Global, regional, and national burden of lower extremities peripheral artery disease from 1990 to 2021 and forecast for 2050: a cross-sectional analysis from the 2021 global burden of disease study

Background: Lower extremity peripheral artery disease (PAD) represents a critical global health challenge, with rising burden due to population aging and increasing prevalence of risk factors. While previous Global Burden of Disease (GBD) studies have documented PAD disparities across socioeconomic regions and countries, updated analyses incorporating recent epidemiological transitions and forecasting future trends remain limited. Materials and Methods: In this study, all overall age-standardized rates (ASRs) specific to the 40 + age population. Using GBD 2021 data, we analyzed ASRs of PAD prevalence, incidence, mortality, and disability-adjusted life years (DALYs) across 204 countries from 1990-2021, stratified by Socio-demographic Index (SDI), sex, and age. Bayesian age-period-cohort modeling forecasted trends to 2050. Risk factor attributions were quantified using comparative risk assessment. Results: Globally, the total number of all measures in PAD patients almost doubled from 1990 to 2021, all ASRs showed declines, with significant regional disparities evident across SDI regions. Higher SDI regions demonstrated substantial ASR reductions, while lower-SDI regions exhibited increasing trends. The ASRs for prevalence, mortality and DALY displayed progressive age-dependent increases, and the incidence ASR peaking in the 80-84 age group. Notable sex differences emerged as females had higher prevalence and incidence ASRs whereas males showed higher mortality and DALY ASRs. In low and low-middle SDI regions, ASRs for mortality and DALYs attributable to major risk factors (especially high fasting plasma glucose and kidney dysfunction) continued to rise. Although forecasts indicate further ASR declines through 2050, the overall disease burden is anticipated to remain substantial. Conclusion: The global burden of PAD shows a declining trend but remains at a high level. Significant disparities exist in disease burden and risk factors across different SDI regions. Age and sex also exert distinct influences on the distribution of PAD burden. Targeted prevention and treatment strategies are essential to further reduce this burden and improve patient outcomes.