Burden of Pulmonary Arterial Hypertension in China from 1990 to 2021, with Projections to 2050: An Analysis of Data from the Global Burden of Disease Study 2021

Burden of Pulmonary Arterial Hypertension in China from 1990 to 2021, with Projections to 2050: An Analysis of Data from the Global Burden of Disease Study 2021 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Burden of Pulmonary Arterial Hypertension in China from 1990 to 2021, with Projections to 2050: An Analysis of Data from the Global Burden of Disease Study 2021 Shuoshuo Wei, Yonghui Han, Min Liu, Hanli Wang, Zhiwei Lu, Yusheng Cheng, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5904466/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Pulmonary arterial hypertension (PAH) is a severe condition with high morbidity and mortality, yet its epidemiology in China remains poorly understood. This study aims to assess the burden of PAH in China from 1990 to 2021 and project trends to 2050, providing insights for effective management and prevention strategies. Method Data from the Global Burden of Disease (GBD) Study 2021 were analyzed, focusing exclusively on PAH. Key metrics included incidence, prevalence, mortality, and disability-adjusted life years (DALYs), along with their corresponding age-standardized rates (ASRs). Average annual percent changes (AAPCs) were calculated using joinpoint regression analysis, and a Bayesian age-period-cohort model was employed to project trends through 2050. Results In 2021, there were 41,135 estimated prevalent cases of PAH (95% UI: 32,838.91 to 51,357.25) in China, with an age-standardized prevalence rate (ASPR) of 2.24 per 100,000. Females accounted for approximately 58% of cases. PAH caused 7,318 deaths (95% UI: 4,835.72 to 9,075.75; 3,683 males, 3,635 females), with an age-standardized death rate (ASDR) of 0.42 per 100,000. From 1990 to 2021, the ASPR increased slightly from 2.07 (95% UI: 1.68 to 2.54) to 2.24 (95% UI: 1.81 to 2.75), while the ASDR decreased from 0.61 (95% UI: 0.46 to 0.83) to 0.42 (95% UI: 0.28 to 0.51). Projections suggest declining trends in both ASPR and ASDR, although the overall prevalence of PAH is expected to rise over the next 30 years. Conclusion PAH imposes a significant disease burden in China, particularly among women and older adults. These findings highlight the urgent need to enhance diagnostic capabilities and develop improved treatment strategies to address this challenging condition in the Chinese population. Pulmonary arterial hypertension disease burden epidemiology Global Burden of Disease China Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Pulmonary arterial hypertension (PAH), a severe and life-threatening subtype of pulmonary hypertension (PH), is characterized by significant remodeling of the pulmonary vasculature 1 . This remodeling process leads to a progressive increase in pulmonary vascular resistance, imposing a substantial workload on the right ventricle 1 , 2 . The resulting ventricular strain induces hypertrophy and remodeling, ultimately compromising cardiac function and contributing to disease-related morbidity and mortality 3 . Globally, PAH represents a significant public health challenge affecting all age groups 4 , substantially impacting patients' quality of life and placing considerable burdens on healthcare systems and economies 5 . PAH is the Group 1 subtype of pulmonary hypertension which encompasses various etiologies, including idiopathic origins, heritable connective tissue diseases, congenital heart defects, portal hypertension, HIV infection, drug and toxin exposure, and multifactorial causes. Idiopathic PAH (IPAH) represents the predominant subtype, accounting for 50–60% of cases 6 . The disease presents with nonspecific symptoms that develop insidiously, including exertional dyspnea, fatigue, chest pain, syncope, palpitations, and peripheral edema 7 – 9 . These manifestations significantly impact patients' physical mobility and emotional well-being, compromising their health-related quality of life 10 , 11 . Despite advances in targeted