Liu Taixiang, Liu Xiaoliang, Wang Chenhong, Zheng Jinxin, Shi Liping, Chen Zheng
Department of NICU, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child, Hangzhou, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education (MOE), West China Institute of Women and Children's Health, Key Laboratory of Development and Diseases of Women and Children of Sichuan Province, Department of Pediatrics, Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Pediatr Cardiol. 2025 Aug 29. doi: 10.1007/s00246-025-04009-x.
Pediatric pulmonary arterial hypertension (PAH) remains a critical global health threat characterized by disparities in burden driven by sociodemographic factors, with persistent gaps in early screening and equitable healthcare access despite therapeutic advances. Leveraging Global Burden of Disease 2021 data including 204 countries and territories from 1990 to 2021, this study analyzed trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) using joinpoint regression to discern temporal patterns, inequality metrics to quantify disparities, and decomposition and frontier analyses to investigate DALY change drivers and health system inefficiencies. Globally, pediatric PAH incidence increased by 20.1% from 1990 to 2021, while deaths and DALYs decreased significantly by 57.7 and 57.9%, respectively. Low-middle socio-demographic index (SDI) regions reported the highest incidence and deaths, whereas high-SDI regions achieved the most substantial mortality reductions. Neonates faced the highest mortality risk (4.86 per 100,000 population). Females demonstrated higher incidence and prevalence, while males under 10 years had elevated mortality and DALYs-a trend reversing in adolescence. Low-SDI regions experienced increasing burdens due to demographic shifts, and frontier analysis revealed inefficiencies even in resource-rich high-SDI countries. Addressing persistent inequities necessitates tailored regional strategies: optimizing resource allocation in high-SDI settings and expanding low-cost screening and treatment in low-SDI regions, alongside prioritizing neonatal care and risk mitigation to achieve global health equity in pediatric PAH.
小儿肺动脉高压（PAH）仍然是全球重大的健康威胁，其特征是社会人口因素导致疾病负担存在差异，尽管治疗取得了进展，但早期筛查和公平医疗服务获取方面仍存在持续差距。本研究利用1990年至2021年来自204个国家和地区的全球疾病负担2021数据，使用Joinpoint回归分析发病率、患病率、死亡率和伤残调整生命年（DALY）的趋势，以识别时间模式，使用不平等指标量化差异，并通过分解分析和前沿分析来研究DALY变化驱动因素和卫生系统效率低下问题。全球范围内，1990年至2021年小儿PAH发病率上升了20.1%，而死亡人数和DALY分别显著下降了57.7%和57.9%。社会人口指数（SDI）低-中等的地区报告的发病率和死亡率最高，而SDI高的地区死亡率降幅最大。新生儿面临的死亡风险最高（每10万人口中有4.86人）。女性的发病率和患病率较高，而10岁以下男性的死亡率和DALY较高，这一趋势在青春期发生逆转。由于人口结构变化，SDI低的地区负担不断增加，前沿分析显示，即使在资源丰富的SDI高的国家也存在效率低下问题。解决持续存在的不平等问题需要制定有针对性的区域战略：在SDI高的地区优化资源分配，在SDI低的地区扩大低成本筛查和治疗，同时优先考虑新生儿护理和降低风险，以实现小儿PAH的全球健康公平。
