Global Burden, Health Disparities, and Projections of Lower Extremity Peripheral Artery Disease: Insights from Global Burden of Disease, Injuries, and Risk Factors Study 2021.

Abstract

Lower extremity peripheral artery disease (PAD) represents a major global health challenge. However, comprehensive insights into its burden, temporal trends, risk factors, global inequalities, and long term projections remain limited. This is the first global ecological analysis based on population level estimates from the Global Burden of Disease (GBD 2021) 2021 study. PAD prevalence, incidence, mortality rate, disability adjusted life years (DALYs), and their age standardised rates were extracted from the GBD 2021 database (1990 - 2021), with subgroup analyses by sociodemographic index (SDI), region, age, and sex. Health inequality was assessed using the slope index of inequality and concentration index. The PAD attributable burden for seven modifiable risk factors was estimated using the comparative risk assessment framework. Future projections to 2040 were generated using a Bayesian age-period-cohort model. From 1990 to 2021, global PAD prevalence, incidence, mortality, and DALYs increased by 102.0%, 96.9%, 72.8%, and 70.7%, respectively, despite declines in age standardised rates. Although lower SDI regions experienced the largest relative increases, high SDI regions bore the highest burden in 2021. The most pronounced relative increase occurred among individuals aged ≥ 95 years. In 2021, women had a higher overall burden, whereas men exhibited higher age standardised mortality and DALY rates; however, the sex gap in mortality is projected to narrow by 2040. High fasting plasma glucose surpassed smoking in 2021 as the leading global risk factor for PAD related DALYs. Despite improvements in global inequalities, the burden is increasingly concentrated in lower SDI settings. By 2040, PAD prevalence, incidence, mortality, and DALYs are projected to increase by 69.0%, 62.5%, 80.0%, and 71.3%, respectively. The global PAD burden continues to rise with patterns shifting towards older age, women, and lower SDI settings, underscoring the need for targeted prevention strategies tailored to demographic and socio-economic contexts.