therapies improving outcomes and quality of life, the five-year survival rate remains relatively low at approximately 60% 6,12 . Significant challenges persist, including ongoing disability and and extensive healthcare needs, which impose substantial financial burdens on patients, healthcare systems, and society 13 , 14 , 15 . Global epidemiological data on PAH primarily derives from registry-based studies 6 , 14 – 17 . Prevalence rates vary geographically, ranging from 15 to 50 cases per million in the US and Europe 18 , with the US reporting approximately 25 cases per million 19 and Central Australia showing a higher prevalence of 48 per million 20 . The Global Burden of Diseases (GBD) study recently provided comprehensive global data, reporting an age-standardized prevalence of 2.28 per 100,000 and an age-standardized mortality rate of 0.27 deaths per 100,000 population in 2021, with women and elderly populations disproportionately affected 21 . In China, the epidemiological landscape differs notably, with congenital heart disease (CHD)-associated PAH being most prevalent 22 , and a higher proportion of systemic lupus Erythematosus(SLE)-associated PAH in connective tissue diseases(CTD) 23 . However, comprehensive epidemiological data for China remains limited 24 . Available studies suggests lower incidence and survival rates compared to Western countries; however, the prevalence may be underestimated due to diagnostic challenges and underreported cases 23 , 25 – 27 . With the comprehensive data provided by GBD 2021, which integrates multiple sources through advanced statistical modeling 28 , we have a unique opportunity to conduct an in-depth assessment of the PAH disease burden in China. Our analysis encompasses trends in prevalence, incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021, with projections extending to 2050, focusing exclusively on Group 1 PAH. This assessment aims to provide crucial insights for developing targeted prevention and treatment strategies that address the evolving healthcare needs of the Chinese population. Methods Overview This is a population study based on a publicly available database that utilized data from the Global Burden of Disease (GBD) 2021 study, accessible at http://ghdx.healthdata.org/gbd-results-tool. GBD 2021, the project's latest iteration, assessed the burden of 371 diseases, injuries and 88 risk factors for 204 countries and territories from 1990–2021 28 . The GBD database employs advanced statistical methods to address missing data and adjust for confounding factors. Detailed descriptions of the GBD study design and methodologies are available in the existing literature 28 . Furthermore, the GBD Study adheres to the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) Statement 29 . Data acquisition and download The GBD study provides a comprehensive assessment of disease burden by cause, age, sex, year, and location, enabling direct comparisons across populations, time periods, and regions. This study specifically focused on the burden of PAH. From the GBD 2021 database, we extracted data on PAH for all ages, including age-standardized, age-specific, and sex-specific prevalence, incidence, mortality, and DALYs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs), with 95% uncertainty intervals (UIs) derived from the 25th and 95th values of 1,000 statistical draws 30 . The current hemodynamic definition of PAH includes three key criteria obtained through right heart catheterization: a resting mean pulmonary arterial pressure exceeding 20 mm Hg, a pulmonary capillary wedge pressure below 15 mm Hg, and a pulmonary vascular resistance of at least 2 Wood units 31 . In resource-limited settings, echocardiography is often used to estimate pulmonary arterial pressure, although this method can impact the sensitivity and specificity of the diagnosis. The GBD study applied a standardized case definition requiring a physician diagnosis of PAH, supported by evidence from either right heart catheterization or echocardiography. Vital registration records were mapped to