Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH; VA Outcomes Group, White River Junction VA Medical Center, White River Junction, VT.
Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH; Department of Vascular Surgery, White River Junction VA Medical Center, White River Junction, VT.
J Vasc Surg. 2024 Jul;80(1):81-88.e1. doi: 10.1016/j.jvs.2024.02.025. Epub 2024 Feb 24.
Globally, there has been a marked increase in aortic aneurysm-related deaths between 1990 and 2019. We sought to understand the underlying etiologies for this mortality trend by examining secular changes in both demographics and the prevalence of risk factors, and how these changes may vary across sociodemographic index (SDI) regions.
We queried the Global Burden of Disease Study (GBD) for aortic aneurysm deaths from 1990 to 2019 overall and by age group. We identified the percentage of aortic aneurysm deaths attributable to each risk factor identified by GBD modeling (smoking, hypertension, lead exposure, and high sodium diet) and their respective changes over time. We then analyzed aneurysm mortality by SDI region.
The number of aortic aneurysm-related deaths have increased from 94,968 in 1990 to 172,427 in 2019, signifying an 81.6% increase, which greatly exceeds the 18.2% increase in all-cause mortality observed over the same time interval. Examination of age-specific mortality demonstrated that the number of aortic aneurysm deaths markedly correlated with advancing age. However, when considering rate of death rather than mortality count, overall age-standardized death rates decreased 18% from 2.72 per 100,000 in 1990 to 2.21 per 100,000 in 2019. Analysis of the specific risk factors associated with aneurysm death revealed that the percentage of deaths attributable to smoking decreased from 45.6% in 1990 to 34.6% in 2019, and deaths attributable to hypertension decreased from 38.7% to 34.7%. Globally, hypertension surpassed smoking as the leading risk factor. The reported rate of death was consistently greater as SDI increased, and this effect was most pronounced among low-middle and middle SDI regions (173.2% and 170.4%, respectively).
Despite an overall increase in the number of aneurysm deaths, there was a decrease in the age-standardized death rate, demonstrating that the observed increased number of aortic aneurysm deaths between 1990 and 2019 was primarily driven by an overall increase in the age of the global population. Fortunately, it appears that the increase in overall aneurysm-related deaths has been modulated by improved risk factor modification, in particular smoking. Given the rise in aneurysm-related deaths, global expansion of vascular specialty capabilities is warranted and will serve to amplify improvements in population-based aneurysm health achieved with risk factor control.
1990 年至 2019 年期间，全球与主动脉瘤相关的死亡人数显著增加。我们试图通过检查人口统计学和危险因素流行率的长期变化以及这些变化如何因社会人口指数（SDI）区域而异来了解这种死亡率趋势的潜在病因。
我们通过全球疾病负担研究（GBD）查询了 1990 年至 2019 年期间的主动脉瘤死亡病例，并按年龄组进行了分析。我们确定了 GBD 建模确定的每个危险因素（吸烟、高血压、铅暴露和高钠饮食）导致的主动脉瘤死亡比例及其随时间的变化。然后我们按 SDI 区域分析了动脉瘤死亡率。
与主动脉瘤相关的死亡人数从 1990 年的 94968 人增加到 2019 年的 172427 人，增长了 81.6%，大大超过了同期所有原因死亡率 18.2%的增长。对特定年龄死亡率的检查表明，主动脉瘤死亡人数与年龄的增长呈显著相关。然而，当考虑死亡率而不是死亡率计数时，1990 年每 10 万人 2.72 人，2019 年降至每 10 万人 2.21 人，总体年龄标准化死亡率下降了 18%。对与动脉瘤死亡相关的特定危险因素的分析表明，吸烟导致的死亡比例从 1990 年的 45.6%下降到 2019 年的 34.6%，高血压导致的死亡比例从 38.7%下降到 34.7%。全球范围内，高血压已超过吸烟成为主要危险因素。随着 SDI 的增加，报告的死亡率一直保持较高水平，而在中低和中高 SDI 地区，这一影响最为明显（分别为 173.2%和 170.4%）。
尽管动脉瘤死亡人数总体上有所增加，但年龄标准化死亡率却有所下降，这表明 1990 年至 2019 年期间主动脉瘤死亡人数的增加主要是由于全球人口年龄的整体增长。幸运的是，主动脉瘤相关死亡人数的增加似乎已通过改善危险因素控制得到调节，特别是吸烟。鉴于动脉瘤相关死亡人数的上升，有必要扩大全球血管专业能力，这将有助于提高通过危险因素控制实现的基于人群的动脉瘤健康水平。
