Systematic analysis of the global, regional and national burden of peripheral artery disease from 1990 to 2021 and projections to 2040

Background: Peripheral artery disease (PAD) is a type of atherosclerotic vascular disease. Understanding its global burden and trends is essential to inform effective preventive strategies. Method: The GBD 2021 database was used to analyze trends in the burden of PAD from 1990 to 2021, and to assess temporal and spatial changes in the incidence, prevalence, deaths, and disability-adjusted life years (DALY) of PAD. The Bayesian Age-Period-cohort (BAPC) model was used to predict future trends, and the burden distribution was explored using decomposition analysis, health inequality index, and Sociodemographic index (SDI). Result: From 1990 to 2021, the global age standardization rate showed a consistent decline. However, absolute case numbers rose significantly, driven by population growth and aging. The burden was highest in high-SDI countries, while low- and middle-SDI countries experienced the most rapid increase. The gender gap suggested that older women should have been a major concern. The health inequality analysis showed that despite the narrowing of the relative gap, the absolute burden gap between high and low SDI countries continued to widen. The number of global PAD cases was expected to continue to rise by 2040, but the rate was expected to decline. Conclusion: Despite a decline in age-standardized rates, the absolute burden of PAD continues to grow due to demographic changes, with marked regional and demographic disparities. Targeted interventions and comprehensive management strategies are urgently needed to mitigate the growing public health impact of PAD worldwide.