Guang-Wei Huang, Yue Cui, Zhi-Cheng Jing, Hai-Long Dai
This study reveals significant and enduring geographical disparities in the prevalence of PAH among women aged 55 years and older worldwide. Women aged 55-69 years represented the age group with the highest population-level incidence of PAH in the GBD estimates and may therefore warrant priority in surveillance and preventive strategies. High and middle SDI countries must swiftly establish long-term monitoring and chronic management systems specifically designed for women aged ≥55 years. Targeted policies and healthcare services are crucial for mitigating the global impact of PAH.
BACKGROUND: Pulmonary arterial hypertension (PAH) exhibits significant sex disparities; however, the impact on women aged ≥55 years-a population-level proxy for postmenopausal women who experience substantial hormonal and cardiometabolic changes-has not been comprehensively assessed. This research assessed long-term trends, regional variations, and structural factors influencing PAH in women aged ≥55 years.
METHOD: This study utilizes standardized estimation data from GBD 2023, focusing on women aged 55 years and older as a population-level proxy for postmenopausal status. Joinpoint regression analysis was employed to investigate the trends in load. Decomposition analysis was utilized to measure the distinct impacts of population increase, aging, and epidemiological shifts. Frontier analysis was utilized to assess health output efficiency across different nations, while the ARIMA model was employed to forecast data until 2040.
RESULTS: In 2023, the Age-Standardized Incidence Rate (ASIR) showed a six-fold variation among nations (0.18-1.06 per 100,000), whilst the Age-Standardized Mortality Rate (ASMR) demonstrated almost a 160-fold disparity (0.007-1.13 per 100,000), with Central Asia and sub-Saharan Africa identified as high-burden hotspots. Between 1990 and 2023, global ASMR decreased by over 40%, while ASDR diminished by almost 35%. In persons aged 55 years and older, the age-specific incidence rate (ASIR) and age-specific prevalence rate (ASPR) for females were 1.3 to 1.8 times greater than those for males. Population growth accounted for 40-65% of the increases in burden in South Asia, East/Southeast Asia, and Africa, while aging was the predominant factor in China and high-SDI regions. By 2040, global mortality and disability-adjusted life years (DALYs) are anticipated to persist in their decline, whereas incidence and prevalence are likely to stabilize; China's age-standardized incidence rate (ASIR) is forecasted to maintain a high plateau, while age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) will continue to diminish, exhibiting a steady trajectory.
CONCLUSION: This study reveals significant and enduring geographical disparities in the prevalence of PAH among women aged 55 years and older worldwide. Women aged 55-69 years represented the age group with the highest population-level incidence of PAH in the GBD estimates and may therefore warrant priority in surveillance and preventive strategies. High and middle SDI countries must swiftly establish long-term monitoring and chronic management systems specifically designed for women aged ≥55 years. Targeted policies and healthcare services are crucial for mitigating the global impact of PAH.