Abstract
Background
Despite being a life-threatening condition that may rupture without prior symptoms—potentially resulting in sudden death—comprehensive research on its global burden remains limited. This study was conducted to estimate the global burden and associated risk factors of aortic aneurysms and to project future trends through to 2050.
Methods
Data on aortic aneurysms were extracted from the Global Burden of Disease Study 2021, encompassing 204 countries and territories from 1990 to 2021. An aortic aneurysm was defined as a full-thickness dilation of the aorta, including both abdominal and thoracic types. The study stratified the burden by geographical region, age, year, sex, and Socio-demographic Index (SDI). Additionally, attributable risk factors were analyzed, and projections for the burden of aortic aneurysms in 2050 were generated using scenario modelling. These models evaluated the potential impact of eliminating smoking, dietary risks, and high body mass index among adults through improved behavioral and metabolic risk management.
Results
In 2021, there were an estimated 153.93 thousand (95% uncertainty interval [UI], 138.41–165.74) deaths globally due to aortic aneurysm. From 1990 to 2021, the global age-standardized mortality rate (ASMR) decreased from 2.54 (95% UI, 2.35–2.69) to 1.86 (1.67–2.00), and the age-standardized years of life lost rates declined from 48.79 (46.01–51.80) to 36.54 (33.52–39.46) per 100,000 population. While regions with higher SDI exhibited a sharp decline, the burden remained significant in both high (ASMR, 2.87 [95% UI, 2.51–3.06]) and high-middle (1.79 [1.66–1.92]) SDI areas. Conversely, regions with lower SDI demonstrated an increasing trend. Males consistently exhibited a higher burden than females, and burden increased with age. Tobacco use and high systolic blood pressure were identified as the predominant risk factors for aortic aneurysm-related mortality. Specifically, tobacco use was a more significant risk factor in males, while high systolic blood pressure was more prominent in females. Projections suggest that the global ASMR for aortic aneurysm will remain stable under the reference scenario in 2022 (1.87 [95% UI, 1.67–2.02]) and 2050 (1.44 [1.23–1.70]). However, improved behavioral and metabolic risk management could substantially reduce rates to 0.84 (0.71–0.99) by 2050.
Conclusion
The findings demonstrate a global decline in the burden of aortic aneurysms, though pronounced regional differences persist. Effective management strategies must be tailored to account for healthcare infrastructure, socioeconomic status, and risk factors unique to each geographical region.
Keywords: Aortic Aneurysm, Forecasting, Global Health, Mortality, Risk Factors, Trend
Graphical Abstract
INTRODUCTION
An aortic aneurysm is characterized by localized dilation of the aorta, typically remaining asymptomatic but posing a risk of sudden fatal rupture, contributing to a significant global health burden with an estimated 150,000–200,000 deaths annually.1 Older males are particularly at risk; as the global population ages, the disease burden is expected to increase. In response, the World Health Organization (WHO) implemented the Global Action Plan for the Prevention and Control of Noncommunicable Diseases in 2013 to reduce cardiovascular disease incidence and address associated lifestyle-related risk factors.1 Despite these initiatives, most targets have not been achieved, with evidence indicating that mortality from aortic aneurysms has increased.2 As such, a comprehensive analysis of the global epidemiology and trends of aortic aneurysms remains critical for informing policy measures to mitigate the disease burden.
Although extensive investigations have evaluated the burden of cardiovascular diseases, research on aortic aneurysms is comparatively limited. Previous studies have explored the global prevalence of aortic aneurysms, analyzing variables such as age, sex, and national income levels.3,4 However, they did not assess region-specific risk factors or predict future trends, hindering efforts to identify geographic disparities and forecast disease burden effectively. Furthermore, the available data are largely drawn from periods ending in 2017 and 2019 and may be considered relatively outdated for evaluating the current aortic aneurysm burden. Consequently, there is an incomplete understanding of the global burden of this condition.
Addressing this gap, the present study aims to estimate mortality rates and years of life lost (YLL) attributable to aortic aneurysms using data from the Global Burden of Diseases Study (GBD) 2021. Additionally, it examines key risk factors and projects trends through 2050. This analysis advances our understanding of aortic aneurysms and supports the development of informed policy recommendations for effective global disease management.
METHODS
Overview
This study leveraged GBD 2021 data to assess the global, regional, and national burden of aortic aneurysms.5 The GBD 2021 offers a comprehensive evaluation of 371 diseases and conditions across 204 countries and territories from 1990 to 2021.5 A detailed classification of geographical regions included in this study is provided in Supplementary Table 1. Key health metrics were prioritized, including cause-specific mortality and YLLs. Years lived with disability were not estimated for aortic aneurysm due to the infrequency and minimal impact of associated disabilities, preventing reliable quantification.5,6 Country-level estimates of aortic aneurysm burden were further stratified by GBD region and the Socio-demographic Index (SDI). The SDI is a composite indicator that reflects the key social and economic determinants influencing health outcomes across different populations. Additionally, risk factors and future projections of the aortic aneurysm burden through to 2050 were analyzed. Compliance with the Guidelines for Accurate and Transparent Health Estimates Reporting was maintained (Supplementary Table 2).7 All computations were performed using Python (version 3.10.4; Python Software Foundation, Wilmington, DE, USA).
Case definition
An aortic aneurysm was defined as a full-thickness dilation of the aorta, primarily resulting from atherosclerosis, hypertension, or vascular inflammation.5 Both abdominal and thoracic aortic aneurysms were included in the cause-specific mortality estimates. Relevant International Classification of Diseases (ICD) codes are 441–441.9 for ICD-9 and I71–I71.9 for ICD-10.3 Data sources, including surveys, censuses, and vital statistics, used to estimate the occurrence of aortic aneurysms are detailed in GBD 2021.5
Input data
Vital registration data served as the basis for modeling cause-specific mortality from aortic aneurysm. Records from Oman presenting implausibly high values compared to neighboring countries were excluded as outliers. ICD-8-coded observations that disrupted time series continuity and yielded unrealistic temporal trends were also omitted.5 In Latin America, a subset of vital registration entries reflecting excessive values at advanced ages, which led to inconsistencies in time trends, was excluded. Data for Estonia (ages 20–24 years) and Ukraine were removed due to implausibly low values.8
Modelling the burden of aortic aneurysms
GBD 2021 estimated cause-specific mortality attributable to aortic aneurysm using the Cause of Death Ensemble Model (CODEm).8 Ill-defined or “garbage” coded deaths were reallocated to more probable underlying causes via GBD redistribution algorithms, and age–sex splitting was implemented where required to achieve complete detail. To enhance comparability across heterogeneous study designs and case definitions, a meta-regression, Bayesian, regularized, trimmed (MR-BRT) approach was applied for pre-model adjustments, facilitating crosswalk factor generation and robust trimming of influential observations.8 When input time series were limited or discontinuous, spatiotemporal Gaussian process regression was employed to strengthen estimates across age, sex, location, and year, thereby improving temporal and spatial coherence.5
Within CODEm, candidate specifications—ranging from linear mixed-effects models to spatiotemporal models with epidemiologically motivated covariates—were fitted and validated using out-of-sample predictive performance.8 Final estimates were synthesized via a weighted ensemble of top-performing models. Covariate selection followed a structured literature review, and categorized variables into three levels based on the strength of supporting evidence (Supplementary Table 3). Outcomes were scaled to the all-cause mortality envelope using CoDCorrect to ensure internal consistency across demographics and geographies, and findings were reported as 95% uncertainty intervals (UIs).8 YLL calculations involved multiplying age-specific death counts by remaining life expectancy at the time of death, as defined in the reference life table.
