Global, regional, and national prevalence of peripheral arterial disease in 2023: an updated systematic review and modelling study.

Abstract

Peripheral arterial disease is a growing public health concern. We aimed to provide updated estimates of peripheral arterial disease prevalence and case numbers at the global, regional, and national levels in 2023, and synthesise evidence on factors associated with peripheral arterial disease. In this systematic review and modelling analysis, we searched PubMed, Embase, MEDLINE, CINAHL, Global Health, AMED, and ProQuest Dissertations and Theses Global for articles and grey literature published between April 30, 2019, and Dec 9, 2024, reporting peripheral arterial disease prevalence in the general population. This search was supplemented by eligible studies identified through relevant systematic reviews and manual reference screening. Studies were eligible if peripheral arterial disease was defined as an ankle-brachial index (ABI) lower than or equal to 0·90. Studies using hospital-based or clinical samples and studies conducted exclusively in populations with specific characteristics (eg, diabetes) were excluded. Two reviewers independently screened records for eligibility, extracted study-level data, and assessed the study quality using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. An age-sex splitting procedure was applied to disaggregate prevalence data. A multilevel multivariable mixed-effects meta-regression approach was used to examine the associations between age and peripheral arterial disease prevalence, stratified by sex and income level (high-income countries [HICs] and low-income and middle-income countries [LMICs]). Pooled odds ratios (ORs) for factors associated with peripheral arterial disease were estimated through a random-effects meta-analysis. Peripheral arterial disease prevalence at regional and national levels was derived using an associated factor-based distribution model. The study protocol was registered in PROSPERO (CRD420261290434). Of 12 733 records identified, 157 articles from 37 countries met the inclusion criteria, encompassing more than 9·7 million participants. In 2023, the global prevalence of peripheral arterial disease among individuals aged 25 years and older was 6·58% (95% CI 4·83-9·02), equivalent to 316·54 million (232·34-433·78) affected individuals. Peripheral arterial disease prevalence increased consistently with age, ranging from 4·31% (2·82-6·81) among those aged 25-29 years to 22·09% (15·50-30·26) among those aged 90-99 years, with a similar pattern in both sexes. Prevalence was slightly higher in women (6·79% [5·14-9·05]) than in men (6·37% [4·52-9·00]), and was higher in HICs (7·52% [5·57-10·45]) than in LMICs (6·33% [4·63-8·63]). Despite the lower prevalence in LMICs, these countries accounted for over three-quarters of the global peripheral arterial disease cases (239·35 million [175·11-326·50]). Four associated factors were incorporated into the distribution model, namely current smoking (OR 2·85 [95% CI 2·13-3·80]), diabetes (1·81 [1·63-2·00]), hypertension (1·64 [1·48-1·81]), and hypercholesterolaemia (1·34 [1·17-1·53]). Across WHO regions, prevalence was the highest in the European region (8·09% [5·99-11·14]) and the lowest in the African region (5·18% [3·78-7·07]). The largest number of cases was in the Western Pacific region (91·91 million [67·45-125·34]), whereas the smallest was in the African region (25·40 million [18·57-34·70]). Approximately 60% of global cases (189·67 million) were concentrated in just ten countries. Peripheral arterial disease is a substantial and growing global public health challenge, particularly in LMICs. Reducing its long-term health consequences will require standardised population-based studies in under-represented regions, early detection through ABI-based and risk-based case-finding, improved access to diagnosis and vascular care, and integration of peripheral arterial disease into broader cardiovascular prevention and health-system planning. None.