Changes in Global Mortality from Aortic Aneurysm

Global deaths from aortic aneurysm (AA) have increased, and primary drivers of these changes remain unknown. We sought to characterize the impact of global changes in demographics and risk factors on AA deaths. We queried the Global Burden of Disease Study (GBD) for AA deaths from 1990 to 2019 as well as percentage of deaths attributable to each risk factor identified by GBD modeling (smoking, hypertension, lead exposure, and high sodium diet). We then stratified data by age and socio-demographic index (SDI) region. The expected mortality in 2019 due to overall population increase and shifts in age distribution were calculated. We then determined the change in deaths attributable to specific risk factors. Observed deaths from AA increased from 94,968 in 1990 to 172,427 in 2019. Expected AA deaths in 2019 from overall global population growth alone was 136,934 (+44.6% from 1990 observed mortality). Incorporating the shift in age distribution led to an estimated 210,031 deaths in 2019 (+121.8%). Overall, observed deaths in 2019 were 17.9% lower than the number expected due to demographic changes. The percentage of deaths attributable to smoking decreased from 45.6% to 34.6%, leading to an expected decrease of 23,103 deaths. The percent attributable to hypertension fell 38.7% to 34.7%, leading to an expected decrease of 8401 deaths. When considering SDI region, low-middle and middle SDI regions had the most rapid growth in observed deaths (173.2% and 170.4%, respectively). Deaths attributable to hypertension increased in low-middle and middle SDI regions and globally hypertension surpassed smoking as the leading risk factor (Table). The increase in AA deaths was primarily driven by increases in global population and longevity. However, observed deaths in 2019 were lower than expected, suggesting that public health efforts have been effective. Continued risk factor modification, with heightened emphasis on hypertension, could lead to further improvements.TableChange in deaths from aortic aneurysm (AA) globally and by socio-demographic index (SDI) regionA. Observed deaths 1990B. Expected change from overall population growthC. Expected change from aging of populationD. Expected change from change in smokingE. Expected change from change in hypertensionF. Expected change from change in lead exposureG. Expected change from change in high sodium intakeH. Expected change from changes in unidentified risk factors and/or clinical careI. Observed deaths 2019Global94,69942,235 (+44.6)73,097 (+53.4)−23,103 (−11)−8401 (−4.0)210 (+0.1)−210 (−0.1)−31,505 (−15.0)172,427 (+82.1)Low SDI42544837 (+113.7)562 (+6.2)−202 (−2.1)314 (+3.2)19 (+0.2)−90 (−0.9)−1436 (−14.8)8258 (+94.1)Low middle SDI76186602 (+86.7)4507 (+31.7)−1099 (−5.9)494 (+2.6)−60 (−0.3)−45 (−0.2)2794 (+14.9)20,811 (+173.2)Middle SDI11,9714740 (+39.6)14,337 (+85.8)−1757 (−5.7)925 (+3.0)−133 (−0.4)−375 (−0.1)2664 (+8.6)32,372 (+170.4)High middle SDI21,4605223 (+24.3)15,933 (+59.7)−3102 (−7.3)−903 (−2.1)−89 (−0.2)−251 (−0.5)6757 (+15.9)45,028 (+98.2)High SDI49,33411,485 (+23.3)32,159 (+52.9)−15,397 (−17.1)−8834 (−9.5)483 (+0.5)−214 (−0.2)−3169 (−3.4)65,848 (+33.5)Data are presented as number (%). Open table in a new tab