Methodological enhancements in GBD 2021 included a refined algorithm for redistributing deaths initially attributed to hypertension, accounting for complete event chains leading to death, thus enabling more precise reallocation to cardiovascular causes, such as aortic aneurysms. An updated empirical Bayesian noise-reduction technique was adopted to mitigate random variation across age, sex, location, and time, thereby enhancing the regional consistency of mortality estimates. Additional methodological details are available in the cause-of-death section of the GBD 2021.5 The aortic aneurysm burden was estimated using the mortality count, YLL, age-standardized mortality rate (ASMR), and age-standardized years of life lost rate (ASYR).
Annual percentage change (APC)
Long-term trends in aortic aneurysm burden were assessed by calculating APCs in ASMR and ASYR from 1990 to 2021, with statistical significance determined by two-sided testing (P < 0.05).8 APC values were estimated separately for each country and GBD region using a log-linear regression model, wherein
| y = α + βx + ε |
y represents the natural logarithm of the burden of aortic aneurysms, x is the year, and β is the regression coefficient. APC was calculated using the following formula:
| APC (%) = (exp(β)−1) × 100 |
Risk factors
GBD 2021 estimated the disease burden attributable to specific risk factors using a comparative risk assessment framework. Attributable burden was estimated by quantifying reductions achievable if exposure levels were reduced to the theoretical minimum risk levels. Risk–outcome pairs were selected based on robust causal evidence.9
Population-attributable fractions were calculated using population exposure data and relative risks, and by defining theoretical minimum risk exposure levels. Population exposure data were sourced from national surveys, environmental datasets, and health examinations, while relative risks were drawn from meta-analyses and large-scale cohort studies.10 In GBD 2021, risk factors were arranged hierarchically into four levels, from broad categories (level 1) to specific exposures (level 4). The current study focused on level 2 risk factors associated with aortic aneurysms, including tobacco use, high systolic blood pressure, high body mass index (BMI), and other environmental risks.
Forecasting aortic aneurysm mortality and YLLs to 2050
Aortic aneurysm mortality and YLL projections to 2050 incorporated independent health determinants, sociodemographic factors, including SDI, and key interventions, including vaccination coverage and antiretroviral therapy.10 The forecasting framework integrated historical trends, recent changes, and external disruptions. Projections for future risk factor trajectories used summary exposure values to estimate population-attributable fractions and cause-specific mortality multipliers. A comprehensive ensemble modeling strategy was implemented by combining 12 submodels derived from two principal approaches: an annualized rate-of-change model and a two-stage spline model using an MR-BRT.10 Further ensemble methods were applied to compute mediator summary exposure values to avoid overestimation of risk contributions. Submodel weights were assigned based on out-of-sample predictive validity using training data from 1990 to 2009 and validation data from 2010 to 2019, measured by root mean squared error.11 Final forecasts up to 2050 were produced from 500 Monte Carlo simulations per model.
Mortality and YLL forecasts were generated for reference and alternative scenarios to improve the behavioral and metabolic risk profiles. In the alternative scenario, smoking, dietary risk, and high BMI in adults were assumed to reach zero by 2050, with a linear decline beginning in 2023. Furthermore, no new smoking initiations were included post-2022.12
Ethics statement
The GBD used de-identified data, approved by the University of Washington IRB (Study Number 9060). The requirement for written consent was waived by the board owing to the population-level dataset.
RESULTS
Global burden of aortic aneurysm from 1990 to 2021
In 2021, there were an estimated 153.93 thousand (95% UI, 138.41–165.74) global deaths attributable to aortic aneurysms. The global ASMR of aortic aneurysm was 1.86 per 100,000 population (1.67–2.00), while the global ASYR was 36.54 per 100,000 population (33.52–39.46; Table 1). Geographically, higher ASYR and ASMR values were observed in Eastern Europe (ASMR: 3.82 [95% UI, 3.52–4.12] per 100,000 population; ASYR: 91.31 [95% UI, 83.88–98.46]), Tropical Latin America (4.04 [3.70–4.26]; 91.10 [85.46–95.50]), and High-income Asia Pacific (4.38 [3.72–4.75]; 79.73 [71.78–84.48]). In contrast, regions such as East Asia (0.50 [0.41–0.63] per 100,000 population; 13.31 [10.60–16.97]), North Africa and the Middle East (0.89 [0.78–1.03]; 19.96 [17.33–23.11]), and Andean Latin America (0.93 [0.78–1.12]; 20.07 [16.76–24.27]) exhibited lower ASMR and ASYR (Fig. 1, Table 1, Supplementary Fig. 1A).
Table 1. Global counts (thousand) and age-standardized mortality and YLL rates (per 100,000 population) for aortic aneurysm in 2021 and annual percentage change from 1990 to 2021.
| Region | Mortality (95% UI) | YLLs (95%UI) | |||||
|---|---|---|---|---|---|---|---|
| Count (thousand)2021 | Age-standardized rate per 100,000 population in 2021 | Annual percentage change between 1990 and 2021 (%) | Count (thousand) 2021 | Age-standardized rate per 100,000 population in 2021 | Annual percentage change from 1990 to 2021 (%) | ||
| Global | 153.93 (138.41–165.74) | 1.86 (1.67–2.00) | −1.28 (−1.39 to −1.17) | 3,107.76 (2,857.32–3,353.86) | 36.54 (33.52–39.46) | −1.23 (−1.33 to −1.12) | |
| Sex | |||||||
| Male | 93.86 (86.61–102.15) | 2.57 (2.36–2.79) | −0.91 (−1.01 to −0.80) | 2,050.25 (1,909.08–2,253.80) | 51.78 (48.04–56.76) | −1.46 (−1.57 to −1.36) | |
| Female | 60.06 (51.30–66.30) | 1.28 (1.10–1.42) | −1.63 (−1.74 to −1.52) | 1,057.51 (938.75–1,161.22) | 23.01 (20.49–25.27) | −0.97 (−1.07 to −0.86) | |
