Abstract
AIMS: This study investigates the global burden of pulmonary arterial hypertension (PAH) from 1990 to 2021, examines its association with sociodemographic factors, and predict the trends from 2020 to 2035. METHODS: Utilizing the Global Burden of Disease database, we collected global PAH burden indicators from 1990 to 2021, stratified by age, sex, and Socio-Demographic Index (SDI). Global burden of PAH were assessed using comparative analyses, decomposition analyses, cluster analyses, and health inequality analysis. Bayesian age-period cohort model was used to predict PAH burden from 2020 to 2035. RESULTS: From 1990 to 2021, global PAH age-standardized prevalence rate (ASPR) and age-standardized incidence rate (ASIR) increased by 22.8% and 4.0%, respectively, while the age-standardized mortality rate (ASMR) and disability-adjusted life years rate (ASDR) decreased by 22.9% and 37.6%. The global PAH burden is strongly linked to sociodemographic factors, with notable gender and age disparities, especially among women and the elderly. Decomposition analysis showed population growth drove the global increase in PAH burden, while aging was the main factor in high and upper-middle SDI regions. Frontier analysis and health inequality analysis revealed health improvements but widening disparities. Clustering analysis identified three distinct trajectory groups. By 2035, global ASPR, ASMR, and ASDR are expected to decline, with the largest reduction in ASDR (approximately 31.8%), while ASIR is projected to increase slightly. CONCLUSIONS: Despite overall improvements in PAH mortality and disability rates, substantial inequalities persist across regions and demographic groups. Addressing aging challenges and ensuring equitable healthcare distribution will help reduce the burden.