What is the clinical evidence from this study?

Study design: Systematic Review. Population: Patients with clinically diagnosed pulmonary arterial hypertension (WHO Group 1) in the Eastern Mediterranean Region (EMR) from 1990 to 2021 (n=11100). Primary outcome: Age-standardized incidence rate (ASIR) of pulmonary arterial hypertension (-5.4% change in ASIR from 1990 to 2021, 95% CI -6.8% to -4.3%).

What question did this study set out to answer?

The goal is to examine the burden of pulmonary arterial hypertension in the Eastern Mediterranean from 1990 to 2021, focusing on sex, age, and socioeconomic factors.

February 28, 2026Open Access

Sex, age, and socioeconomic determinants of pulmonary arterial hypertension burden in the Eastern Mediterranean

Key Result

Pulmonary arterial hypertension incidence in the Eastern Mediterranean Region decreased by 5.4% from 0.6 to 0.5 per 100,000 population between 1990 and 2021.

Key Points

The goal is to examine the burden of pulmonary arterial hypertension in the Eastern Mediterranean from 1990 to 2021, focusing on sex, age, and socioeconomic factors.
Systematic analysis using data from Global Burden of Disease 2021
Evaluated incidence, prevalence, deaths, and disability-adjusted life years for PAH
Presented findings with absolute counts and age-standardized rates
In 2021, 11.1 thousand prevalent cases and 3.4 thousand incident cases of PAH were reported
The age-standardized incidence rate was 0.5 per 100,000, and the prevalence rate was 1.8
PAH contributed to over 92,400 disability-adjusted life years and more than 1,800 deaths
Higher burden observed in women and older adults, especially those aged 75-79
Low SDI countries reported higher DALY and death rates compared to high SDI countries

Study Design

Type

Systematic Review (n=11,100)

Structured PICO

Population

Individuals with Pulmonary Arterial Hypertension (WHO Group 1) in the Eastern Mediterranean Region (22 countries) from 1990 to 2021.

Outcome

Incidence, prevalence, disability-adjusted life years (DALYs), and deaths for PAHhard clinical

While the age-standardized burden of PAH in the Eastern Mediterranean Region decreased from 1990 to 2021, the disease disproportionately affects women, older adults, and populations in lower socio-demographic index countries.

Main Result

Effect estimate: -5.4% change in ASIR from 1990 to 2021 (95% CI -6.8% to -4.3%)

Absolute Event Rate: 0.5% vs 0.6%

Limitations

Potential data quality issues and underreporting in GBD database affecting estimate validity.
Differences in diagnostic capacity and incomplete reporting across countries may bias results.
Reliance on statistical modeling in data-sparse regions may cause uncertainty in trends.
GBD framework does not differentiate idiopathic vs associated PAH limiting etiology-specific insights.
Conflict-affected regions rely heavily on modeled data, increasing uncertainty.

Abstract

Pulmonary arterial hypertension (PAH; WHO Group 1 pulmonary hypertension) is a serious and progressive vascular disorder. Recent studies indicate that the global prevalence of PAH is rising. The burden of PAH in the Eastern Mediterranean Region (EMR) has not been well studied. To examine the epidemiology and burden of PAH in the EMR from 1990 to 2021, comparing data by sex, age, location, and socio-demographic index (SDI). Systematic analysis. Data from the Global Burden of Disease 2021 (GBD 2021) was analyzed to evaluate incidence, prevalence, disability-adjusted life years (DALYs), and deaths for PAH. Accompanying 95% uncertainty intervals were provided and findings were presented as absolute counts and age-standardized rates. In 2021, the EMR reported 11.1 thousand prevalent cases and 3.4 thousand incident cases of PAH, with an age-standardized incidence rate (ASIR) of 0.5 per 100.000 and an age-standardized prevalence rate of 1.8. PAH contributed to more than 92,400 DALYs and was responsible for more than 1,800 deaths. The age-standardized DALYs rate and age-standardized death rate were 13.7 and 0.4, respectively. From 1990 to 2021, the age-standardized rates of all of the metrics decreased significantly. The disease was more prevalent among women than in men, with their incidence and prevalence peaking in the 75–79 age group. High SDI countries generally reported lower DALY and death rates. The burden of PAH in the EMR varied by country, with older adults, especially women, facing higher incidence and death. To reduce the PAH burden, effective management is needed, including early diagnosis, improved treatment access, and preventive care.

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