This comparative study used estimates from the Global Burden of Disease Study 2023 to characterize changes in pulmonary arterial hypertension (PAH) burden in China and the G20 aggregate between 1990 and 2023 and to project future patterns. The analysis extracted country- and aggregate-level results from GBD 2023 and reported both absolute counts and age-standardized rates for multiple burden metrics.
Reported outcomes included annual incidence, prevalence, deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Each outcome was presented as absolute numbers and as age-standardized rates to enable comparison across time and populations with differing age structures.
Temporal trends from 1990 to 2023 were assessed using Joinpoint regression to identify changes in direction and magnitude over time. To project future burden, the investigators applied autoregressive integrated moving average (ARIMA) models to overall burden through 2050. Sex-specific projections through 2038 used Bayesian age-period-cohort (BAPC) models. The study also examined sex- and age-specific patterns and conducted demographic decomposition to separate the contributions of population growth and aging from epidemiological change.
Across both China and the G20 aggregate, females generally exhibited higher age-standardized prevalence and YLD rates than males, reflecting a greater measured prevalence and non-fatal burden among women in the GBD estimates. Sex differences in mortality-related outcomes varied between China and the G20 aggregate. Over the study period, the absolute burden of PAH shifted toward older age groups in both settings, indicating an increasing share of incident and prevalent cases occurring at older ages.
The authors decomposed changes in absolute burden into components attributable to population growth, population aging, and epidemiological change. Population growth and aging were identified as important contributors to increases in absolute numbers of incident and prevalent cases. In contrast, epidemiological change—reflecting risk, diagnosis, and management improvements—generally acted to reduce absolute burden, producing the observed divergence between rising case counts and falling age-standardized mortality metrics.
Model projections suggested that age-standardized mortality-related burden (deaths, DALYs, YLLs) would continue to decline through 2050, while absolute numbers of incident and prevalent PAH cases were expected to increase. Sex-specific BAPC projections to 2038 were used to examine differing future patterns by sex, although the abstract does not detail sex-specific projected values. The combined projection results point to a future in which lower age-standardized mortality coexists with higher absolute caseloads driven by demographic change.
The divergent trends—declining age-standardized mortality-related indicators alongside increasing incident and prevalent case numbers—underscore the need for sustained disease surveillance and health-service planning. Rising absolute numbers of people living with PAH, especially among older age groups, have implications for long-term care resources, specialized clinical services, and public health strategies, even as per-capita mortality risk falls.
Strengths of the analysis include use of a comprehensive, comparable global dataset (GBD 2023), multiple burden metrics, decomposition analyses, and two projection frameworks (ARIMA and BAPC) to assess future trends. The abstract reports specific numeric changes for China—prevalent cases rose by 63.5% (from 17,020.87 to 27,834.41) and the age-standardized death rate declined by 74.3% (from 0.29 to 0.08 per 100,000)—and notes similar mortality-related declines in the G20 aggregate. The study concludes that mortality-related PAH burden declined in both China and the G20 aggregate while absolute case numbers increased, driven in part by population growth and aging. The abstract does not provide further methodological details, sex-specific projected values, model fit statistics, or region-specific numerical results beyond those reported for China; these details were not reported in the source abstract and would require consultation of the full article for clarification.
Overall, the findings highlight a consistent pattern in GBD 2023 estimates: reductions in age-standardized mortality and DALYs for PAH over the past three decades, concurrent with growing absolute numbers of people affected, with important implications for health-system planning and long-term care needs.