
Pulmonary Arterial Hypertension Incidence Surges in Recent Decades
The global disease burden of PAH continues to evolve not only because of medical advances but also because of the aging of the global population and the impact of socio-economic factors such as diet and exposure to environmental toxins, Zhenhao Liu, MD, of Pingxiang People's Hospital, Pingxiang, China, and colleagues wrote.
'Despite notable advancements in diagnostic and therapeutic modalities in recent years, there remains a critical need for a deeper comprehension of the global disease burden of PAH to better understand its specific impact on public health,' the researchers wrote.
In a report published in Frontiers in Public Health , the researchers analyzed data on PAH incidence, mortality, and DALYs at the national, regional, and global level from 1990 to 2021 using the Global Burden of Disease 2021 dataset.
Globally, PAH incident cases increased by 85.6% over the study period, and the age-standardized incidence rate (ASIR) increased only slightly, with a 0.05% estimated annual percentage change (EAPC).
The overall death rate from PAH decreased, with an EAPC of -0.57%, but PAH-related deaths increased from 14,842 in 1990 to 22,021 in 2021. The DALYs rate showed a downward trend, with an EAPC of -1.31%, and PAH accounted for 642,104 DALYs in 2021.
Notably, regions with the lowest sociodemographic index (SDI) quintiles had the highest ASIR, but death rates and DALYs decreased across all SDI groups.
Regionally, the highest PAH incidence occurred in Southern Sub-Saharan Africa, and the greatest increases in death and DALYs occurred in Central Asia. Nationally, Zambi, Ethiopia, and Uganda showed the highest age-standardized incidence rates for PAH in 2021 (1.06, 1.00, and 1.00 per 100,000 persons, respectively).
Latvia had the greatest rise in age-standardized mortality, while Puerto Rico had the greatest decreases in age-standardized mortality and DALYs (EAPC -6.64% and EAPC -6.72%, respectively).
Age and Gender Trends
The researchers also found a shift toward increased PAH in older adults in regions of higher SDI and a high prevalence in women. 'This increase is primarily attributed to the increased prevalence of noncommunicable diseases such as cardiovascular disease, cancer, and diabetes, which are more common in aging populations,' the authors wrote in their discussion.
The study was limited by several factors, including the variation in consistency and accessibility of data across nations, and the potential inaccuracies in the Global Burden of Disease dataset, the researchers noted.
However, the results emphasized the need for developing targeted preventive and therapeutic PAH management strategies tailored to diverse populations, especially in areas of high prevalence of disease, the researchers wrote.
Global Trends Drive Treatment
Evaluating global trends helps determine whether rising case numbers reflect improved diagnosis or a true increase in disease burden, said Ahmed Sadek, MD, assistant professor of medicine at the Lewis Katz School of Medicine at Temple University, Philadelphia, in an interview. Global trend studies also reveal region-specific factors, such as infectious causes including schistosomiasis in developing countries, said Sadek, who was not involved in the study. 'By analyzing these patterns, we can learn which public health interventions have worked and identify communities where we need to improve detection, address environmental or infectious exposures, or increase access to specialized diagnostics and treatments,' he said.
'It's encouraging, though not surprising, that overall mortality has decreased over the last 30 years, a trend that closely mirrors the introduction of multiple highly effective, PAH-specific therapies where none previously existed,' Sadek told Medscape Medical News . 'The slight rise in incidence in higher-income countries may seem surprising at first glance but likely reflects improved awareness and earlier detection rather than a true increase in disease burden,' he said. 'The rising mortality among women is more surprising, given that they have traditionally been viewed as having a more favorable prognosis,' he added. Although the reasons for some of the trends remain unclear, they may reflect increased attribution of PAH as the cause of death, especially as the population ages, and may be less able to tolerate disease at the time of diagnosis, he noted.
Policy Priorities
'At the policy level, the most cost-effective approach is to address the root causes of PAH, particularly in developing nations,' Sadek told Medscape Medical News . 'Public health initiatives focused on preventing and treating infections such as HIV, schistosomiasis, and hepatitis C can have a major downstream impact on reducing PAH incidence,' he noted. In addition, strengthening health infrastructure to support early diagnosis and management is critical to manage PAH, he said.
'At the clinical level, increasing physician education is essential to ensure timely recognition of PAH, especially in patients with known risk factors like connective tissue disease, so that we can initiate effective therapies earlier in the disease course, when outcomes are more favorable,' Sadek added.
As for additional research, greater understanding of the health disparities highlighted by the current trends is critical, said Sadek. 'We need to investigate the precise impact of factors like impaired access to expensive specialty medications and a lack of advanced diagnostic tools,' he said. 'For example, when a country has a high death rate but a low reported incidence rate, it suggests that late diagnosis is a key problem, and research should focus on identifying and overcoming these barriers to care,' he explained.
