Global Mortality from Aortic Aneurysm: What Is Driving the Changes?

Globally, deaths from aortic aneurysm have increased over the past three decades. Primary drivers of these changes over time and whether preventative efforts have led to a reduction in deaths remains unknown. We sought to characterize the impact of changes in demographics and risk factors on aortic aneurysm deaths using a global database. We queried the Global Burden of Disease Study for number of aortic aneurysm deaths from 1990 to 2019 as well as percentage of deaths attributable to each risk factor identified by Global Burden of Disease Study modeling (smoking, hypertension, lead exposure, and a high-sodium diet). We then stratified data by age and Socio-Demographic Index (SDI) region. The expected number of deaths in 2019 due to overall population increase and due to shifts in age distribution were calculated. We then determined the change in deaths resulting from specific risk factors between 1990 and 2019. Global deaths from aortic aneurysm increased from 94,968 (1 of every 552 deaths) in 1990 to 172,427 (1 of every 328 deaths) in 2019. Expected deaths in 2019 from overall global population growth alone was 136,934 (+44.6% from 1990 observed mortality). Incorporating the shift in age distribution led to an estimated 210,031 deaths in 2019 (+121.8%) (Figure). Overall, the observed deaths in 2019 were 17.9% lower than the number expected due to demographic changes. The percentage of deaths attributable to smoking decreased from 45.6% to 34.6%, leading to an expected decrease of 23,103 deaths. The percent attributable to hypertension decreased from 38.7% to 34.7%, leading to an expected decrease of 8401 deaths. With regard to SDI region, number of deaths increased as SDI went up, but low-middle and middle SDI regions had the most rapid growth in observed deaths (173.2% and 170.4%, respectively), while high SDI had the smallest (35.5%). Deaths attributable to hypertension increased in low-middle and middle SDI regions and globally hypertension surpassed smoking as the leading risk factor (Table). The increase in aortic aneurysm deaths from 1990 to 2019 was primarily driven by increases in global population and longevity. However, the observed deaths in 2019 were lower than expected, suggesting that public health efforts toward improved aneurysm care and risk factor reduction have been effective. Continued efforts at risk factor modification, with heightened emphasis on hypertension, could lead to further improvements. Finally, the ongoing rise in deaths highlights the need for expanding vascular surgery capabilities globally.TableChange in deaths from aortic aneurysm globally and by Socio-Demographic Index (SDI) regionA. Observed deaths 1990B. Expected change from overall population growthaC. Expected change from aging of populationbD. Expected change from change in smokingcE. Expected change from change in hypertensioncF. Expected change from change in lead exposurecG. Expected change from change in high sodium intakecH. Expected change from changes in unidentified risk factors and/or clinical carecI. Observed deaths 2019aGlobal94,69942,235 (+44.6%)73,097 (+53.4%)−23,103 (–11.0%)−8401 (–4.0%)210 (+0.1%)−210 (–0.1%)−31,505 (–15.0%)172,427 (+82.1%)Low SDI42544837 (+113.7%)562 (+6.2%)−202 (–2.1%)314 (+3.2%)19 (+0.2%)−90 (–0.9%)−1436 (–14.8%)8258 (+94.1%)Low-middle SDI76186602 (+86.7%)4507 (+31.7%)−1099 (–5.9%)494 (+2.6%)−60 (–0.3%)−45 (–0.2%)2794 (+14.9%)20,811 (+173.2%)Middle SDI11,9714740 (+39.6%)14,337 (+85.8%)−1757 (–5.7%)925 (+3.0%)−133 (–0.4%)−375 (–0.1%)2664 (+8.6%)32,372 (+170.4%)High-middle SDI21,4605223 (+24.3%)15,933 (+59.7%)−3102 (–7.3%)−903 (–2.1%)−89 (–0.2%)−251 (–0.5%)6757 (+15.9%)45,028 (+98.2%)High SDI49,33411,485 (+23.3%)32,159 (+52.9%)−15,397 (–17.1%)−8834 (–9.5%)483 (+0.5%)−214 (–0.2%)– 3169 (–3.4%)65,848 (+33.5%)a Parenthesis = % change from observed deaths 1990, Column A.b Parenthesis = % change from observed deaths 1990 + expected deaths from overall population growth, columns A + B.c Parenthesis = % change from observed deaths 1990 + expected deaths from overall population growth and from aging of the population, columns A + B + C. Open table in a new tab