Abstract
BACKGROUNDS: Maternal hypertensive disorders (MHDs) remain a critical global health challenge, disproportionately impacting low-resource regions. Using GBD (Global Burden of Disease, Injury, and Risk Factor Study) 2021 data, we first analyze global MHD epidemiology from 1990 to 2021 and project trends to 2035. METHODS: Age-standardized rates and estimated annual percentage change quantified incidence, prevalence, mortality rate, and disability-adjusted life years. Trends were stratified by sociodemographic index (SDI) and geography. Decomposition analysis attributed temporal variances (1990-2021) to demographic aging, population dynamics, and epidemiological shifts. Temporal patterns were assessed via age-period-cohort and Bayesian models, while socioeconomic disparities were measured using Slope and Concentration Index of Inequality, and frontier analysis identified SDI-specific optimal burden thresholds. RESULTS: New MHD cases rose 15.2% (1990: 15.7 million; 2021: 18.1 million), while deaths and disability-adjusted life years declined by ≈29% (0.038 million deaths; 2.47 million disability-adjusted life years in 2021). Age-standardized incidence fell from 554 to 462 per 100 000 (estimated annual percentage change: -0.51). Sub-Saharan Africa and South Asia bore the highest burden. Higher SDI quintiles demonstrated lower MHD burdens, though all metrics exhibited more pronounced declines in lower-SDI regions during 1990-2021. Women aged 25 to 29 years faced elevated risks, with incidence peaking in this group. Bayesian age-period-cohort modeling projects consistent global declines in incidence, disability-adjusted life years, prevalence, and mortality rates through 2035. CONCLUSIONS: Despite progress, inequities in MHD burden persist across SDI levels. Targeted interventions in high-risk regions, particularly enhancing prenatal care access and mitigating age-specific risks, are critical. Strengthening primary health care systems and prioritizing maternal health quality could reduce preventable complications.