| SDI regions | |||||||
| High SDI | 67.20 (57.74–72.29) | 2.87 (2.51–3.06) | −1.98 (−2.12 to −1.85) | 1,120.32 (1,010.91–1,182.28) | 54.48 (50.26–57.11) | −2.04 (−2.17 to −1.91) | |
| High-middle SDI | 34.83 (32.31–37.27) | 1.79 (1.66–1.92) | −0.66 (−0.82 to −0.50) | 760.35 (709.82–817.07) | 39.69 (37.02–42.66) | −0.68 (−0.84 to −0.52) | |
| Middle SDI | 28.53 (25.80–30.96) | 1.15 (1.04–1.25) | 0.16 (0.04 to 0.29) | 662.16 (600.45–722.83) | 24.88 (22.56–27.10) | 0.21 (0.09 to 0.32) | |
| Low-middle SDI | 16.81 (13.96–22.47) | 1.31 (1.09–1.76) | 1.27 (1.21 to 1.33) | 398.28 (333.99–529.92) | 27.49 (22.93–36.66) | 1.20 (1.15 to 1.25) | |
| Low SDI | 6.37 (3.93–10.43) | 1.48 (0.91–2.44) | 0.19 (−0.03 to 0.41) | 162.86 (99.21–267.96) | 30.81 (18.94–50.42) | 0.09 (−0.11 to 0.30) | |
| Central Europe, Eastern Europe, and Central Asia | |||||||
| Central Asia | 1.44 (1.28–1.62) | 1.98 (1.77–2.21) | 2.50 (2.25–2.74) | 35.16 (30.89–39.78) | 42.68 (37.78–47.93) | 1.83 (1.63–2.03) | |
| Central Europe | 6.68 (6.14–7.32) | 2.93 (2.69–3.21) | −0.43 (−0.61 to −0.25) | 134.48 (123.46–148.46) | 63.67 (58.32–70.61) | −0.55 (−0.74 to −0.36) | |
| Eastern Europe | 13.41 (12.35–14.43) | 3.82 (3.52–4.12) | 1.00 (0.66 to 1.34) | 304.64 (280.05–328.88) | 91.31 (83.88–98.46) | 0.84 (0.55 to 1.13) | |
| High-income regions | |||||||
| Australasia | 1.55 (1.35–1.68) | 2.60 (2.29–2.81) | −4.11 (−4.27 to −3.95) | 24.88 (22.37–26.61) | 45.52 (41.27–48.61) | −4.28 (−4.45 to −4.12) | |
| High-income Asian Pacific | 25.77 (20.94–28.52) | 4.38 (3.72–4.75) | 1.57 (1.40–1.75) | 378.28 (325.39–408.69) | 79.73 (71.78–84.48) | 1.46 (1.31–1.60) | |
| High-income North America | 13.97 (12.47–14.79) | 2.09 (1.89–2.20) | −3.64 (−3.90 to −3.38) | 271.84 (253.83–283.63) | 45.43 (42.91–47.25) | −3.33 (−3.60 to −3.07) | |
| Southern Latin America | 2.35 (2.17–2.53) | 2.64 (2.43–2.83) | −2.02 (−2.23 to −1.80) | 48.69 (45.14–52.22) | 56.50 (52.39–60.58) | −2.04 (−2.25 to −1.83) | |
| Western Europe | 27.51 (24.10–29.19) | 2.57 (2.30–2.71) | −2.49 (−2.74 to −2.24) | 449.31 (408.55–471.93) | 48.51 (45.11–50.60) | −2.57 (−2.81 to −2.33) | |
| Latin America and Caribbean | |||||||
| Andean Latin America | 0.54 (0.45–0.64) | 0.93 (0.78–1.12) | −0.09 (−0.23–0.06) | 12.09 (10.09–14.63) | 20.07 (16.76–24.27) | −0.13 (−0.28 to 0.01) | |
| Caribbean | 1.41 (1.24–1.58) | 2.59 (2.29–2.92) | −1.58 (−1.74 to −1.42) | 26.86 (23.70–30.39) | 49.95 (44.08–56.54) | −1.46 (−1.62 to −1.29) | |
| Central Latin America | 3.29 (2.87–3.77) | 1.37 (1.19–1.56) | −1.16 (−1.44 to −0.88) | 72.06 (62.33–83.07) | 28.77 (24.93–33.11) | −1.30 (−1.58 to −1.02) | |
| Tropical Latin America | 10.17 (9.35–10.73) | 4.04 (3.70–4.26) | 0.36 (0.10–0.61) | 235.45 (221.29–246.97) | 91.10 (85.46–95.50) | 0.11 (−0.15–0.36) | |
| North Africa and Middle East | 3.69 (3.20–4.26) | 0.89 (0.78–1.03) | 1.23 (1.06–1.39) | 96.33 (83.72–112.19) | 19.96 (17.33–23.11) | 0.81 (0.66–0.96) | |
| South Asia | 15.98 (11.38–23.41) | 1.22 (0.88–1.78) | 1.87 (1.73–2.01) | 367.48 (260.60–539.64) | 25.00 (17.79–36.65) | 1.64 (1.54–1.75) | |
| Southeast Asia, East Asia, and Oceania | |||||||
| East Asia | 10.20 (8.23–12.82) | 0.50 (0.41–0.63) | 1.15 (1.04–1.26) | 269.44 (213.79–344.58) | 13.31 (10.60–16.97) | 1.16 (1.05–1.27) | |
| Oceania | 0.12 (0.09–0.15) | 1.94 (1.54–2.45) | −0.71 (−0.80 to −0.61) | 3.30 (2.50–4.38) | 41.50 (32.09–53.54) | −0.58 (−0.67 to −0.50) | |
| Southeast Asia | 7.39 (6.48–8.51) | 1.39 (1.21–1.60) | 0.79 (0.72–0.87) | 158.46 (137.44–182.39) | 25.87 (22.55–29.83) | 0.75 (0.67–0.83) | |
| Sub-Saharan Africa | |||||||
| Central Sub-Saharan Africa | 1.06 (0.59–1.71) | 2.41 (1.35–3.88) | −0.53 (−0.80 to −0.26) | 28.16 (15.58–46.22) | 50.55 (28.25–81.64) | −0.52 (−0.78 to −0.25) | |
| Eastern Sub-Saharan Africa | 2.64 (1.43–4.29) | 1.80 (0.99–2.96) | −0.25 (−0.44 to −0.07) | 72.03 (38.94–115.79) | 38.53 (20.81–62.60) | −0.25 (−0.43 to −0.07) | |
| Southern Sub-Saharan Africa | 1.24 (1.12–1.35) | 2.46 (2.23–2.68) | −1.36 (−1.70 to −1.01) | 30.97 (27.98–34.41) | 51.99 (46.99–57.21) | −1.19 (−1.52 to −0.86) | |
| Western Sub-Saharan Africa | 3.52 (1.74–5.98) | 2.19 (1.10–3.68) | −0.56 (−0.71 to −0.40) | 87.86 (42.72–151.83) | 43.50 (21.40–74.12) | −0.53 (−0.69 to −0.37) | |
YLL = year of life lost, UI = uncertainty interval, SDI = Socio-demographic Index.
Fig. 1. Global distribution of aortic aneurysms for both sexes in 2021. (A) ASMR (per 100,000 population) and (B) age-standardized APC of mortality, 1990–2021.
ASMR = age-standardized mortality rate, APC = annual percentage change.
From 1990 to 2021, the global APC for ASMR and ASYR due to aortic aneurysms was −1.28 (95% UI: −1.39 to −1.17) and −1.23 (−1.33 to −1.12), respectively. Australasia exhibited the most pronounced reductions, with an APC of −4.11 (−4.27 to −3.95) for ASMR and −4.28 (−4.45 to −4.12) for ASYR (Table 1, Supplementary Fig. 1B). The trends in ASMR and ASYR from 1990 to 2021 followed a similar pattern. ASMR continuously declined from 2.54 (95% UI, 2.35–2.69) per 100,000 population in 1990 to 1.86 (1.67–2.00) in 2021, while ASYR decreased from 48.79 (46.01–51.80) per 100,000 population in 1990 to 36.54 (33.52–39.46) in 2021. Notably, the decline accelerated during the early 2000s before slowing in recent years (Supplementary Fig. 2, Supplementary Tables 4, 5, 6).
Burden of aortic aneurysm by age, sex, and SDI regions
The burden of aortic aneurysms remained consistently higher in males compared to females across all age groups. Mortality rates and YLLs increased substantially with age, particularly after age 60. In 2021, the highest male mortality rate was 100.50 (95% UI, 76.52–112.24) per 100,000 population among individuals aged 95+, whereas the lowest was 0.04 (0.03–0.05) among males aged 15–19. For females, the highest mortality rate was 89.24 (95% UI, 60.11–105.90) per 100,000 population in individuals over age 95, and the lowest was 0.02 (0.02–0.03) at ages 15–19 (Supplementary Fig. 3, Supplementary Tables 7, 8, 9, 10, 11, 12).
