Wang Wei, Shi Yong, Li Xinyao, Gu Tianxiang, Shi Enyi
Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, China.
Department of Urology, Baoji Central Hospital, Baoji, China.
BMC Public Health. 2025 Jul 2;25(1):2224. doi: 10.1186/s12889-025-23502-9.
Aortic aneurysms (AA) pose a significant risk to women of childbearing age due to the added physiological stress of pregnancy and hormonal changes. This study aims to assess the global disease burden of AA among women of childbearing age from 1990 to 2021, project future trends, and provide evidence-based insights to inform public health policies and clinical decision-making.
Aortic aneurysm mortality and disability-adjusted life years (DALYs) data for women of childbearing age (15-49 years) from 1990 to 2021 were extracted from the 2021 Global Burden of Disease (GBD) dataset. Temporal trends and attributable risks were evaluated using estimated annual percentage change (EAPC) and linear regression model from 1990 to 2021. Cluster analysis identified patterns across GBD regions. The Socio-demographic Index (SDI) assessed regional and national differences in mortality and DALYs rates related to AA. In addition, all potential risk determinants associated with AA were systematically examined. An age-period-cohort model assessed trends, period, and cohort effects, while the Bayesian age-period-cohort model predicted the disease burden through 2036.
In 2021, AA was associated with 2,552 (95% UI: 2,273 to 2,827) mortality and 86,466 (95% UI: 72,510 to 115,049) DALYs counts worldwide among women of childbearing age. The age-standardized mortality rate (ASMR) and age-standardized DALYs rate for AA decreased from 1.58 (95% UI: 1.41 to 1.76) to 1.28 (95% UI: 1.10 to 1.42), and from 28.52 (95% UI: 25.56 to 32.53) to 23.01 (95% UI: 20.49 to 25.27), respectively, between 1990 and 2021. By SDI quintile, the EAPC for both mortality and DALYs increased in the low-middle and middle SDI regions. Using the average age, period, and cohort as reference groups, the risk of AA death increased with age [RR = 0.026 to RR = 0.384]. The risk of DALYs followed a similar age-related trend. Among the risk factors associated with AA, mortality counts and DALYs attributable to smoking declined over time, whereas those related to high systolic blood pressure and high body mass index (BMI) showed increasing trends. Predicted results indicate that mortality and DALY rates among women of childbearing age are expected to continue declining from 2022 to 2036.
Although the global burden of AA among women of childbearing age is decreasing, significant regional disparities persist, and the rising prevalence of hypertension and high BMI poses ongoing challenges. Strengthened prevention strategies targeting modifiable risk factors are urgently needed to further reduce disease burden and promote health equity.
由于怀孕带来的额外生理压力和激素变化，主动脉瘤（AA）对育龄妇女构成重大风险。本研究旨在评估1990年至2021年育龄妇女中AA的全球疾病负担，预测未来趋势，并提供基于证据的见解，为公共卫生政策和临床决策提供参考。
从2021年全球疾病负担（GBD）数据集中提取1990年至2021年育龄妇女（15 - 49岁）的主动脉瘤死亡率和伤残调整生命年（DALYs）数据。使用1990年至2021年的估计年度百分比变化（EAPC）和线性回归模型评估时间趋势和归因风险。聚类分析确定了GBD各区域的模式。社会人口指数（SDI）评估了与AA相关的死亡率和DALYs率的区域和国家差异。此外，系统检查了与AA相关的所有潜在风险决定因素。年龄 - 时期 - 队列模型评估趋势、时期和队列效应，而贝叶斯年龄 - 时期 - 队列模型预测了到2036年的疾病负担。
2021年，全球范围内AA导致育龄妇女死亡2552例（95% UI：2273至2827），伤残调整生命年86466例（95% UI：72510至115049）。1990年至2021年期间，AA的年龄标准化死亡率（ASMR）从1.58（95% UI：1.41至1.76）降至1.28（95% UI：1.10至1.42），年龄标准化伤残调整生命年率从28.52（95% UI：25.56至32.53）降至23.01（95% UI：20.49至25.27）。按SDI五分位数划分，中低收入和中等SDI区域的死亡率和DALYs的EAPC均有所上升。以平均年龄组、时期组和队列组作为参照组，AA死亡风险随年龄增加而上升[相对风险（RR）从0.026升至0.384]。DALYs风险呈现相似的年龄相关趋势。在与AA相关的风险因素中，归因于吸烟的死亡数和DALYs随时间下降，而与收缩压升高和高体重指数（BMI）相关的则呈上升趋势。预测结果表明，2022年至2036年育龄妇女的死亡率和DALY率预计将继续下降。
尽管育龄妇女中AA的全球负担正在下降，但区域差异仍然显著，高血压和高BMI患病率的上升带来持续挑战。迫切需要加强针对可改变风险因素的预防策略，以进一步减轻疾病负担并促进健康公平。
