Impact of lead exposure on global hypertensive CKD: YLDs/YLLs-based findings from 1990 to 2021 and projected trends to 2035

Hypertensive Chronic kidney disease (CKD) constitutes a major global health challenge, and lead exposure further exacerbates this disease burden. However, the burden characteristics of lead-attributable hypertensive CKD across different Socio-Demographic Index (SDI) contexts remain incompletely elucidated—hindering the development of targeted public health strategies. This study aims to analyze the global burden of Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) related to lead-attributable hypertensive CKD from 1990 to 2021, as well as the projected trends up to 2035.. Data on YLDs and YLLs related to lead-attributable hypertensive CKD were extracted from the GBD Study 2021 database, covering 204 countries/regions (further categorized into 21 GBD regions and 5 SDI regions). The analyzed indicators included number of cases, age-standardized rate (ASR), age and sex disparities, and temporal trends. Pearson correlation analysis was used to explore the association between SDI and disease burden, while the Quality of Care Index (QCI) was employed to assist in explaining the relationship with SDI. Frontier analysis was conducted to assess differences in burden levels across countries. The Autoregressive Integrated Moving Average (ARIMA) model was used to predict future trends, with the Bayesian Age-Period-Cohort (BAPC) model employed for supplementary validation. From 1990–2021, global YLDs and YLLs of lead-attributable hypertensive CKD exhibited an upward trend, with significant regional disparities: the burden was heavier among the elderly and males; Low SDI regions had the highest disease burden, while High SDI regions had the lowest; among the 21 GBD regions, South Asia had the heaviest burden, whereas Eastern Europe and Oceania had relatively low burdens. SDI correlation analysis revealed a significant association between burden and SDI. Frontier analysis indicated substantial heterogeneity in disease burden across countries, and identified countries with high and low burdens at the same SDI level. Predictive analysis showed that the declining trend of YLLs from 2022 to 2035 was consistently validated by both the ARIMA and BAPC models. Although there were discrepancies in YLDs trends between the two models, the overall results suggested promising prospects for prevention and control effectiveness. Controlling lead exposure is a key measure to reduce the disease burden of hypertensive CKD. It is recommended to develop targeted intervention strategies based on different SDI levels and draw lessons from countries at the forefront of disease burden control, so as to promote the equitable reduction of disease burden globally. • From 1990 to 2021, global YLDs and YLLs of lead-attributable hypertensive CKD rose, with notable disparities across regions, age groups and sexes • SDI was significantly linked to disease burden: low-SDI regions had the heaviest, high-SDI the lightest, with a non-linear correlation between YLDs and SDI. • Frontier analysis showed large heterogeneity in national disease burden, identifying high- and low-burden countries even at the same SDI level. • ARIMA and BAPC models confirmed YLLs’ declining trend (2022–2035); YLD trends differed, but overall prevention/control prospects are promising. • Controlling lead exposure is key to reducing hypertensive CKD’s burden, needing SDI-based targeted interventions and learning from leading burden-control countries.