Regionally, in 2021, ASMR and ASYR were highest in high SDI regions (ASMR: 2.87 [95% UI, 2.51–3.06] per 100,000 population; ASYR: 54.48 [95% UI, 50.26–57.11]), followed by high-middle SDI (1.79 [1.66–1.92]; 39.69 [37.02–42.66]), low SDI (1.48 [0.91–2.44]; 30.81 [18.94–50.42]), low-middle SDI (1.31 [1.09–1.76]; 27.49 [22.93–36.66]), and middle SDI (1.15 [1.04–1.25]; 24.88 [22.56–27.10]) areas (Fig. 2, Supplementary Tables 4 and 13). High SDI areas displayed the steepest declines, and although high-middle SDI regions showed an overall decreasing trend, they experienced a temporary increase in the early 2000s. Middle SDI regions exhibited relatively stable rates with slight reductions, while low-middle SDI regions showed an increasing trend, with ASMR rising from 0.89 (0.71–1.20) per 100,000 population in 1990 to 1.31 (1.09–1.76) in 2021, and ASYR increasing from 18.85 (14.98–25.69) to 27.49 (22.93–36.66). The low SDI regions remained stable until the early 2000s, then gradually declined until 2010, and subsequently showed a slight increase (Supplementary Fig. 2, Supplementary Tables 14, 15, 16, 17, 18).
Fig. 2. ASMR (per 100,000 population) of aortic aneurysm for both sexes by SDI, 1990–2021; shaded regions indicate the 95% uncertainty intervals.
ASMR = age-standardized mortality rate, SDI = Socio-demographic Index.
Risk factors for aortic aneurysm
The leading risk factors contributing to the ASMR of aortic aneurysms in 2021 were tobacco use, high systolic blood pressure, high BMI, dietary risks, and other environmental variables (Fig. 3, Supplementary Fig. 4A, Supplementary Tables 19, 20, 21). Tobacco use accounted for the highest ASMR attributable to aortic aneurysm across most regions (0.56 [95% UI, 0.46–0.66] per 100,000 population), followed by high systolic blood pressure (0.32 [0.24–0.41]). High BMI and dietary risks were ranked third, with almost equal scores, while other environmental risks had minimal impact across all regions. Geographically, the influence of tobacco use was particularly pronounced in Tropical Latin America, Southern Latin America, the Caribbean, Central Asia, Europe, high-income North America, and the high-income Asia-Pacific region.
Fig. 3. ASMR (per 100,000 population) attributable to five key risk factors (tobacco use, high systolic blood pressure, high body mass index, dietary risks, and other environmental risks) ranked globally and by region for both sexes in 2021. (A) Both sexes, (B) male, and (C) female.
ASMR = age-standardized mortality rate.
Eastern Europe bore the greatest burden of aortic aneurysms attributable to these risk factors, whereas Andean Latin America presented the lowest (Supplementary Fig. 4A, Supplementary Table 19). Stratification by sex indicated that tobacco use was the primary risk factor in males, whereas high systolic blood pressure had the greatest influence in females (Supplementary Fig. 4B and C, Supplementary Tables 20 and 21). Patterns in risk factors influencing ASYR were consistent with those observed in ASMR (Supplementary Tables 22, 23, 24).
Projected burden of aortic aneurysm up to 2050
The global ASMR for aortic aneurysm was projected to remain stable across all age groups, at 1.87 (95% UI, 1.67–2.02) per 100,000 population in 2022 to 1.44 (1.23–1.70) by 2050 (Fig. 4). However, under the improved behavioral and metabolic risk scenario, a steeper decline in mortality rates was projected, potentially reaching 0.84 (95% UI, 0.71–0.99) per 100,000 population in 2050 (Supplementary Fig. 5A, Supplementary Tables 25 and 26).
Fig. 4. Forecasted (A) global ASMR (per 100,000 population) for the aortic aneurysm from 2022 to 2050 under reference and improved behavioral and metabolic risk scenarios, and (B) ASMR by region, shaded regions indicate the 95% uncertainty intervals, dashed line marks the beginning of the forecast period in 2022.
ASMR = age-standardized mortality rate.
Regionally, ASMR was projected to decrease gradually in Central Europe, Eastern Europe, and Central Asia (3.30 [95% UI, 3.07–3.52] in 2022 to 2.70 [95% UI, 2.34–3.11] in 2050), Latin America and the Caribbean (2.54 [2.32–2.74] in 2022 to 2.02 [1.61–2.46] in 2050), and North Africa and the Middle East (0.89 [0.77–1.03] in 2022 to 0.70 [0.55–0.85] in 2050; Supplementary Fig. 5B, Supplementary Table 27).
In contrast, ASMR was predicted to remain steady in Sub-Saharan Africa (2.13 [1.27–3.26] in 2022 to 2.13 [1.20–3.41] in 2050), Southeast Asia, East Asia, and Oceania (0.68 [0.59–0.79] in 2022 to 0.64 [0.52–0.77] in 2050), and South Asia (1.23 [0.87–1.76] in 2022 to 1.14 [0.80–1.76] in 2050; Supplementary Fig. 5B, Supplementary Table 28). ASYR trends were similar to those observed for ASMR (Supplementary Tables 29 and 30).
DISCUSSION
This study assessed the global burden of aortic aneurysms from 1990 to 2021, highlighting differences by sex, age, region, and associated risk factors, with projections to 2050. In 2021, the global number of deaths due to aortic aneurysm was 153.93 thousand (95% UI, 138.41–165.74). Although the global burden of aortic aneurysms declined slightly from 1990 to 2021, it remained substantial in high, high-middle, and low-SDI regions. ASMR and ASYR exhibited a decreasing trend in high- and high-middle SDI regions during the same period, while both metrics increased in the low-middle and low SDI regions. Notably, before 2000, ASMR in high-SDI regions was elevated. The burden of aortic aneurysms was higher in males than in females and increased sharply with advancing age. Tobacco use and high systolic blood pressure were identified as leading risk factors, significantly impacting males and females. Projections through 2050 suggested that, under the reference scenario, ASMR will not show significant improvement; however, a substantial decrease is anticipated with enhanced behavioral and metabolic risk management. Despite the overall decline, marked regional disparities persisted.