the GBD cause hierarchy using specific ICD codes: 416.0 (ICD-9) and I27.0 (ICD-10). To ensure the most accurate and conservative estimates of PAH burden, the analysis was restricted to deaths coded as I27.0 after the introduction of I27.2, with all input data from affected locations prior to I27.2 implementation excluded. This study focused exclusively on Group 1 PAH, excluding other forms of pulmonary hypertension. Statistical analysis A comprehensive assessment was conducted to quantify the burden of PAH in China in 2021, including prevalence, incidence, mortality, and DALYs. The analysis also examined the distribution of the disease burden across different age groups and genders. To evaluate time trends in prevalence, incidence, mortality, and DALY rates from 1990 to 2021, we calculated the average annual percent changes (AAPCs) with corresponding 95% confidence intervals (CIs) using joinpoint regression analysis 32 . We also employed age-period-cohort (APC) modeling to assess the associations between age, period, birth cohort, and PAH mortality 33 . APC and AAPC were considered statistically significant if the 95% CI did not overlap with zero and the P <0.05. Bayesian Age-Period-Cohort (BAPC) models were used to project future trends, utilizing integrated nested Laplace approximations (INLA) for full Bayesian inference. Critical features of BAPC models include the generation of age-specific and age-standardized projected rates and the automatic incorporation of Poisson noise for predictive distributions 34 , 35 . The preceding BAPC analysis is based on the R package "BAPC" (version 0.0.36) and "INLA" (version 24.02.09) 36 . All statistical analyses and visualizations were conducted using the R statistical software program (version 4.4.3) and JD_GBDR (V2.31, Jing ding Medical Technology Co.Ltd). P <0.05 was considered statistically significant. Results Burden of Pulmonary Arterial Hypertension in 2021 The burden of PAH was measured through incidence, prevalence, mortality, and DALYs, along with their age-standardized rates for all ages in 2021. In China, there were 9257 incidence cases (95%UI:7349.72,11507.74) of PAH, with an age-standard incidence rate (ASIR) of 0.50 per 100,000, comprising 4,569 males and 4,688 females ( Table 1 ). The prevalence reached 41,135 cases (95% UI: 32,838.91,51,357.25) with an age-standardized prevalence rate (ASPR) of 2.24 per 100,000, with females accounting for nearly 58% of cases ( Table 2 ). PAH contributes to 7318 deaths (95%UI:4835.72,9075.75) with an age-standard death rate (ASDR) of 0.42 per 100,000, including 3683 males and 3635 females ( Table 3 ). The DALYs attributed to 150941 (95%UI: 99583.31,186503.40) with an age-standardized DALY rate of 8.95(95%UI:6.04,11.13) per 100,000 person-years ( Table 4 ). Analysis of age-specific patterns revealed distinct distributions across different measures and metrics ( Figure 1 ). The highest number of incident cases was observed in the 65-69 age group (1135 cases), while the peak crude incidence rate occurred in the 75-79 age group (1.83 per 100,000) ( Figure 1A ). For prevalence, the highest number of cases was recorded in the 55-59 age group (4,942 cases), while the highest crude prevalence rate was observed in the 75-79 age group (6.58 per 100,000) (Figure 1B). By contrast to prevalence, the greatest number of deaths occurred in the 80-84 age group (1,291 cases), while the highest crude death rate was observed in individuals aged 95+ years (23.13 per 100,000) ( Figure 1C ). The 70-74 age group had the largest number of DALYs (19236 cases), with the highest DALYs rate occurring in the 95+ age group (189.06 per 100,000) ( Figure 1D ). Gender-specific analysis revealed distinct trends in the burden of PAH. Among individuals younger than 50-54 years, the number of incident cases was higher in males than in females. However, starting from the 55–59 age group, the number of incident cases in females gradually surpassed that of males. The highest number of incident cases in females was observed in the 65-69 age group (579 cases), while the