The global burden of aortic aneurysm attributable to hypertension from 1990 to 2021: Current trends and projections for 2050

Abstract

Background and objectives: Hypertension is a major risk factor for aortic aneurysm (AA), but the global, regional, and national patterns of its related disease burden are not well studied. This study uses 2021 GBD data to examine trends in hypertension-related AA from 1990 to 2021, project future trends, and provide evidence for targeted prevention strategies.

Methods: This study extracted data on mortality, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) associated with AA attributable to hypertension from the 2021 GBD study. The estimated annual percentage change (EAPC) was employed to assess burden trends from 1990 to 2021.The study utilized the Bayesian Age-Period-Cohort (BAPC) model to project disease trends from 2022 to 2050. Additionally, decomposition analysis and frontier analysis were employed to conduct a more comprehensive examination of the data.

Results: In 2021, 26,782 deaths and 529,977 DALYs were caused by hypertension-related AA globally, reflecting increases of about 49% and 47% since 1990. However, both ASMR and ASDR declined worldwide. From 1990 to 2021, the ASDR for hypertension-related AA decreased by 54.08% and 15.56% in high-SDI and upper-middle-SDI regions, respectively, while it increased by 25.23%, 62.02%, and 17.99% in middle-SDI, lower-middle-SDI, and low-SDI regions. The disease burden is significantly higher in males than in females and increases with age.The findings from the decomposition analysis reveal that population growth and the aging process are the primary contributors to the escalating burden, with varying impacts across different regions. The frontier analysis identified 15 countries with the greatest potential for improvement. According to the BAPC model, the ASDR for females is projected to rise across the 20-80 age group, while for males, the increase is particularly pronounced in the 55-75 age group. Globally, the ASDR is expected to initially decline before gradually rising, reaching 12.07 per 100,000 by 2050, a 5% increase compared to 2021.

Conclusion: While the global number of deaths and DALYs attributable to hypertension-related AA continues to rise, the ASMR and ASDR are showing a declining trend. However, in middle, lower-middle, and low SDI regions, ASMR and ASDR remain on an upward trajectory. Projections indicate that the global ASDR will initially decline before gradually increasing, with an expected rise by 2050.

Fig 1. The disease burden of AA caused by hypertension in 204 countries and regions.

(A)The ASDR in 2021. (B)The EAPC from 1990 to 2021. ASDR, age-standardized DALYs rate; EAPC, estimated annual percentage; AA, aortic aneurysm.

Fig 2. Time trend of ASDR and ASMR for hypertension -related AA by sex globally and acorss diverse SDI region from 1990 to 2021.

A. The ASDR. B.The ASMR. ASDR, age-standardized DALYs rate; ASMR, age-standardized mortality rate, AA, aortic aneurysm, SDI, socio demographic index.

Fig 3. The Age-standardized number and rates of DALYs and deaths due to AA caused by hypertension in different age groups for males and females in 2021.

DALYs, disability-adjusted life years; AA, aortic aneurysm.

Fig 4. Decomposition analysis of the changes in AA deaths attributed to hypertension across diverse SDI regions from 1990 to 2021.

AA, aortic aneurysm; SDI, socio-demographic index.

Fig 5. The relationship between age-standardized DALYs due to hypertension-induced AA and the SDI.

(A) Trend in Age-Standardized DALYs Rates (ASDR) based on the SDI across 21 regions from 1990 to 2020. (B) Trend in Age-Standardized DALYs Rates (ASDR) based on the SDI across 204 countries in 2021. DALYs, disability-adjusted life-years; AA, aortic aneurysm; SDI, socio-demographic index.

Fig 6. Frontier analysis findings: (A) A frontier analysis diagram based on Age-Standardized DALYs Rate (ASDR) and the SDI from 1990 to 2021.

The color gradient transitions from light blue (1990) to dark blue (2021), with the black solid line denoting the frontier. (B) A frontier analysis diagram for ASDR and SDI in 2021. The black solid line represents the frontier, and the dots signify individual countries and regions. The top 15 countries and regions with the most notable effective differences are marked in black.DALYs, disability-adjusted life year rate; SDI, socio-demographic index.

Fig 7. The trend of ASDR for hypertension-related AA in global age groups from 2022 to 2050 predicted using the Bayesian age-period-cohort (BAPC) model.

(A) Female; (B) males. The blue shading represents the corresponding confidence intervals. ASDR, age-standardized disability-adjusted life year rate; AA,aortic aneurysm.