The steady decline in ASMR and ASYR since 1990 is likely due to medical advances and early detection efforts. In particular, the introduction of endovascular aortic repair and thoracic endovascular aortic aneurysm repair has contributed to improved post-surgical survival rates, with several randomized trials demonstrating the benefits of early screening for aortic aneurysms.12 Higher ASMR observed in high SDI regions may be attributable to the older population and enhanced diagnostic capabilities; potential underestimation in low SDI regions may result from limited healthcare infrastructure.13 Furthermore, the burden of aortic aneurysm declined in high and high-middle SDI regions between 1990 and 2021, while remaining relatively stable in other regions, suggesting that well-developed healthcare infrastructure and high screening rates in high SDI countries have contributed to reducing disease burden.14 Delayed diagnosis, which can lead to increased aneurysm size, may elevate mortality risk and contribute to a higher burden of aortic aneurysm in low SDI regions.15 Notably, previous research indicates that for abdominal aortic aneurysm, each 1 cm increase in size is associated with a 14% reduction in survival rate.16
Before 2000, the ASMR was particularly high in countries with high SDI, largely due to higher smoking prevalence during the 1980s and 1990s,17 population ageing,18 and advances in diagnostic and recording systems. After 2000, broader use of medications like statins and β-blockers contributed to a sharp decline in mortality.19,20,21 Specifically, simvastatin, rosuvastatin, and atorvastatin are effective in preventing aortic aneurysm rupture by reducing oxidative stress and decreasing collagen accumulation. Additionally, β-blockers have proven successful at reducing mortality associated with various cardiovascular diseases.19,20,21
The burden of aortic aneurysm was highest among older males, likely due to a combination of hormonal, behavioral, and biological factors. Estrogen may exert a protective effect against aneurysms, as suppression of aromatase—an enzyme involved in estrogen synthesis—increases aneurysm risk by promoting inflammation and aortic wall degradation.22 With age, levels of elastin and collagen in the aortic wall decline, facilitating vascular degeneration.23
In 2021, the primary risk factors for aortic aneurysms were tobacco use and high systolic blood pressure. Tobacco use had the greatest impact, likely due to its role in promoting vascular inflammation and extracellular matrix degradation through increased matrix metalloproteinase activity.24 High blood pressure was the second most influential risk factor, leading to the loss of elastic fibres.25 Tobacco use was the predominant risk factor in males, whereas high systolic blood pressure was more influential in females. This difference may be explained by global male smoking rates being approximately five times higher than those of females.26 Furthermore, the increased prevalence of hypertension in females may be attributed to reduced cardiovascular protection from estrogen after menopause.27
Projections indicate that the burden of aortic aneurysms will continue to decline beyond 2022 if behavioral and metabolic risk factors improve. Measures such as quitting smoking, using appropriate pharmacological treatments, and maintaining a healthy diet are important. A diet rich in fruit reduces the burden of vascular diseases and may lower the risk of aortic aneurysm.28 Regional variations in aortic aneurysm rates are also expected, influenced by healthcare accessibility, behavioral health changes, and policy interventions. In particular, a rapid decline is projected for high-income countries, likely due to their advanced healthcare infrastructure.14
Aortic aneurysms continue to pose a considerable public health challenge worldwide. The WHO has launched the Global Action Plan for the Prevention and Control of Noncommunicable Diseases, targeting noncommunicable diseases, including aortic aneurysms. Despite limited progress in reducing the global burden of aortic aneurysms,1 several policy recommendations are proposed to address this issue more effectively. In countries with a low SDI, treatment options are often scarce due to the high costs of vascular surgery. Thus, it is critical to strengthen public health infrastructure and enhance education in vascular surgery.4 Policies that broaden health insurance coverage can help ensure individuals in low-income areas or those with restricted healthcare access receive appropriate treatment.29
Additionally, limited awareness of aortic aneurysms can delay treatment, underscoring the importance of public education initiatives.30 Considering that the incidence of complications following endovascular aneurysm repair varies depending on aneurysm size, tailored management approaches should be developed.20 In particular, as small aneurysms tend to be asymptomatic, establishing stricter guidelines for early surgical intervention and postoperative management is paramount.15 Effective strategies should also focus on managing risk factors and maintaining ongoing disease surveillance. National efforts—such as smoking prevention and cessation policies—are essential, given that smoking is a leading risk factor. Implementing national screening programs and systems for early diagnosis and timely treatment can significantly reduce the burden of aortic aneurysms.31,32 Moreover, statins and β-blockers have demonstrated efficacy in lowering mortality across cardiovascular diseases.19,20,21 Accordingly, in countries with limited access to medication, it is particularly important to create robust supply chains and promote affordable, widespread availability through structured policies.
Although previous studies have comprehensively examined the global burden of cardiovascular disease,34,35 relatively few have focused specifically on aortic aneurysms worldwide. An earlier study assessed the mortality, YLL, and risk factors associated with aortic aneurysms according to sex, age, and region; however, it relied solely on data from China and did not predict future burdens.6
Additionally, several studies have investigated the global burden of aortic aneurysms,3,4 analyzing trends by age, sex, and country income level. While certain findings align with those of the current study, estimates from 1990 to 2021 have changed due to updated methodologies introduced in GBD 2021. Changes in the contribution of each risk factor have altered the ranking of the leading risk factors. Additionally, they did not analyze risk factors at the regional level or provide future projections, making it difficult to identify regional differences in risk factors and to estimate the future burden of aortic aneurysms.
To bridge these gaps, the current study offers a comprehensive analysis of the global burden of aortic aneurysms across various regions, sexes, and age groups. Furthermore, it systematically examines regional risk factors and projects future trends through 2050. This study aimed to provide a detailed assessment of global epidemiological patterns of aortic aneurysms and to support the development of tailored management systems for these conditions.
This study used the GBD 2021 to analyze the global burden of aortic aneurysms. Several limitations must be noted. The most significant limitation of the GBD data was limited availability, particularly in regions with low SDI, where official statistics on aortic aneurysms are scarce, necessitating reliance on extrapolation methods. Further research is required to address these data gaps.
Second, the burden of aortic aneurysms in settings with limited diagnostic tools and healthcare accessibility may have been underestimated. Given that aortic aneurysms are often asymptomatic during early stages and frequently misdiagnosed in emergency contexts,35,36 the actual mortality rates may exceed those reported here. Enhancing basic public health infrastructure and implementing targeted management programs could help mitigate this issue. Third, data on the burden of aortic aneurysms in individuals aged < 15 years were unavailable. However, given the extremely low prevalence of aortic aneurysms in adolescents, typically due to congenital factors,14 this omission is unlikely to significantly impact the study conclusions. Fourth, not all potential risk factors for aortic aneurysms could be included due to limitations in the available data. Beyond tobacco use and high systolic blood pressure, other factors such as genetic predisposition and cholesterol levels may also contribute to mortality.37,38 By focusing on the primary risk factors, diverse perspectives were provided on the key contributors to disease burden. Fifth, GBD 2021 incorporated data from 1994 onwards, during which ICD coding transitioned from ICD-9 to ICD-10. To address this, GBD systematically mapped ICD-9 codes to their ICD-10 counterparts and applied adjustments based on bridge coding studies, wherein identical death records were coded using both systems.18 Ensemble modeling techniques further mitigated discrepancies arising from coding differences;18 however, residual effects from this transition may have influenced the results and should be considered during interpretation.
Despite these limitations, this study presents several notable strengths and novel contributions. It offers a comprehensive and current analysis of the global burden of aortic aneurysms using GBD 2021. The examination of regional variation supports the development of region-specific policies, while age- and sex-specific analyses identify vulnerable demographic groups. Additionally, it provides a longer-term projection that offers valuable insights for future public health planning.
Globally, the burden of aortic aneurysms has declined from 1990 to 2021; however, notable regional variations persist. Significant burdens were observed across high-, middle-, and low-SDI regions. Countries with higher SDI levels exhibited greater reductions in mortality, although overall mortality rates remained high. Tobacco use and high systolic blood pressure were identified as the key risk factors contributing to regional and sex-specific differences, with older males showing particular vulnerability. Projections to 2050 suggest a continued decline in the burden of aortic disease with improved behavioral and metabolic management. These findings underscore the importance of implementing country-specific strategies that reflect local healthcare systems and socioeconomic contexts to effectively mitigate the burden of aortic aneurysms.
Footnotes
Funding: This research was supported by the Ministry of Science and ICT (RS-2024-00509257 and IITP-2026-RS-2024-00438239) and the Ministry of Health & Welfare (RS-2025-02220492), Republic of Korea. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors had full access to the study data and had final responsibility for the decision to submit for publication.
Disclosure: The authors have no potential conflicts of interest to disclose.