peak incidence rate was observed in the 95+ age group (1.90 per 100,000) ( Figure 1A, Supplementary eTable 1 ). Prevalence was consistently higher in females across all age groups. The largest number of prevalent cases in females was recorded in the 55-59 years age group (2869 cases), while the highest prevalence rate occurred in the 75-79 years age group (7.38/100,000) ( Figure 1B, Supplementary eTable 2 ). Mortality data showed that males aged 55-94 years had higher death cases compared to females in the same age range. Among females, the highest number of deaths occurred in the 80-84 age group (634 cases), while the highest death rate was observed in the 90-94 age group (29.86 per 100,000) ( Figure 1C, Supplementary eTable 3 ). For DAYLs, males had higher rates than females starting from the 50-54 age group, except in the 95+ age group. The DAYLs rate peaked at 258.70 per 100,1000 in males aged 90-94 years and at 193.40 per 100,000 in females aged 95+ years ( Figure 1D, Supplementary eTable 4 ). Trends of Pulmonary Arterial Hypertension from 1990 to 2021 From 1990 to 2021, the ASIR of PAH per 100,000 decreased slightly from 0.51 (95% UI: 0.41,0.62) to 0.50 (95% UI: 0.40,0.60), with an estimated annual percent changes(EAPC) of -0.12 (95% CI: -0.17,-0.08). The decline in ASIR was more pronounced in females (-0.21, 95% CI: -0.26, -0.17) compared to males (-0.03, 95% CI: -0.09, 0.02) ( Table 1 ). In contrast, the ASPR per 100,000 increased from 2.07(95%UI:1.68,2.54) in 1990 to 2.24(95%UI:1.81,2.75) in 2021, with an EAPC of 0.39(95% CI:0.34,0.44). The increase in ASPR was faster in males at 0.56(95%CI:0.51,0.62) than in females at 0.26(0.21,0.32) ( Table 2 ). The ASDR per 100,000 decreased from 0.61 (95% UI: 0.46–0.83) in 1990 to 0.42 (95% UI: 0.28, 0.51) in 2021, with an EAPC of -0.61 (95% UI: -1.00 to, 0.22). The decline in ASDR was more pronounced in females (-0.87, 95% CI: -1.18,-0.57) compared to males (-0.37, 95% CI: -0.85, 0.12) ( Table 3 ). Similarly, the age-standardized DALY rate per 100,000 declined significantly from 16.18(95%UI:12.63,21.60) in 1990 to 8.95(95%UI:6.04,11.13) in 2021 with an EAPC of -1.38(95%CI: -1.74,-1.01). The decline in DAYL rates was faster in females (-1.56,95%CI:-1.85,-1.27) compared to males (-1.17,95%CI:-1.62,-0.72) ( Table 4) . Temporal Trends of Pulmonary Arterial Hypertension Burdens in China Using Joinpoint models, the age-standard incidence rate (ASIR) of PAH showed three declining phases followed by a significant increase. From 1990 to 2000, the ASIR declined at an annual percentage change (APC) of -0.444%, followed by a slower decline from 2000 to 2008 (APC = -0.050%) and a moderate decline from 2008 to 2016 (APC = -0.223%). However, from 2016 to 2021, the ASIR significantly increased with an APC of 0.712%. Over the entire study period, the average annual percent change (AAPC) was 0 (Figure 2A). The age-standard prevalence rate (ASPR) showed a steady increase from 1990 to 2013, with APCs of 0.287% (1990-1995) and 0.531% (1995-2013). From 2013 to 2019, the prevalence trend increased moderately (APC = 0.068%), but from 2019 to 2021, the ASPR declined significantly (APC = -1.471%). The overall AAPC for the study period was 0.005% (95%CI: 0.005% to 0.006%, P ＜0.05) ( Figure 2B ). The ASDR decreased significantly by -2.548% per year from 1990 to 2001, followed by a slower decline from 2001 to 2006 (APC = -0.303%). The death rate increased from 2006 to 2010 (APC = -6.684%), but declined rapidly from 2010 to 2021 (APC = -3.852%). The overall AAPC for the study period was -0.007% (95%CI: -0.008% to 0.007%, P ＞0.05) ( Figure 2C ). By contrast, the age-standardized DAYL rate decreased significantly from 1990 to 2004 (APC= -3.096%), followed by an increase from 2004 to 2011(APC = 4.519%). From 2011 to 2021, the DAYL rate decreased again, with APCs of -4.867% (2011-2017) and -2.574% (2017-2021). The overall AAPC of DAYL for the study period was -0.257% (95%CI:-0.268% to 0.247%, P ＜0.05) ( Figure 2D ). Age, Period, and Cohort Effects on Incidence and Death Rates Age Effect The age-period-cohort (APC) analysis revealed distinct PAH incidence and mortality patterns. After controlling for period and cohort effects, the age effect showed that incidence rate risk substantially increased with age, reaching a peak in the 75-79 age group, followed by a slight decrease before rising again in the 95+ age group ( Figure 3A, Supplementary eTable 5) . From age groups＜5 years to 75-79 years, the incidence increased by 10.81-fold. The PAH death rate showed a continuous increase with advancing age from the 70-74 age group, with the death rate in the 95+ age group being approximately 38.81 times higher than in the ＜5 age group（ Figure 3D, Supplementary eTable 5 ）. Period Effect The period effect analysis revealed that incidence risk gradually declined from 1995 (RR = 1.03, 95% CI: 0.99 to 1.07) to 2015 (RR = 0.98, 95% CI: 0.95 to 1.02), followed by a slight increase from 2015 to 2020 (RR = 1.00, 95% CI: 0.96 to 1.04) (Figure 3B, Supplementary eTable 5). Mortality rates showed a decline from 1995 (RR = 1.31, 95% CI: 1.25 to 1.37) to 2005 (RR = 1.09, 95% CI: 1.04 to 1.14), followed by an increase from 2005 to 2010 (RR = 1.23, 95% CI: 1.18 to 1.28), and then another decline from 2010 to 2020 (RR = 0.91, 95% CI: 0.87 to 0.95) (Figure 3E, Supplementary eTable 5). Cohort Effect The cohort effects analysis of incidence risk ( Figure 3C, Supplementary eTable 5 ) revealed an inverse relationship between birth cohort and risk levels. The 1895-1899 cohort exhibited the highest incidence risk ( RR =1.11, 95% CI: 0.14-8.13). A distinct pattern emerged: cohorts from 1895-1955 showed elevated incidence rate ratios ( RR >1), while cohorts from 1981-2021 demonstrated reduced ratios ( RR <1). Overall, the incidence rate ratio displayed a declining trend. For mortality risk, the cohort effects analysis ( Figure 3F, Supplementary eTable 5 ) showed that cohorts born between 1895-1919 experienced elevated death rate ratios ( RR >1), peaking in the 1915-1919 cohort ( RR =1.29, 95% CI: 1.18-1.41). From 1920 onward, death rate ratios steadily declined, with the most pronounced decrease observed in cohorts 1991-2021. Projected Burden of Pulmonary Arterial Hypertension from 2021 to 2050 Using data from the GBD database (1990-2021), we employed the Bayesian Age-Period-Cohort (BAPC) model to project the future burden of PAH in China through 2050. The ASIR for China's total population is projected to decline modestly from 0.493 per 100,000 in 2021 to 0.486 per 100,000 by 2050, representing a 1.42% decrease (Figure 4A) . Regarding gender-specific ASIR, the projections showing an increase in male from 0.488 to 0.493 per 100,000 and a decrease in female from 0.493 to 0.475 per 100,000 (Supplementary eTable 6) . In contrast, the ASPR is expected to reach 2.443 per 100,000 by 2050, representing an 8.29% increase from 2021 levels (Figure 4B) , with male rising from 1.907 to 2.163 per 100,000 and female increasing from 2.573 to 2.725 per 100,000, respectively (Supplementary eTable 6) . The ASDR shows a substantial projected decline for the total population, decreasing from 0.418 per 100,000 to 0.236 per 100,000 by 2050, representing a 43.54% reduction (Figure 4C) , with male decreasing from 0.498 to 0.283 per 100,000 and female declining from 0.374 to 0.211 per 100,000 (Supplementary eTable 6) . The age-standardized DALY rate is projected to demonstrate the most substantial improvement, with a remarkable decrease of 49.69%, reaching 4.370 per 100,000 by 2050 ( Figure 4D )/ Specfically, the rate for males is expected to decline to 4.942 per 100,000, while the rate for female will decrease to 4.067 per 100,000 ( Supplementary eTable 6 ). Discussion This study represents the first comprehensive analysis of PAH disease burden in China based on the GBD 2021 data, providing crucial epidemiological insights from 1990 to 2021. Our findings reveal that in 2021, the burden of PAH in China experienced an incidence rate of 0.51 per 100,000 population, a prevalence rate of 2.24 per 100,000, a mortality rate of 0.42 per 100,000, and a DALY rate of 8.95 per 100,000. Compared