'Additionally, understanding region-specific risk factors can guide more effective, localized interventions — for instance, targeting schistosomiasis infection rates is a much more impactful strategy in Sub-Saharan Africa than in the United States, given the much higher incidence of infections in that region,' Sadek said.
Hashtags

Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles


Medscape
4 minutes ago
- Medscape
Claims Data Fail to Accurately Identify MI Types
TOPLINE: Clinical auditing reveals significant misclassification in administrative codes for myocardial infarction (MI), with only 39% of type 1 (T1MI) codes and 72% of type 2 (T2MI) codes for the condition accurately reflecting the true diagnosis, researchers found. Nearly half of patients coded for T1MI had T2MI, whereas 26% of T2MI codes represented myocardial injury. METHODOLOGY: Researchers identified 350 randomly sampled patients with T1MI codes and 350 patients with T2MI codes during inpatient encounters using the International Statistical Classification of Diseases and Related Health Problems-10th Revision. The analysis included patients aged 65 years and older from October 1, 2017, to May 9, 2024, within eight hospitals in the Mass General Brigham system. Using the 4th Universal Definition of MI, the researchers reviewed the clinical encounters to assess evidence of plaque erosion or thrombus vs oxygen demand-supply imbalance. A second physician review was conducted for 146 challenging and 146 nonchallenging cases. TAKEAWAY: Among the 350 patients coded as having had T1MI, clinical adjudication revealed 138 (39%) as correctly diagnosed; 159 (45%) in fact had T2MI, and 35 (10%) had myocardial injury. Of the 350 patients coded as having had T2MI, 251 (72%) were confirmed, four (1%) were found to have T1MI, and 91 (26%) had myocardial injury. A second physician review demonstrated a high degree of agreement with the initial review, with a 94% agreement in nonchallenging cases and 86% in challenging cases. Hospitals equipped with vs without cardiac catheterization laboratories showed significantly lower misclassification rates (43% vs 58%; P = .0298). IN PRACTICE: 'Among individuals assigned a T1MI claims code, nearly one half have T2MI and many others have myocardial injury; fewer than one half have true T1MI,' the researchers reported. 'Our results also confirm and extend previous work showing that among those with T2MI codes, slightly more than one half have true T2MI, with most of the misclassification related to myocardial injury rather than T1MI. This has critically important implications for epidemiology and public policy' related to acute myocardial infarction. SOURCE: The study was led by Andrea Martinez, MD, of the Department of Medicine at Massachusetts General Hospital, Boston. It was published online on July 21 in Journal of the American College of Cardiology. LIMITATIONS: The results may not be generalized to other hospital systems and countries, where patterns of misclassification might differ. The researchers noted external validity assessment across multiple healthcare systems and in countries that have already introduced International Classification of Diseases-11th revision coding would be beneficial. While patterns of misclassification might have changed over time, the analysis was intentionally restricted to the period when codes for both T1MI and T2MI were available. DISCLOSURES: The study received support through a grant to Jason Wasfy from the Massachusetts General Hospital Executive Committee on Research. Individual authors reported receiving other grants and support, including grants from industry. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.


Medscape
34 minutes ago
- Medscape
5-Grass SLIT Shows Benefit in Allergic Rhinoconjunctivitis
TOPLINE: Five-grass-pollen liquid sublingual immunotherapy (SLIT) reduced symptoms and the need for medications to treat symptoms in patients with allergic rhinoconjunctivitis (ARC) with or without asthma — while maintaining a favorable safety profile and providing consistent benefits across ages, comorbidities, and treatment durations. METHODOLOGY: Researchers conducted a systematic review and meta-analysis to evaluate the efficacy of five-grass-pollen liquid SLIT in patients with ARC with or without asthma. Nine studies comparing the efficacy of interventional immunotherapy with that of placebo in this population were included. The key outcomes comprised symptom severity, assessed as the symptom score; a reduction in medication use, assessed as the medication score; and the incidence of adverse events (AEs). TAKEAWAY: A pooled analysis of eight studies showed a significant reduction in symptom score in the interventional immunotherapy group vs the placebo group (standardized mean difference [SMD], -0.34; 95% CI, -0.62 to -0.06; P < .05) over a mean follow-up of 19 months. Analysis of data pooled from six studies showed a significant reduction in use of drugs for symptoms in the interventional immunotherapy group vs the placebo group (SMD, -0.54; 95% CI, -0.97 to -0.10; P < .05) over a mean follow-up of 20 months. AEs occurred in 20.6% of participants in the interventional immunotherapy group vs 17.5% in the placebo group (P = .46), with treatment discontinuation rates due to AEs of 3.0% and 1.8%, respectively (P = .41). Treatment efficacy remained consistent regardless of cumulative dose, treatment duration, or asthma status. IN PRACTICE: '[The findings] suggest that the dose of five-grass SLIT-liquid can be safely adjusted for better adverse event management without compromising treatment outcomes,' the authors of the study wrote. 'This flexibility makes it possible to tailor treatment according to the patient's condition while addressing their needs and expectations,' they added. SOURCE: Danilo Di Bona, with the University of Foggia, Foggia, Italy, was the corresponding author of the study, which was published online on July 17 in the Journal of Investigational Allergology and Clinical Immunology. LIMITATIONS: The analysis had a relatively small sample size, variation in dosages and treatment durations across studies, and incomplete reporting of AEs in some studies. DISCLOSURES: This study was funded by Stallergenes Greer, a pharmaceutical company. One author declared receiving fees from this company. Some authors reported receiving consulting fees; payments or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events; or support for attending meetings or travel and serving on data safety monitoring boards or advisory boards for various pharmaceutical companies. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.