Data Availability Statement: The findings from this study were produced using data available in public online repositories or in the published literature, data that are publicly available on request from the data provider, and data that are not publicly available due to restrictions by the data provider and which were used under license for the current study. Details on data sources can be found on the GHDx website, including information about the data provider and links to where the data can be accessed or requested (where available). To download the data used in these analyses, please visit the Global Health Data Exchange GBD 2021 website at https://ghdx.healthdata.org/gbd-2021.
- Conceptualization: Jung M, Jeong J, Jo Y, Yon DK.
- Data curation: Jung M, Jeong J, Jo Y, Yon DK.
- Formal analysis: Jung M, Jeong J, Jo Y, Yon DK.
- Funding acquisition: Yon DK.
- Investigation: Jung M, Jeong J, Jo Y, Yon DK.
- Methodology: Jung M, Jeong J, Jo Y, Yon DK.
- Project administration: Yon DK.
- Resources: Jung M, Jeong J, Jo Y, Yon DK.
- Software: Jung M, Jeong J, Jo Y, Yon DK.
- Supervision: Yon DK.
- Validation: Jung M, Jeong J, Jo Y, Yon DK.
- Visualization: Jung M, Jeong J, Jo Y, Yon DK.
- Writing - original draft: Jung M, Jeong J, Jo Y, Yon DK.
- Writing - review & editing: Hong SH, Lee S, Kim TH, Park S, Kong J, Kim H, Rahmati M, Cho H.
SUPPLEMENTARY MATERIALS
Classification of seven super-regions and 21 regions by GBD 2021
Checklist of information that should be included in new reports of global health estimates for GBD 2021
Covariates used in aortic aneurysm mortality modeling
Global total count (thousands) and age-standardized rates (per 100,000 population) of mortality and DALYs of aortic aneurysm by year for both sexes
Global total count (thousands) and age-standardized rates (per 100,000 population) of mortality and DALYs of aortic aneurysm by year for females
Global total count (thousands) and age-standardized rates (per 100,000 population) of mortality and DALYs of aortic aneurysm by year for males
Global mortality and YLL counts (thousand) and rates (per 100,000 population) of aortic aneurysm by age group in 1990, for both sexes
Global mortality and YLL counts (thousand) and rates (per 100,000 population) of aortic aneurysm by age group in 1990, for females
Global mortality and YLL counts (thousand) and rates (per 100,000 population) of aortic aneurysm by age group in 1990, for males
Global mortality and YLL counts (thousand) and rates (per 100,000 population) of aortic aneurysm by age group in 2021, for both sexes
Global mortality and YLL counts (thousand) and rates (per 100,000 population) of aortic aneurysm by age group in 2021, for females
Global mortality and YLL counts (thousand) and rates (per 100,000 population) of aortic aneurysm by age group in 2021, for males
Trends in age-standardized mortality rates (per 100,000 population) of aortic aneurysm by SDI level for both sexes from 1990 to 2021
Trends in age-standardized mortality rates (per 100,000 population) of aortic aneurysm by SDI level for females from 1990 to 2021
Trends in age-standardized mortality rates (per 100,000 population) of aortic aneurysm by SDI level for males from 1990 to 2021
Trends in age-standardized YLL rates (per 100,000 population) of aortic aneurysm by SDI level for both sexes from 1990 to 2021
Trends in age-standardized YLL rates (per 100,000 population) of aortic aneurysm by SDI level for females from 1990 to 2021
Trends in age-standardized YLL rates (per 100,000 population) of aortic aneurysm by SDI level for males from 1990 to 2021
Age-standardized aortic aneurysm mortality rates (per 100,000 population) attributable to dietary risk, high body-mass index, high systolic blood pressure, other environmental risks, and tobacco globally and by region in 2021 for both sexes
Age-standardized aortic aneurysm mortality rates (per 100,000 population) attributable to dietary risk, high body-mass index, high systolic blood pressure, other environmental risks, and tobacco globally and by region in 2021 for males
Age-standardized aortic aneurysm mortality rates (per 100,000 population) attributable to dietary risk, high body-mass index, high systolic blood pressure, other environmental risks, and tobacco globally and by region in 2021 for females
Age-standardized aortic aneurysm YLL rates (per 100,000 population) attributable to dietary risk, high body-mass index, high systolic blood pressure, other environmental risks, and tobacco globally and by region in 2021 for both sexes
Age-standardized aortic aneurysm YLL rates (per 100,000 population) attributable to dietary risk, high body-mass index, high systolic blood pressure, other environmental risks, and tobacco globally and by region in 2021 for males
Age-standardized aortic aneurysm YLL rates (per 100,000 population) attributable to dietary risk, high body-mass index, high systolic blood pressure, other environmental risks, and tobacco globally and by region in 2021 for females
The forecasted global age-standardized mortality rates (per 100,000 population) and counts (thousands) for the aortic aneurysm from 2022 to 2050 under both reference and improved behavioral and metabolic risk scenarios
The forecasted global age-standardized YLL rates (per 100,000 population) and counts (thousands) for the aortic aneurysm from 2022 to 2050 under both reference and improved behavioral and metabolic risk scenarios
Forecasted global age-standardized mortality rates of aortic aneurysm (per 100,000 population) from 2022 to 2050 and by region
Forecasted global mortality count of aortic aneurysm from 2022 to 2050 by region
Global age-standardized YLL rates of aortic aneurysm (per 100,000 population) from 2022 to 2050 by region
Forecasted global YLLs count of aortic aneurysm from 2022 to 2050 by region
Global distribution of aortic aneurysms for both sexes in 2021. (A) Age-standardized YLLs rate (per 100,000 population) and (B) age-standardized annual percentage change of mortality, 1990–2021. YLLs, years of life lost.
Age-standardized YLLs rate (per 100,000 population) of aortic aneurysm for both sexes, by SDI, 1990–2021. The shaded error regions indicate the 95% uncertainty intervals. SDI, Socio-demographic Index; YLLs, years of life lost.
Aortic aneurysm mortality and YLLs rate (per 100,000 population) stratified by sex and age groups in 2021, globally and by region. YLLs, years of life lost.
The age-standardized YLL rate (per 100,000 population) is attributable to five risk factors (tobacco, high systolic blood pressure, high body mass index, dietary risks, and other environmental risks), ranked globally and by region for both sexes in 2021. (A) Both sexes, (B) male, and (C) female. YLLs, years of life lost.
The forecasted (A) global age-standardized YLLs rate (per 100,000 population) for the aortic aneurysm from 2022 to 2050 under both reference and improved behavioral and metabolic risk scenarios and (B) age-standardized YLLs rate by region. The shaded error regions indicate the 95% uncertainty intervals, while the dashed line marks the beginning of the forecast period in 2022. YLLs, years of life lost.