to 1990, while the incidence, mortality, and DALYs have declined, the prevalence has increased. The observed prevalence increase might be attributed to several factors: improved early diagnostic techniques, an aging population, increased exposure to risk factors (including tobacco smoke, drug abuse, and environmental pollutants), and lacking awareness among healthcare providers and the public 4 , 37 – 42 . Our findings align with previous registry-based studies. The French registry (2002–2003) reported an incidence of 0.24 and a prevalence of 1.5 per 100,000 15 , while the US REVEAL registry (2006–2007) documented an incidence of 0.20 and a prevalence of 1.06 per 100,000 43 . The current global GBD estimate of 2.28 prevalent cases per 100,000 in 2021 closely matches our finding of 2.24 per 100,000 in China 21 , validating the reliability of GBD data for PAH surveillance. Nevertherless, the mortality rate of PAH in China (0.42 per 100,000) exceeds the average death rate globally (0.27 per 100,000). This disparity likely stems from unbalanced medical resource distribution and delayed diagnosis, particularly in rural areas, leading to more advanced-stage diagnoses when treatment efficacy is reduced 27 , 44 – 46 . Therefore, in the future, efforts should focus on improving access to medical resources and early diagnosis in rural areas. Gender-specific analysis reveals higher incidence (0.50 vs 0.49 per 100,000) and prevalence (2.57 vs 1.97 per 100,000) in females compared to males. However, males experience higher mortality (0.49 vs 0.37 per 100,000) and DALY rates (9.48 vs 8.78 per 100,000). These discrepancies align with findings from previous studies, which indicate that while females are more susceptible to developing PAH, they tend to exhibit better right ventricular (RV) function and higher survival rates compared to males 21 , 47 – 49 . This phenomenon, often referred to as the "estrogen paradox" or "estrogen puzzle," is partly attributed to the protective effects of estrogen on vascular and RV function 50 , 51 . Additionally, females are more likely to respond positively to treatment with prostacyclin analogs, which may contribute to their lower mortality rates. These factors affirm the long-standing recognition that PAH is more prevalent in females but often more severe in males 52 . Historically, PAH was believed to have a higher incidence among younger individuals, particularly younger females 14 , 49 , 53 , 54 . This view arose from studies focused on specific types of PAH, which are more common in younger populations. However, as research has advanced, it has become evident that PAH incidence increases significantly in older adults. Our study shows that the peak age-standardized incidence and prevalence occur in the 75–79 age group, while mortality rates increase with advancing age. These findings are consistent with global GBD estimates 21 , suggesting that the growing recognition of PAH in older populations may be due to the availability of PAH-specific therapies and the widespread use of Doppler echocardiography 48 , improving the diagnosis in older adults. Looking ahead, our 30-year projections suggest declining overall incidence and mortality. This trend is likely driven by advancements in PAH management, including the use of endothelin receptor antagonists (ERAs), phosphodiesterase-5 inhibitors (PDE5is), prostacyclin analogs, and novel therapeutic strategies such as initial combination therapy, exercise training, and psychological support 2 , 19 , 55 – 57 . These treatments have demonstrably improved symptoms, slowed disease progression, and extended survival, contributing to reduced mortality and morbidity. However, the prevalence rate is projected to rise, which might be driven by the aging population, unhealthy lifestyle factors (e.g., smoking, obesity, and physical inactivity), and environmental pollution 58 – 61 . Additionally, advancements in diagnostic tools, including echocardiography, CT, MRI, hemodynamic variables (e.g., right atrial pressure, cardiac index, and venous oxygen saturation), and