Global, Regional, and National Burden of Aortic Aneurysm, 1990-2021, and Projections to 2050

Despite being a life-threatening condition that may rupture without prior symptoms-potentially resulting in sudden death-comprehensive research on its global burden remains limited. This study was conducted to estimate the global burden and associated risk factors of aortic aneurysms and to project future trends through to 2050.

Data on aortic aneurysms were extracted from the Global Burden of Disease Study 2021, encompassing 204 countries and territories from 1990 to 2021. An aortic aneurysm was defined as a full-thickness dilation of the aorta, including both abdominal and thoracic types. The study stratified the burden by geographical region, age, year, sex, and Socio-demographic Index (SDI). Additionally, attributable risk factors were analyzed, and projections for the burden of aortic aneurysms in 2050 were generated using scenario modelling. These models evaluated the potential impact of eliminating smoking, dietary risks, and high body mass index among adults through improved behavioral and metabolic risk management.

In 2021, there were an estimated 153.93 thousand (95% uncertainty interval [UI], 138.41-165.74) deaths globally due to aortic aneurysm. From 1990 to 2021, the global age-standardized mortality rate (ASMR) decreased from 2.54 (95% UI, 2.35-2.69) to 1.86 (1.67-2.00), and the age-standardized years of life lost rates declined from 48.79 (46.01-51.80) to 36.54 (33.52-39.46) per 100,000 population. While regions with higher SDI exhibited a sharp decline, the burden remained significant in both high (ASMR, 2.87 [95% UI, 2.51-3.06]) and high-middle (1.79 [1.66-1.92]) SDI areas. Conversely, regions with lower SDI demonstrated an increasing trend. Males consistently exhibited a higher burden than females, and burden increased with age. Tobacco use and high systolic blood pressure were identified as the predominant risk factors for aortic aneurysm-related mortality. Specifically, tobacco use was a more significant risk factor in males, while high systolic blood pressure was more prominent in females. Projections suggest that the global ASMR for aortic aneurysm will remain stable under the reference scenario in 2022 (1.87 [95% UI, 1.67-2.02]) and 2050 (1.44 [1.23-1.70]). However, improved behavioral and metabolic risk management could substantially reduce rates to 0.84 (0.71-0.99) by 2050.

The findings demonstrate a global decline in the burden of aortic aneurysms, though pronounced regional differences persist. Effective management strategies must be tailored to account for healthcare infrastructure, socioeconomic status, and risk factors unique to each geographical region.