References
- 1.World Health Organization. Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2014–2020) Manila, Philippines: WHO Regional Office for the Western Pacific; 2014. [Google Scholar]
- 2.Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. J Am Coll Cardiol. 2020;76(25):2982–3021. doi: 10.1016/j.jacc.2020.11.010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Tyrovolas S, Tyrovola D, Giné-Vázquez I, Koyanagi A, Bernabe-Ortiz A, Rodriguez-Artalejo F, et al. Global, regional, and national burden of aortic aneurysm, 1990–2017: a systematic analysis of the Global Burden of Disease Study 2017. Eur J Prev Cardiol. 2022;29(8):1220–1232. doi: 10.1093/eurjpc/zwab015. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Krafcik BM, Stone DH, Cai M, Jarmel IA, Eid M, Goodney PP, et al. Changes in global mortality from aortic aneurysm. J Vasc Surg. 2024;80(1):81–88.e1. doi: 10.1016/j.jvs.2024.02.025. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Naghavi M, Ong KL, Aali A, Ababneh HS, Abate YH, Abbafati C, et al. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):2100–2132. doi: 10.1016/S0140-6736(24)00367-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Hou X, Zhang F, Ye Z, Xu Q, Huang L, Guo Q, et al. The burden of aortic aneurysm in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019. BMC Public Health. 2022;22(1):782. doi: 10.1186/s12889-022-13221-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Kim S, Kim S, Woo S, Oh J, Son Y, Jacob L, et al. Temporal trends and patterns in mortality from falls across 59 high-income and upper-middle-income countries, 1990-2021, with projections up to 2040: a global time-series analysis and modelling study. Lancet Healthy Longev. 2025;6(1):100672. doi: 10.1016/j.lanhl.2024.100672. [DOI] [PubMed] [Google Scholar]
- 8.Yim Y, Lee JE, Son Y, Kim S, Lee H, Lee S, et al. Long-term trends in the prevalence of cardiovascular-kidney-metabolic syndrome in South Korea, 2011–2021: a representative longitudinal serial study. Lancet Reg Health West Pac. 2025;55:101474. doi: 10.1016/j.lanwpc.2025.101474. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Oh J, Kim S, Kim MS, Abate YH, Abd ElHafeez S, Abdelkader A, et al. Global, regional, and national burden of asthma and atopic dermatitis, 1990–2021, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Respir Med. 2025;13(5):425–446. doi: 10.1016/S2213-2600(25)00003-7. [DOI] [PubMed] [Google Scholar]
- 10.Shin YH, Hwang J, Kwon R, Lee SW, Kim MS, Shin JI, et al. Global, regional, and national burden of allergic disorders and their risk factors in 204 countries and territories, from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Allergy. 2023;78(8):2232–2254. doi: 10.1111/all.15807. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Vollset SE, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M, et al. Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):2204–2256. doi: 10.1016/S0140-6736(24)00685-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Ashton HA, Buxton MJ, Day NE, Kim LG, Marteau TM, Scott RA, et al. The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet. 2002;360(9345):1531–1539. doi: 10.1016/s0140-6736(02)11522-4. [DOI] [PubMed] [Google Scholar]
- 13.Huang X, Wang Z, Shen Z, Lei F, Liu YM, Chen Z, et al. Projection of global burden and risk factors for aortic aneurysm - timely warning for greater emphasis on managing blood pressure. Ann Med. 2022;54(1):553–564. doi: 10.1080/07853890.2022.2034932. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Wang H, Li Y, Fan K, Zhao T, Xu K, Zahin M, et al. Global epidemiology of early-onset aortic aneurysm: temporal trends, risk factors, and future burden projections. J Epidemiol Glob Health. 2025;15(1):25. doi: 10.1007/s44197-025-00369-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Ulug P, Powell JT, Martinez MA, Ballard DJ, Filardo G. Surgery for small asymptomatic abdominal aortic aneurysms. Cochrane Database Syst Rev. 2020;7(7):CD001835. doi: 10.1002/14651858.CD001835.pub5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Paraskevas KI. Abdominal aortic aneurysm size and mortality. Int J Cardiol. 2017;242:42. doi: 10.1016/j.ijcard.2017.03.079. [DOI] [PubMed] [Google Scholar]
- 17.Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA. 2014;311(2):183–192. doi: 10.1001/jama.2013.284692. [DOI] [PubMed] [Google Scholar]
- 18.Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151–1210. doi: 10.1016/S0140-6736(17)32152-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Kopacz A, Werner E, Grochot-Przęczek A, Klóska D, Hajduk K, Neumayer C, et al. Simvastatin attenuates abdominal aortic aneurysm formation favoured by lack of Nrf2 transcriptional activity. Oxid Med Cell Longev. 2020;2020:6340190. doi: 10.1155/2020/6340190. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Chen S, Tian P, Estau D, Li Z. Effects of β-blockers on all-cause mortality in patients with diabetes and coronary heart disease: a systematic review and meta-analysis. Front Cell Dev Biol. 2023;11:1076107. doi: 10.3389/fcell.2023.1076107. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Marcus ME, Manne-Goehler J, Theilmann M, Farzadfar F, Moghaddam SS, Keykhaei M, et al. Use of statins for the prevention of cardiovascular disease in 41 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data. Lancet Glob Health. 2022;10(3):e369–e379. doi: 10.1016/S2214-109X(21)00551-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Johnston WF, Salmon M, Su G, Lu G, Ailawadi G, Upchurch GR., Jr Aromatase is required for female abdominal aortic aneurysm protection. J Vasc Surg. 2015;61(6):1565–74.e1. doi: 10.1016/j.jvs.2014.01.032. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Pham MHC, Sigvardsen PE, Fuchs A, Kühl JT, Sillesen H, Afzal S, et al. Aortic aneurysms in a general population cohort: prevalence and risk factors in men and women. Eur Heart J Cardiovasc Imaging. 2024;25(9):1235–1243. doi: 10.1093/ehjci/jeae103. [DOI] [PubMed] [Google Scholar]
- 24.Aune D, Schlesinger S, Norat T, Riboli E. Tobacco smoking and the risk of abdominal aortic aneurysm: a systematic review and meta-analysis of prospective studies. Sci Rep. 2018;8(1):14786. doi: 10.1038/s41598-018-32100-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Hibino M, Otaki Y, Kobeissi E, Pan H, Hibino H, Taddese H, et al. Blood pressure, hypertension, and the risk of aortic dissection incidence and mortality: results from the J-SCH study, the UK biobank study, and a meta-analysis of cohort studies. Circulation. 2022;145(9):633–644. doi: 10.1161/CIRCULATIONAHA.121.056546. [DOI] [PubMed] [Google Scholar]
- 26.Bryazka D, Reitsma MB, Abate YH, Abd Al Magied AHA, Abdelkader A, Abdollahi A, et al. Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Public Health. 2024;9(10):e729–e744. doi: 10.1016/S2468-2667(24)00166-X. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Drury ER, Wu J, Gigliotti JC, Le TH. Sex differences in blood pressure regulation and hypertension: renal, hemodynamic, and hormonal mechanisms. Physiol Rev. 2024;104(1):199–251. doi: 10.1152/physrev.00041.2022. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Stackelberg O, Björck M, Larsson SC, Orsini N, Wolk A. Fruit and vegetable consumption with risk of abdominal aortic aneurysm. Circulation. 2013;128(8):795–802. doi: 10.1161/CIRCULATIONAHA.112.000728. [DOI] [PubMed] [Google Scholar]
- 29.Ramadan OI, Kelz RR, Sharpe JE, Wirtalla CJ, Keele LJ, Harhay MO, et al. Impact of Medicaid expansion on outcomes after abdominal aortic aneurysm repair. J Vasc Surg. 2023;78(3):648–656.e6. doi: 10.1016/j.jvs.2023.04.029. [DOI] [PubMed] [Google Scholar]
- 30.Ultee KHJ, Bastos Gonçalves F, Hoeks SE, Rouwet EV, Boersma E, Stolker RJ, et al. Low socioeconomic status is an independent risk factor for survival after abdominal aortic aneurysm repair and open surgery for peripheral artery disease. Eur J Vasc Endovasc Surg. 2015;50(5):615–622. doi: 10.1016/j.ejvs.2015.07.006. [DOI] [PubMed] [Google Scholar]
