Metabolic Risk-Attributable Burden of Peripheral Arterial Disease across Socioeconomic Regions: Insights from the Global Burden of Disease Study2021

Introduction: Peripheral arterial disease (PAD) is a significant contributor to global morbidity, with regional burdens exhibiting considerable heterogeneity. The PAD burden attributable to metabolic risks across regions with varying socioeconomic levels has yet to be adequately characterized. Methods: This study analyzes PAD burden attributable to metabolic risks across different socioeconomic regions using data from the Global Burden of Disease (GBD) 2021 study. We analyzed data on PAD attributable to metabolic risks, including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), kidney dysfunction (KD), and high body mass index (BMI), across four health systems, four world bank income levels, five Socio-demographic Index (SDI) levels, and 21 GBD regions, from 1990 to 2021. We presented age-standardized mortality rates (ASMR), age-standardized disability-adjusted life year rates (ASDR) and estimated annual percentage changes (EAPC) to assess burden and trends. Results: In 2021, the burden of PAD due to metabolic risks remained high in regions with higher socioeconomic levels, though it showed a declining trend. Conversely, the burden in regions with lower socioeconomic levels was also high but exhibited an increasing trend. High FPG has become a significant factor in the burden of PAD, particularly in higher socioeconomic regions. Gender disparities in the burden of PAD attributable to metabolic risks were evident, with males exhibiting higher ASMR and ASDR, although females in middle-income regions had slightly elevated ASDRs. Finally, an inverted "U" relationship was observed between SDI and burden, with regions around an SDI of 0.75 exhibiting a higher burden of PAD attributable to metabolic risks. Discussion: These findings underscore the urgent need to tailor region-specific public health strategies that account for socioeconomic disparities in metabolic risk exposures contributing to the PAD burden. Conclusions: Effective public health interventions targeting these metabolic risks are urgently needed, especially in low-socioeconomic regions where the burden remains disproportionately high. Enhanced blood glucose control and early intervention strategies should be prioritized to mitigate the growing impact of PAD globally.