Background: Pulmonary arterial hypertension (PAH) represents a substantial global
public health burden, particularly among women of reproductive age, who face significant risks during pregnancy if affected by the condition. This study seeks to provide a thorough evaluation of the disease burden and trends of PAH in women of
reproductive age (WPAH), aiming to guide the development of targeted prevention and control strategies. Methods: Data on the incidence, prevalence, disability-adjusted life years (DALYs), and deaths of WPAH were extracted from the Global Burden of Disease study (GBD)
database for the years 1990 to 2021. Age-standardized rate (ASR) of incidence (ASIR)
and ASR of prevalence (ASPR), ASR of DALYs (ASDR), and ASR of mortality(ASMR) were calculated at global, regional and national level, stratified by sociodemographic index (SDI) and age, to assess percentage changes and estimated annual percentage change (EAPC). The Spearman correlation test was employed to quantify the interlink between SDI and disease burden indicators, while burden disparities were analysed using decomposition analysis. Health inequality was
assessed using the slope index of inequality and the concentration index of inequality. Finally, the Bayesian age-period-cohort (BAPC) model was employed to project the future disease burden. Results:
In 2021, the global case of incidence, prevalence, DALYs, and deaths of WPAH all
increased. Since 1990, the global incidence rate of pulmonary hypertension has
increased, while the prevalence rate has remained relatively stable, and both DALYs
and death rates have decreased significantly. Across the 5 SDI regions, the ASIR and ASPR in the low SDI region demonstrated a marked decline. In contrast, the ASIR in other regions remained stable or showed a slight decrease, while the ASPR remained stable or increased slightly. Nonetheless, both the ASDR and ASMR displayed a clear
downward trend across regions. The global cases of WPAH across all age groups has
risen, with the 45–49 age group experiencing the most substantial growth. Results
from the Spearman correlation test indicated a negative correlation between SDI and the ASIR. The ASPR initially decreased and then increased with rising SDI levels, while both the ASDR and ASMR initially increased and then declined as SDI
increased. Decomposition analysis highlighted that population expansion was the key determinant of fluctuations in global incidence, prevalence, DALYs and death rates. The health inequality analysis indicates relatively minor disparities in inequality across regions with different SDI levels. Furthermore, projections using the BAPC model suggest that the ASIR, ASPR, ASDR and ASMR are likely to experience a decline by 2040. Conclusions:
Overall, the burden of WPAH remains substantial. However, with advancements in treatment, the burden has improved from 1990 to 2021 and is projected to continue improving by 2040.