Abstract
BACKGROUND: To evaluate the trends and cross-country inequality of global aortic aneurysm (AA) burden from 1990 to 2021, and predict its development to 2050. METHODS: The data on AA deaths and disability-adjusted life years (DALYs) and associated risk factors were extracted from the 2021 Global Burden of Disease (GBD). The epidemiology of AA was discussed from three levels of global, sociodemographic index (SDI) regions, and GBD regions. The trend of AA burden was analyzed from an overall, local, and multi-dimensional scope. Besides, cross-country inequality in AA burden was quantified with standard health equity methods, and changes in AA burden were predicted to 2050. RESULTS: GBD 2021 estimated 153 927 [95% uncertainty interval (UI): 138 413-165 739] death cases and 3 107 762 (95% UI: 2 857 320-3 353 858) DALYs cases of AA in 2021, with an age-standardized rate (ASR) of 1.86 and 36.54 per 100 000. The highest death case was observed in Western Europe and the highest ASR in high-income Asia Pacific. Globally, the fastest change of AA burden was observed in the first decade of the 21st century. The gap in deaths between the highest SDI country and the lowest SDI country increased from 2.82 [95% confidence interval (CI): 3.50-4.18] per 100 000 in 1990 to 4.03 (95% CI: 4.68-5.33) per 100 000 in 2021, indicating a significant increase in SDI-related inequalities. The number of deaths and DALYs of AA was predicted to keep increasing, with predicted values of 133 388 (95% UI: 59 675-207 101) and 4 001 196 (95% UI: 3 592 618-4 409 773) in 2050, whereas the ASR of these metrics was expected to decrease annually. Smoking and hypertension were identified as the primary risk factors for AA. CONCLUSION: Although a decreasing trend was detected for the ASR of death and DALYs, AA remained an incremental public health issue globally, proven by both growing case numbers and distributive inequalities worldwide. The result revealed great challenges in the prevention and management of AA, which could be informative for public policy makers and allow for a more effective allocation of medical resources.