Medscape
an hour ago
- Medscape
More Data Cement COVID's Impact on Patients With Cancer
TOPLINE: New data confirm the impact COVID infection can have on patients with cancer and identified several risk factors associated with hospitalization and death. Receipt of chemotherapy as well as a baseline history of stroke, atrial fibrillation, or pulmonary embolism were each associated with nearly double the risk for COVID-related hospitalization. Prior vaccination halved this risk. Older age and earlier hospitalization were associated with a greater risk for death. METHODOLOGY: Patients undergoing active cancer treatment are at increased risk for severe COVID-19 due to immunosuppression, but risk factors for hospitalization and death are not well-defined. Researchers conducted a prospective cohort study involving 1572 patients with cancer (median age, 60 years; 53.4% women), enrolled within 14 days of a positive SARS-CoV-2 test; participants had received active treatment for cancer within 6 weeks before testing or had undergone prior stem cell transplant or CAR T-cell therapy. Patient screening and enrollment took place between May 2020 and February 2022. Treatments included chemotherapy (34.3%), targeted therapy (27.7%), and immunotherapy (10.6%). Breast (23.6%) and lung (13.9%) cancers were the most common cancer types. Overall, 64% of participants had metastatic disease, and at enrollment, 64% had not received a COVID vaccine. Study outcomes were COVID-related hospitalization or death. Risk factors for hospitalization and for death among hospitalized patients were evaluated separately. TAKEAWAY: At 90 days after an initial positive test, COVID-related mortality was 3% and remained stable at subsequent follow-ups. The highest incidence occurred in patients with lymphoma, followed by those with acute leukemia or lung cancer; the lowest incidence occurred in those with other types of solid tumors and blood cancers. Hospitalization for COVID-19 occurred in 18.4% of patients within 90 days of enrollment. The risk for hospitalization was elevated among patients who received chemotherapy (hazard ratio [HR], 1.97) and those with a history of stroke, atrial fibrillation, and pulmonary embolism (HR, 1.78). Vaccination prior to infection reduced the risk for hospitalization by nearly half (HR, 0.52). Hospitalization for COVID-19 within 30 days of infection was associated with an increased risk for death (HR, 14.6). Among patients hospitalized for COVID within 30 days, age 65 years or older was the only significant predictor of COVID-specific death (HR, 3.49). Over the 2-year follow-up, there were 1739 disruptions to cancer treatment; 50.7% of these were attributed to COVID-19, and most occurred within 30 days of a positive test. IN PRACTICE: 'The data from this prospective cohort study confirm and expand previous retrospective case series that have found factors, including hematologic cancers, chemotherapy receipt, and lung cancer, as associated with COVID-19 severity,' the authors of the study wrote, noting that the results 'showed that COVID-19 had a significant impact on patients with cancer, including hospitalization, treatment disruptions, and death.' SOURCE: This study, led by Brian I. Rini, MD, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, was published online in JAMA Oncology. LIMITATIONS: Information on specific strains was not available. This study lacked a control group of patients without COVID-19, which limited causal inference. Additionally, as participants were enrolled through the National Cancer Institute trial networks, generalizability to a broader population could be limited. DISCLOSURES: This study was funded in part by the Coronavirus Aid, Relief, and Economic Security Act and the National Cancer Institute National Clinical Trials Network, Experimental Therapeutics Clinical Trials Network, and Community Oncology Research Program grants via the U10 funding mechanism. Several authors declared receiving grants and/or personal fees and having other ties with various sources. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.