- 31.Wei L, Bu X, Wang X, Liu J, Ma A, Wang T. Global burden of aortic aneurysm and attributable risk factors from 1990 to 2017. Glob Heart. 2021;16(1):35. doi: 10.5334/gh.920. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Davis M, Harris M, Earnshaw JJ. Implementation of the national health service abdominal aortic aneurysm screening program in England. J Vasc Surg. 2013;57(5):1440–1445. doi: 10.1016/j.jvs.2012.10.114. [DOI] [PubMed] [Google Scholar]
- 33.Chong B, Jayabaskaran J, Jauhari SM, Chan SP, Goh R, Kueh MTW, et al. Global burden of cardiovascular diseases: projections from 2025 to 2050. Eur J Prev Cardiol. 2025;32(11):1001–1015. doi: 10.1093/eurjpc/zwae281. [DOI] [PubMed] [Google Scholar]
- 34.Mensah GA, Fuster V, Murray CJL, Roth GA Global Burden of Cardiovascular Diseases and Risks Collaborators. Global burden of cardiovascular diseases and risks, 1990–2022. J Am Coll Cardiol. 2023;82(25):2350–2473. doi: 10.1016/j.jacc.2023.11.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Gao J, Cao H, Hu G, Wu Y, Xu Y, Cui H, et al. The mechanism and therapy of aortic aneurysms. Signal Transduct Target Ther. 2023;8(1):55. doi: 10.1038/s41392-023-01325-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Arnaoutakis GJ, Ogami T, Aranda-Michel E, Dai Y, Holmes R, Beaver TM, et al. Misdiagnosis of thoracic aortic emergencies occurs frequently among transfers to aortic referral centers: an analysis of over 3700 patients. J Am Heart Assoc. 2022;11(13):e025026. doi: 10.1161/JAHA.121.025026. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Pinard A, Jones GT, Milewicz DM. Genetics of thoracic and abdominal aortic diseases. Circ Res. 2019;124(4):588–606. doi: 10.1161/CIRCRESAHA.118.312436. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Tang W, Yao L, Roetker NS, Alonso A, Lutsey PL, Steenson CC, et al. Lifetime risk and risk factors for abdominal aortic aneurysm in a 24-year prospective study: the ARIC study (atherosclerosis risk in communities) Arterioscler Thromb Vasc Biol. 2016;36(12):2468–2477. doi: 10.1161/ATVBAHA.116.308147. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Classification of seven super-regions and 21 regions by GBD 2021
Checklist of information that should be included in new reports of global health estimates for GBD 2021
Covariates used in aortic aneurysm mortality modeling
Global total count (thousands) and age-standardized rates (per 100,000 population) of mortality and DALYs of aortic aneurysm by year for both sexes
Global total count (thousands) and age-standardized rates (per 100,000 population) of mortality and DALYs of aortic aneurysm by year for females
Global total count (thousands) and age-standardized rates (per 100,000 population) of mortality and DALYs of aortic aneurysm by year for males
Global mortality and YLL counts (thousand) and rates (per 100,000 population) of aortic aneurysm by age group in 1990, for both sexes
Global mortality and YLL counts (thousand) and rates (per 100,000 population) of aortic aneurysm by age group in 1990, for females
Global mortality and YLL counts (thousand) and rates (per 100,000 population) of aortic aneurysm by age group in 1990, for males
Global mortality and YLL counts (thousand) and rates (per 100,000 population) of aortic aneurysm by age group in 2021, for both sexes
Global mortality and YLL counts (thousand) and rates (per 100,000 population) of aortic aneurysm by age group in 2021, for females
Global mortality and YLL counts (thousand) and rates (per 100,000 population) of aortic aneurysm by age group in 2021, for males
Trends in age-standardized mortality rates (per 100,000 population) of aortic aneurysm by SDI level for both sexes from 1990 to 2021
Trends in age-standardized mortality rates (per 100,000 population) of aortic aneurysm by SDI level for females from 1990 to 2021
Trends in age-standardized mortality rates (per 100,000 population) of aortic aneurysm by SDI level for males from 1990 to 2021
Trends in age-standardized YLL rates (per 100,000 population) of aortic aneurysm by SDI level for both sexes from 1990 to 2021
Trends in age-standardized YLL rates (per 100,000 population) of aortic aneurysm by SDI level for females from 1990 to 2021
Trends in age-standardized YLL rates (per 100,000 population) of aortic aneurysm by SDI level for males from 1990 to 2021
Age-standardized aortic aneurysm mortality rates (per 100,000 population) attributable to dietary risk, high body-mass index, high systolic blood pressure, other environmental risks, and tobacco globally and by region in 2021 for both sexes
Age-standardized aortic aneurysm mortality rates (per 100,000 population) attributable to dietary risk, high body-mass index, high systolic blood pressure, other environmental risks, and tobacco globally and by region in 2021 for males
Age-standardized aortic aneurysm mortality rates (per 100,000 population) attributable to dietary risk, high body-mass index, high systolic blood pressure, other environmental risks, and tobacco globally and by region in 2021 for females
Age-standardized aortic aneurysm YLL rates (per 100,000 population) attributable to dietary risk, high body-mass index, high systolic blood pressure, other environmental risks, and tobacco globally and by region in 2021 for both sexes
Age-standardized aortic aneurysm YLL rates (per 100,000 population) attributable to dietary risk, high body-mass index, high systolic blood pressure, other environmental risks, and tobacco globally and by region in 2021 for males
Age-standardized aortic aneurysm YLL rates (per 100,000 population) attributable to dietary risk, high body-mass index, high systolic blood pressure, other environmental risks, and tobacco globally and by region in 2021 for females
The forecasted global age-standardized mortality rates (per 100,000 population) and counts (thousands) for the aortic aneurysm from 2022 to 2050 under both reference and improved behavioral and metabolic risk scenarios
The forecasted global age-standardized YLL rates (per 100,000 population) and counts (thousands) for the aortic aneurysm from 2022 to 2050 under both reference and improved behavioral and metabolic risk scenarios
Forecasted global age-standardized mortality rates of aortic aneurysm (per 100,000 population) from 2022 to 2050 and by region
Forecasted global mortality count of aortic aneurysm from 2022 to 2050 by region
Global age-standardized YLL rates of aortic aneurysm (per 100,000 population) from 2022 to 2050 by region
Forecasted global YLLs count of aortic aneurysm from 2022 to 2050 by region
Global distribution of aortic aneurysms for both sexes in 2021. (A) Age-standardized YLLs rate (per 100,000 population) and (B) age-standardized annual percentage change of mortality, 1990–2021. YLLs, years of life lost.
Age-standardized YLLs rate (per 100,000 population) of aortic aneurysm for both sexes, by SDI, 1990–2021. The shaded error regions indicate the 95% uncertainty intervals. SDI, Socio-demographic Index; YLLs, years of life lost.
Aortic aneurysm mortality and YLLs rate (per 100,000 population) stratified by sex and age groups in 2021, globally and by region. YLLs, years of life lost.
The age-standardized YLL rate (per 100,000 population) is attributable to five risk factors (tobacco, high systolic blood pressure, high body mass index, dietary risks, and other environmental risks), ranked globally and by region for both sexes in 2021. (A) Both sexes, (B) male, and (C) female. YLLs, years of life lost.
The forecasted (A) global age-standardized YLLs rate (per 100,000 population) for the aortic aneurysm from 2022 to 2050 under both reference and improved behavioral and metabolic risk scenarios and (B) age-standardized YLLs rate by region. The shaded error regions indicate the 95% uncertainty intervals, while the dashed line marks the beginning of the forecast period in 2022. YLLs, years of life lost.