Table 5_Trends and cross-country disparity in the burden of pulmonary arterial hypertension among women of childbearing age from 1990 to 2021.xlsx

IntroductionThere 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.
MethodsData 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.
ResultsThere 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.
ConclusionThis 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.

引言 目前尚无针对育龄女性（women of childbearing age, WCBA）群体肺动脉高压（pulmonary arterial hypertension, PAH）全球疾病负担与时间变化趋势的系统性文献分析。本研究通过评估1990年至2021年全球、区域及国家层面育龄女性肺动脉高压的疾病负担与时间演变趋势，填补了这一研究空白。
方法 本研究从2021年全球疾病负担研究（Global Burden of Disease Study 2021, GBD 2021）中提取肺动脉高压疾病负担相关数据，并针对不同年龄分层、社会发展指数（social development index, SDI）分区以及医疗体系类型的人群，深入剖析了肺动脉高压的疾病负担特征。
结果 全球范围内育龄女性的肺动脉高压新发与现患病例数均呈现显著增长态势。伤残调整生命年（Disability-adjusted life years, DALYs）与死亡人数在2010年前持续上升，2010年后开始出现下降。除低社会发展指数区域外，所有社会发展指数分区的年龄标准化新发率（age-standardized incident rate, ASIR）与年龄标准化现患率（age-standardized prevalent rate, ASPR）均有所上升。低社会发展指数与中低社会发展指数区域承担了最为沉重的疾病负担。基础医疗体系与医疗资源有限的区域病例数增幅最为显著，而发达医疗体系的伤残调整生命年年龄标准化率（age-standardized rates, ASR）与死亡年龄标准化率则出现大幅下降。地理分布上，撒哈拉以南非洲区域的年龄标准化新发率最高。与此同时，中亚与热带拉丁美洲地区的伤残调整生命年与死亡年龄标准化率位居全球首位。国家级层面分析显示，印度与中国的病例数最多，瑞典的年龄标准化现患率最高；毛里求斯、蒙古国与塔吉克斯坦的伤残调整生命年与死亡年龄标准化率位列全球榜首。
结论 本研究全面绘制了全球育龄女性肺动脉高压疾病负担与健康不平等的时间序列图景。解决社会经济因素差异并强化医疗体系建设是关键干预措施，在高疾病负担区域尤为如此。