Globally, there has been a marked increase in aortic aneurysm-related deaths between 1990 and 2019. We sought to understand the underlying etiologies for this mortality trend by examining secular changes in both demographics and the prevalence of risk factors, and how these changes may vary across sociodemographic index (SDI) regions. We queried the Global Burden of Disease Study (GBD) for aortic aneurysm deaths from 1990 to 2019 overall and by age group. We identified the percentage of aortic aneurysm deaths attributable to each risk factor identified by GBD modeling (smoking, hypertension, lead exposure, and high sodium diet) and their respective changes over time. We then analyzed aneurysm mortality by SDI region. The number of aortic aneurysm-related deaths have increased from 94,968 in 1990 to 172,427 in 2019, signifying an 81.6% increase, which greatly exceeds the 18.2% increase in all-cause mortality observed over the same time interval. Examination of age-specific mortality demonstrated that the number of aortic aneurysm deaths markedly correlated with advancing age. However, when considering rate of death rather than mortality count, overall age-standardized death rates decreased 18% from 2.72 per 100,000 in 1990 to 2.21 per 100,000 in 2019. Analysis of the specific risk factors associated with aneurysm death revealed that the percentage of deaths attributable to smoking decreased from 45.6% in 1990 to 34.6% in 2019, and deaths attributable to hypertension decreased from 38.7% to 34.7%. Globally, hypertension surpassed smoking as the leading risk factor. The reported rate of death was consistently greater as SDI increased, and this effect was most pronounced among low-middle and middle SDI regions (173.2% and 170.4%, respectively). Despite an overall increase in the number of aneurysm deaths, there was a decrease in the age-standardized death rate, demonstrating that the observed increased number of aortic aneurysm deaths between 1990 and 2019 was primarily driven by an overall increase in the age of the global population. Fortunately, it appears that the increase in overall aneurysm-related deaths has been modulated by improved risk factor modification, in particular smoking. Given the rise in aneurysm-related deaths, global expansion of vascular specialty capabilities is warranted and will serve to amplify improvements in population-based aneurysm health achieved with risk factor control.

中文翻译：

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主动脉瘤全球死亡率的变化

在全球范围内，1990 年至 2019 年间，与主动脉瘤相关的死亡人数显着增加。我们试图通过检查人口统计数据和风险因素患病率的长期变化以及这些变化如何变化来了解这一死亡率趋势的根本原因。跨社会人口统计指数 (SDI) 地区。我们查询了全球疾病负担研究 (GBD) 中 1990 年至 2019 年总体和按年龄组的主动脉瘤死亡情况。我们确定了由 GBD 模型确定的每个危险因素（吸烟、高血压、铅暴露和高钠饮食）引起的主动脉瘤死亡百分比及其随时间的变化。然后我们分析了 SDI 区域的动脉瘤死亡率。主动脉瘤相关死亡人数从1990年的94,968人增加到2019年的172,427人，增加了81.6%，大大超过了同期观察到的全因死亡率18.2%的增幅。对特定年龄死亡率的检查表明，主动脉瘤死亡人数与年龄增长显着相关。然而，当考虑死亡率而不是死亡率计数时，总体年龄标准化死亡率从 1990 年的每 10 万人 2.72 人下降到 2019 年的每 10 万人 2.21 人，下降了 18%。对与动脉瘤死亡相关的具体危险因素的分析显示，死亡百分比吸烟导致的死亡人数从1990年的45.6%下降到2019年的34.6%，高血压导致的死亡人数从38.7%下降到34.7%。在全球范围内，高血压超过吸烟成为主要危险因素。随着 SDI 的增加，报告的死亡率始终较高，这种影响在中低 SDI 和中 SDI 地区最为明显（分别为 173.2% 和 170.4%）。尽管动脉瘤死亡人数总体有所增加，但年龄标准化死亡率却有所下降，这表明 1990 年至 2019 年间观察到的主动脉瘤死亡人数增加主要是由全球人口年龄总体增长推动的。人口。幸运的是，动脉瘤相关死亡总数的增加似乎已通过改善危险因素（特别是吸烟）来调节。鉴于动脉瘤相关死亡人数的增加，有必要在全球范围内扩展血管专业能力，并将有助于通过风险因素控制来扩大以人群为基础的动脉瘤健康的改善。