The global burden of peripheral artery disease

Abstract

INTRODUCTION Previous efforts to characterize the burden of peripheral artery disease (PAD) have focused on national populations. A need for more detailed analysis of how PAD impacts the global population has been identified. Our objective was to study in greater detail the global burden of PAD, including its impact on mortality, over the past three decades. METHODS Using data and models from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD), we estimated the prevalence, years of life lost, years lived with disability and disability-adjusted life years (DALYs, a measure accounting for incurred morbidity and mortality), attributable to PAD. We analyzed results over time and stratified by sex, age, and social demographic index (SDI) group. We compared PAD to other atherosclerosis-related conditions and assessed the contribution of risk factors to PAD DALYs. RESULTS We observed a 72% increase in the global prevalence of PAD from an estimated 65,764,499 persons in 1990 to 113,443,016 in 2019. Prevalence per 100,000 persons increased 13% while prevalence per 100,000 age-standardized decreased 22%. Similar patterns were seen for years of live lost, mortality, years lived with disability and disability adjusted life years. Prevalence and disability were higher among women while mortality and years of life lost were higher among men. Disease burden increased with increasing sociodemographic index. These increases in PAD were in contrast to global trends for overall burden of ischemic heart disease and ischemic stroke, which had decreasing prevalence and disease-related mortality over the same time frame. Overall, only about 55% of PAD disease burden could be attributed to identified risk factors, with tobacco use, diabetes and hypertension being the three major contributors in all SDI groups. CONCLUSION The global prevalence and mortality associated with PAD has increased substantially, in contrast to other forms of ischemic cardiovascular disease. Globally there is a growing need for vascular surgical resources to manage PAD, as well as public health efforts to address risk factors for this increasing health threat.