Global burden and epidemiological determinants of pulmonary arterial hypertension among women aged 55 years and older: a GBD 2023 analysis

Figures

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  Figure 1. ASIR (A), ASPR (B), ASMR (C), and ASDR (D) due to PAH in different countries in global in 2023. ASIR, Age-standardized incidence; ASPR, Age-standardized prevalence; ASMR, Age-standardized mortality rate; DALYs, Disability-adjusted life years; ASDR, Age-standardized DALY rate.

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  Figure 2. Association between SDI and the burden of PAH. (A) SDI vs. ASIR; (B) SDI vs. ASPR; (C) SDI vs. ASMR; (D) SDI vs. ASDR. LOESS curves with 95% CIs are shown; each dot represents a region or country. SDI, Socio-demographic Index; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALY rate; CI, confidence interval.

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  Figure 3. Age-standardized trends in PAH among women aged ≥55 years across seven global regions, SDI levels, and China, 1990–2023. (A–L) show the ASIR, ASPR, ASMR, and ASDR of PAH from 1990–2023 in Central Europe–Eastern Europe–Central Asia, Latin America and the Caribbean, South Asia, Southeast Asia–East Asia–Oceania, North Africa and the Middle East, Sub-Saharan Africa, China, High Income, and four SDI levels. Colored lines denote the four age-standardized indicators for each location. ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALY rate; SDI, sociodemographic index.

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  Figure 4. Sex-specific comparisons of age-standardized incidence rates [ASIR; (A,E)], prevalence rates [ASPR; (B,F)], mortality rates [ASMR; (C,G)], and disability-adjusted life-year rates [ASDR; (D,H)] of PAH among adults aged ≥55 years across global regions and SDI levels and China in 1990 and 2023. Pink bars represent females and blue bars represent males. Error bars indicate the 95% uncertainty intervals. ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALY rate.

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  Figure 5. Regional and age-specific patterns of PAH burden among women aged ≥55 years, 1990–2023. (A–D) Temporal trends in incidence (A) prevalence (B) deaths (C) and DALYs (D) across global regions from 1990–2023. The right-side panels present the age-specific distribution of the four burden indicators in 2023, showing the relative contribution of each age group across regions.

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  Figure 6. (A–L) Depict Joinpoint regression trends for ASMR in women aged ≥55 years across 12 global regions from 1990–2023. APC, annual percentage change.

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  Figure 7. Decomposition analysis of the contributions of aging, epidemiological changes and population factors to the incidence rate (A), prevalence rate (B), mortality rate (C), and disability-adjusted life years rate (D) of PAH in women. Positive values on the x-axis indicate an increase in incidence or mortality, while negative values indicate a decrease. The black dots represent the total impact of these three factors.

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  Figure 8. Health inequality assessment of PAH-related prevalence (A,B), mortality (C,D), DALYs (E,F) across SDI regions, 1990 vs. 2023.

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  Figure 9. Hierarchical clustering of EAPC for mortality rate (A) and DALYs (B) in women aged ≥55 years with PAH from 1990–2023.

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  Figure 10. Frontier analysis exploring the relationship between the SDI and the mortality rate or DALYs. The solid black curve represents the frontier line, indicating countries or territories with exemplary performance that achieved the lowest mortality or DALYs burden relative to their SDI. Each dot corresponds to a specific country or region. In (A,C), the color gradient represents the calendar years from 1990 (lighter shades) to 2023 (darker shades). In (B,D), the top 15 countries and territories with the largest effective difference (i.e., the largest gap in mortality or DALYs burden from the frontier) are labeled in black. The direction of burden change from 1990–2023 is indicated by dot color, with red representing a decrease and blue representing an increase.

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  Figure 11. ARIMA forecast results for ASIR, ASPR, ASMR, and ASDR in women aged 55 and above across different regions from 1990 to 2040. The red line represents historical estimates, the yellow band indicates the forecast interval (95% CI), and the dashed line shows the projected trend.