Zhang Shuai, Hua Zhaohui, Li Zhen, Cao Hui, Cheng Shuai
Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Public Health. 2025 Jul 29;13:1652544. doi: 10.3389/fpubh.2025.1652544. eCollection 2025.
Aortic aneurysm (AA) remains a critical global health challenge, with smoking identified as a major modifiable risk factor contributing to its morbidity and mortality. Despite advancements in screening and treatment, the absolute burden of AA has risen significantly, particularly in aging populations and regions with socioeconomic disparities. This study leverages data from the Global Burden of Disease Study to analyze trends in smoking-related AA burden from 1990 to 2021, focusing on mortality, disability-adjusted life years (DALYs), and socioeconomic determinants.
Using GBD 2021 data, we assessed age-standardized mortality rates (ASMR), age-standardized DALY rates (ASDR). Joinpoint regression identified trend inflection points, validated via grid search and Monte Carlo permutation tests, with annual percent change (APC) quantified. Age-period-cohort modeling was analyzed effects in populations aged ≥30 years (5-year age intervals). Decomposition analysis partitioned contributions of population growth, aging, and epidemiological factors. Spearman's correlation linked the Sociodemographic Index (SDI) to AA burden. ARIMA modeling projected trends to 2022-2036.
Despite a significant global decline in age-standardized mortality and DALYs, the absolute burden of smoking-related AA has increased, with marked disparities by sex, age, and socioeconomic development. Males consistently exhibited higher mortality and DALYs than females, and the older adults remained the most affected. Joinpoint regression and age-period-cohort modeling revealed declining trends in high-income regions but rising burdens in low-SDI areas. Decomposition analysis identified population growth and aging as key drivers of increased mortality and DALYs, while epidemiological improvements partially offset these trends. Socioeconomic analysis showed a threshold effect: AA burden increased with SDI up to a point, then declined with further development, suggesting effective health systems and tobacco control policies play a crucial role. Forecasts using ARIMA modeling predict a continued global decline in ASMR and ASDR by 2036, though disparities will persist, especially in low-resource settings.
These findings underscore the need for targeted, equity-focused tobacco control and vascular health interventions to mitigate the evolving global impact of smoking-related AA.
主动脉瘤（AA）仍然是一项严峻的全球健康挑战，吸烟被确定为导致其发病和死亡的主要可改变风险因素。尽管在筛查和治疗方面取得了进展，但AA的绝对负担仍显著上升，尤其是在老年人群体以及存在社会经济差异的地区。本研究利用全球疾病负担研究的数据，分析了1990年至2021年与吸烟相关的AA负担趋势，重点关注死亡率、伤残调整生命年（DALYs）以及社会经济决定因素。
使用全球疾病负担研究2021年的数据，我们评估了年龄标准化死亡率（ASMR）、年龄标准化伤残调整生命年率（ASDR）。连接点回归确定了趋势转折点，并通过网格搜索和蒙特卡洛置换检验进行验证，同时量化了年度百分比变化（APC）。年龄-时期-队列模型分析了30岁及以上人群（5岁年龄间隔）的影响。分解分析划分了人口增长、老龄化和流行病学因素的贡献。Spearman相关性分析将社会人口学指数（SDI）与AA负担联系起来。自回归积分移动平均（ARIMA）模型预测了2022年至2036年的趋势。
尽管全球年龄标准化死亡率和伤残调整生命年显著下降，但与吸烟相关的AA的绝对负担却有所增加，在性别、年龄和社会经济发展方面存在明显差异。男性的死亡率和伤残调整生命年一直高于女性，老年人仍然受影响最大。连接点回归和年龄-时期-队列模型显示，高收入地区呈下降趋势，而低社会人口学指数地区的负担则在上升。分解分析确定人口增长和老龄化是死亡率和伤残调整生命年增加的关键驱动因素，而流行病学的改善部分抵消了这些趋势。社会经济分析显示出一种阈值效应：AA负担随着社会人口学指数的上升而增加，直至达到某一点，然后随着进一步发展而下降，这表明有效的卫生系统和烟草控制政策起着至关重要的作用。使用ARIMA模型的预测表明，到2036年，全球年龄标准化死亡率和伤残调整生命年率将持续下降，尽管差异仍将存在，尤其是在资源匮乏地区。
这些发现强调了有针对性的、以公平为重点的烟草控制和血管健康干预措施的必要性，以减轻与吸烟相关的AA对全球不断演变的影响。
