# Trends and cross-country disparity in the burden of pulmonary arterial hypertension among women of childbearing age from 1990 to 2021

## TL;DR

This study examines global trends and disparities in pulmonary arterial hypertension among women of childbearing age from 1990 to 2021, highlighting regional and socioeconomic inequalities.

## Contribution

The study provides the first comprehensive global analysis of PAH burden trends among women of childbearing age, revealing cross-country disparities and temporal changes.

## Key findings

- Global incident and prevalent cases of PAH among women of childbearing age increased significantly.
- Low and low-middle SDI regions experienced the heaviest PAH burden with rising case numbers.
- Advanced healthcare systems showed reduced age-standardized rates of DALYs and deaths.

## Abstract

There is currently a lack of comprehensive literature analysis on the global burden and trends of pulmonary arterial hypertension (PAH) among women of childbearing age (WCBA). We fill this evidence gap by evaluating the burden and temporal trends of PAH in WCBA at global, regional, and national levels from 1990 to 2021.

Data about PAH burden were extracted from the Global Burden of Disease Study (GBD) 2021. Moreover, PAH burden was explored across regions with different age, social development index (SDI) or health system.

There was a significant global increase in incident and prevalent cases of PAH among WCBA. Disability-adjusted life years (DALYs) and deaths initially increased but began to decline after 2010. Age-standardized incident rate (ASIR) and age-standardized prevalent rate (ASPR) increased in all SDI regions except in low SDI. Low and low-middle SDI regions bore the heaviest burden. Basic and limited healthcare systems showing the most pronounced increases in cases, but with advanced healthcare systems demonstrating a sharp reduction in age-standardized rates (ASR) of DALYs and deaths. Geographically, the highest ASIR were observed in Sub-Saharan Africa regions. Meanwhile, Central Asia and Tropical Latin America had the highest ASR of DALYs and deaths. National-level analysis identified India and China with the highest case numbers, and Sweden with the highest ASPR. Mauritius, Mongolia and Tajikistan topped ASR of DALYs and deaths.

This study provides a comprehensive, time-series portrait of PAH burden and inequalities among WCBA worldwide. Addressing socioeconomic factors and strengthening healthcare systems are essential measures, especially in high-burden regions.