022.901225. - DOI - PMC - PubMed
    1. Marcaccio CL, Schermerhorn ML. Epidemiology of abdominal aortic aneurysms. Semin Vasc Surg 2021;34(1):29–37. Doi: 10.1053/j.semvascsurg.2021.02.004. - DOI - PubMed
    1. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation 2016;134(6):441–50. Doi: 10.1161/CIRCULATIONAHA.115.018912. - DOI - PMC - PubMed
    1. Reitsma MB, Fullman N, Ng M, Salama JS, Abajobir A, Abate KH, et al. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015. The Lancet 2017;389(10082):1885–906. Doi: 10.1016/S0140-6736(17)30819-X. - DOI - PMC - PubMed