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. 2025 Jul 2;25(1):680.
doi: 10.1186/s12884-025-07777-9.

Global, regional, and national burden, trends, and inequality analysis of maternal hypertensive disorders (MHD) from 1990 to 2021, and predictions to 2046

Junde Zhao #  1 , Ruiting Gong #  2 , Xiaohui Sui  1 , Zuocheng Wang  3 , Xiaotao Bian  4 , Yiider Tseng  5
Affiliations

Global, regional, and national burden, trends, and inequality analysis of maternal hypertensive disorders (MHD) from 1990 to 2021, and predictions to 2046

Junde Zhao et al. BMC Pregnancy Childbirth. .

Abstract

Background: Maternal hypertensive disorders (MHD) are a leading cause of maternal and fetal mortality, with profound short- and long-term public health impacts. MHD epidemiology remains poorly controlled, and the incidence rate has shown an increase over the past few decades. Therefore, a comprehensive assessment of global burden and prevalence inequalities holds considerable significance for optimizing public health strategies.

Methods: The global burden and epidemic trend of MHD from 1990 to 2021 were investigated, and the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were examined utilizing the Global Burden of Disease (GBD). The trends were stratified by age and socio-demographic index (SDI), and further analysis was performed to delve into the correlation between SDI and incidence, prevalence, mortality, and DALYs. Additionally, a Bayesian Age-Period Cohort (BAPC) model was constructed to predict the burden of disease in MHD from 2022 to 2046.

Results: The DALYs induced by MHD decreased significantly from 3.48 million (95% UI, 3.09-3.87 million) in 1990 to 2.47 million (95% UI, 2.08-2.96 million) in 2021, involving an Excess Annual Percentage Change (EAPC) of -2.10. Both the age-standardized DALYs rate (ASDR, AAPC = -2.11) and the age-standardized incidence rate (ASIR, AAPC = -0.60) exhibited evident decreasing trends. The ASDRs of all the age-stratified subgroups decreased as well. Notably, the largest declines were observed in the 20-24 age group with an EAPC of -2.39 (95% UI: -2.56, -2.23). The ASIR exhibited an obvious negative correlation with SDI, and the inequality tended to shrink. Projections for 2046 indicate that global ASDR and ASIR are expected to sustain their downward trajectory. Globally, ASDR in MHD linked to iron deficiency decreased significantly (EAPC = -2.03), with High-middle SDI countries experiencing particularly steep reductions (EAPC = -4.25).

Conclusions: This study performed a comprehensive analysis of the global burden of MHD and observed regional and national inequalities. The investigation also identified a correlation between MHD and SDI, and most regions exhibited an overall declining trend in disease burden. However, further investigations should still be conducted to assist the establishment of public health strategies for MHD prevention.

Keywords: Disability-adjusted life years; Global burden of disease; Hypertension; Incidence; Maternal Hypertensive Disorders.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All data in this study were collected from GBD database, requiring no additional ethical approval. Consent for publication: All authors approved the publication of this article. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Joinpoint regression analysis of total burden related to MHD from 1990 to 2021 at the global level. MHD maternal hypertensive disorder, APC annual percentage change, AAPC average annual percentage change, DALYs disability-adjusted life-years
Fig. 2
Fig. 2
Projected results of MHD disease burden from 2022 to 2046. A Age-standardized DALYs rate. B Age-standardized incidence rate. MHD maternal hypertensive disorder, DALYs disability-adjusted life-years
Fig. 3
Fig. 3
Total burden incidence and DALYs associated with MHD, by age group, worldwide from 1990 to 2021 (A) Age-standardized incidence rate; (B) Age-standardized DALYs rate. MHD maternal hypertensive disorder, DALYs disability-adjusted life-years
Fig. 4
Fig. 4
Global trends in the total burden associated with MHD by age between 1990 and 2021. MHD maternal hypertensive disorder, DALYs disability-adjusted life-years
Fig. 5
Fig. 5
Age-standardized rate of total burden related to MHD in 204 countries and territories (A) Age-standardized incidence rate in 2021; (B) AAPC in age-standardized incidence from 1990 to 2021; (C) Age-standardized DALYs rate in 2021; (D) AAPC in age-standardized DALYs from 1990 to 2021. DALYs disability-adjusted life-years, ASIR age-standardized incidence rate, ASDR age-standardized DALYs rate, AAPC average annual percentage change
Fig. 6
Fig. 6
Global, regional, and national levels of total burden related to MHD by SDI (A) Age-standardized incidence in 2021 in 204 countries and territories; (B) Age-standardized DALYs in 2021 in 204 countries and territories. SDI socio-demographic index, DALYs disability-adjusted life-years
Fig. 7
Fig. 7
Frontier analysis exploring the relationship between SDI and ASR for MHD in 204 countries and territories. DALYs disability-adjusted life-years
Fig. 8
Fig. 8
Health inequality regression curves and concentration curves for the ASR of MHD worldwide, 1990 and 2021. The graph on the left illustrate the slope index of inequality, depicting the relationship between SDI and ASR for each condition, with points representing individual countries and territories sized by population. The graph on the right present the concentration index. SII slope index of inequality, SDI socio-demographic index, DALYs disability-adjusted life-years
Fig. 9
Fig. 9
Population-level determinant changes in aging, population growth, and epidemiological changes for MHD globally and in various SDI regions from 1990 to 2021
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