What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Pulmonary arterial hypertension (n=103382). Intervention: Time period (1990-2021). Primary outcome: Age-standardized prevalence rate (per 100,000 population) in 2021 (95% CI 1.66-2.52).

May 16, 2025Open Access

Burden of pulmonary arterial hypertension in Asia from 1990 to 2021: Findings from Global Burden of Disease Study 2021

Key Result

In 2021, Asia accounted for approximately 60% of global pulmonary arterial hypertension cases, with an age-standardized prevalence rate of 2.05 per 100,000 population.

Study Design

Type

Cross-Sectional (n=103,382)

Structured PICO

Population

A cross-sectional analysis of the Global Burden of Disease 2021 database assessing the incidence, prevalence, mortality, and DALYs of pulmonary arterial hypertension across all age groups in Asia from 1990 to 2021.

Outcome

Incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of pulmonary arterial hypertension.

Despite reductions in age-standardized mortality, pulmonary arterial hypertension continues to impose a substantial and growing burden in Asia, driven primarily by population growth and aging.

Limitations

Reliance on data availability and quality, especially in low SDI countries, may have led to an underestimation of the disease burden.
Lack of subnational data limits the ability to address within-country inequities.
GBD 2021 database only provides aggregate disease burden estimates for PAH, lacking granularity at the subtype level.

Abstract

BACKGROUND: Pulmonary arterial hypertension (PAH) presents a significant health burden in Asia and remains a critical challenge. This study aims to delineate the PAH burden in Asia from 1990 to 2021. METHODS: Using the latest data from the Global Burden of Disease 2021, we evaluated and analyzed the distributions and patterns of PAH disease burden among various age groups, sexes, regions, and countries in Asia. Additionally, we examined the associations between PAH disease burden and key health system indicators, including the socio-demographic index (SDI) and the universal health coverage (UHC) index. RESULTS: In 2021, there were 25,989 new PAH cases, 103,382 existing cases, 13,909 PAH-associated deaths, and 385,755 DALYs attributed to PAH in Asia, which accounted for approximately 60% of global PAH cases. The age-standardized rates (ASRs) for prevalence and deaths were 2.05 (95% uncertainty interval UI: 1.66-2.52) per 100,000 population and 0.31 (95% UI: 0.23-0.38) per 100,000 population, respectively. From 1990 to 2021, Asia reported the lowest ASRs for PAH prevalence but the highest ASRs for deaths compared to other continents. While the ASRs for prevalence increased slightly, ASRs for mortality and DALYs decreased over time. This increasing burden of PAH was primarily driven by population growth and aging. The burden was especially pronounced among individuals aged ≥60 years and <9 years, who collectively accounted for the majority of deaths and DALYs. Moreover, higher SDI and UHC levels were linked to reduced incidence, but higher prevalence rates. CONCLUSIONS: Although progress has been made in reducing PAH-related mortality and DALYs, the disease continues to impose a substantial burden in Asia, particularly among older adults and young children. Region-specific health policies should focus on improving early diagnosis, expanding access to treatment, and effectively addressing the growing PAH burden in the region.

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