biomarker utilization could also increase the number of diagnosed cases 2 , 62 – 66 . This increase should not be interpreted as a genuine rise in incidence but rather as a result of improved diagnostic accuracy. These findings underscore the need for continued surveillance, targeted interventions, and further research to address the complex epidemiological trends of PAH in China. Future studies should focus on quantifying the impact of various risk factors and developing effective public health strategies to manage this challenging condition. This study has several limitations. First, it focuses exclusively on group 1 PAH and does not include groups 2–5 pulmonary hypertension, which limits the scope of our findings. Second, the diagnosis of PAH is complex, and many primary medical institutions may lack the necessary diagnostic equipment and trained professionals. This can lead to a high prevalence of missed or misdiagnosed cases, potentially resulting in an underestimation of PAH cases in the GBD database. Third, we could not obtain data on pulmonary hypertension across different provinces in China, preventing us from analyzing regional and urban-rural disparities in the burden of pulmonary hypertension. Future research should prioritize large-scale, high-quality epidemiological studies that integrate multiple data sources to more accurately assess the epidemiological characteristics of PAH in China. Furthermore, improving PAH diagnostic and reporting systems is crucial for enhancing data quality. These advancements will facilitate better utilization of the GBD database and other resources, enabling a more precise evaluation of the PAH disease burden in China. However, despite these limitaitons, this study still could offer valuable insights into the temporal trends and overall burden of PAH in China, providing an important foundation for future research and public health planning. Conclusions PAH remains a significant public health challenge in China, with an estimated 41,135 individuals affected in 2021, leading to 7,318 deaths and 150,941 DALYs. The burden is particularly pronounced among women and older adults, underscoring the need for gender- and age-specific strategies to address this condition. While projections indicate a continued decline in PAH incidence and mortality rates, the prevalence of PAH is expected to rise, driven by demographic shifts and persistent risk factors. These findings emphasize the urgent need for sustained efforts to enhance early detection, expand access to specialized care, and implement targeted public health interventions to mitigate the growing burden of PAH in China. Future research should prioritize addressing regional disparities, quantifying the influence of risk factors, and developing innovative strategies to reduce the disease burden and improve patient outcomes. Abbreviations PAH, pulmonary arterial hypertension; PH, pulmonary hypertension, IPAH, idiopathic pulmonary hypertension; GBD,Global Burden of Diseases; CHD, congenital heart disease SLE, systemic lupus erythematosus;CTD,connective tissue diseases; DAYLs,disability adjusted life years; GATHER,Guidelines for Accurate and Transparent Health Estimates Reporting; UI,uncertainty intervals; AAPC, average annual percent change; CI,confidence interval; APC,age-period-cohort; BAPC, BayesianAge-Period-Cohort; INLA,integrated nested laplace approximation; ASIR,age-standard incidence rate ; ASPR, age-standardized prevalence rate; ASDR,age-standard death rate; EAPC, estimated annual percent changes, APC, age-period-cohort;RR,rate ratio; RV, right ventricular; ERA,endothelin receptor antagonist; PDE5i,phosphodiesterase-5 inhibitor. Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable Availability of data and materials The data from this study can be accessed openly through the GBD 2021 online database, as outlined in the Methods sections,and also can be obtained by contacting the corresponding author. Competing interests All authors hereby attest that they do not have any conflicts of interest related to this article. Funding This study was funded by Key Research Project of Health Commission of Anhui Province (No. AHWJ2023A10132); Key Project of Natural Science Foundation of Universities of Anhui Province (No.KJ2021A0834); Wannan Medical College High-Level Talent Introduction Program (No.GCCRCJB202320)；Special Research Start-Up Fund for Talent Introduction (YR202450). Authors' contributions LZ conceptualised the study. SSW completed the first draft of the manuscript. ML,YHH and HLW contributed to the study methodology. YSC and ZWL was involved in the interpretation of the data. YSC, JG and LZ provided critical comments on drafts of the manuscript. LZ was responsible for the decision to submit the manuscript. All authors participated in the review of the manuscript and read and approved the final manuscript. All authors had access to the data in the study and had final responsibility to submit for publication. Acknowledgments We acknowledge the exceptional contributions made by the collaborators of the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. We sincerely appreciate the IHME institution for providing the GBD data. References Hassoun PM. Pulmonary Arterial Hypertension. N Engl J Med. 2021;385(25):2361-2376. Boucly A, Gerges C, Savale L, et al. Pulmonary arterial hypertension. Presse Med. 2023;52(3):104168. Tonelli AR, Arelli V, Minai OA, et al. Causes and circumstances of death in pulmonary arterial hypertension. Am J Respir Crit Care Med. 2013;188(3):365-369. Hoeper MM, Humbert M, Souza R, et al. 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Tables Table 1. presents the number of cases and age-standardized incidence rates (ASIR) of pulmonary arterial hypertension in China for the years 1990 and 2021, along with their temporal trends from 1990 to 2021. cases number Incidence rate EAPC,95%CI （1990-2021） 1990,95%UI 2021,95%UI 1990,95%UI 2021,95%UI Both * 5125.86(4139.32,6211.42) 9257.24(7349.72,11507.74) 0.51(0.41,0.62) 0.50(0.40,0.60) -0.12(-0.17,-0.08) male * 2537.10(2041.82,3071.67) 4568.97(3611.35,5721.01) 0.50(0.40,0.60) 0.49(0.40,0.60) -0.03(-0.09,0.02) female * 2588.76(2094.71,3127.96) 4688.27(3732.05,5864.27) 0.52(0.42,0.63) 0.50(0.40,0.61) -0.21(-0.26,-0.17) Age * * ＜5 years 176.44(131.22,237.53) 121.76(90.00,163.41) 0.16(0.12,0.21) 0.16(0.12,0.21) -0.04(-0.07,-0.01) 5-9 years 162.51(118.03,215.26) 147.78(107.22,195.10) 0.16(0.11,0.21) 0.15(0.11,0.20) -0.05(-0.09,-0.01) 10-14 years 158.27(93.34,247.58) 130.84(76.82,203.65) 0.16(0.09,0.24) 0.15(0.09,0.24) -0.07(-0.11,-0.02) 15-19 years 225.55(143.95,346.81) 129.85(82.26,199.89) 0.18(0.11,0.27) 0.17(0.11,0.27) -0.10(-0.16,-0.04) 20-24 years 296.07(189.33,437.69) 160.68(101.82,238.42) 0.22(0.14,0.33) 0.22(0.14,0.33) -0.12(-0.17,-0.07) 25-29 years 296.52(163.33,468.34) 229.92(126.26,367.63) 0.27(0.15,0.43) 0.27(0.15,0.43) -0.11(-0.15,-0.07) 30-34 years 300.47(193.36,442.31) 408.11(260.97,602.43) 0.34(0.22,0.50) 0.34(0.22,0.50) -0.09(-0.13,-0.05) 35-39 years 401.42(267.91，583.04) 457.30(303.38,668.28) 0.44(0.29,0.64) 0.43(0.29,0.63) -0.09(-0.13,-0.05) 40-44 years 360.93(198.05,57.48) 482.46(266.99,763.66) 0.54(0.30,0.85) 0.53(0.29,0.83) -0.09(-0.13,-0.04) 45-49 years 350.49(219.298,51.27) 732.86(457.18,1072.52) 0.68(0.43,0.99) 0.66(0.41,0.97) -0.11(-0.16,-0.05) 50-54 years 408.95(272.40,598.81) 1013.69(675.03,1485.14) 0.86(0.57,1.26) 0.84(0.56,1.23) -0.13(-0.19,-0.07) 55-59 years 448.25(265.48,708.71) 1113.16(659.85,1770.29) 1.03(0.61,1.63) 1.01(0.60,1.61) -0.14(-0.19,-0.08) 60-64 years 443.14(291.02,648.88) 892.68(590.18,1305.06) 1.25(0.82,1.84) 1.22(0.81,1.79) -0.14(-0.18,-0.09) 65-69 years 414.14(296.59,559.20) 1134.91(817.91,1527.88) 1.52(1.09,2.05) 1.48(1.07,1.99) -0.14(-0.18,-0.09) 70-74 years 335.19(220.43,489.32) 925.00(607.86,1346.72) 1.78(1.17,2.60) 1.74(1.14,2.53) -0.14(-0.18,-0.09) 75-79 years 214.48(141.65,307.18) 605.56(397.95,866.10) 1.89(1.25,2.70) 1.83(1.20,2.62) -0.17(-0.21,-0.12) 80-84 years 96.67(69.00,132.30) 347.82(248.73,475.47) 1.83(1.30,2.50) 1.76(1.26,2.40) -0.22(-0.27,-0.16) 85-89 years 29.99(18.49,46.39) 160.39(98.87,250.50) 1.78(1.10,2.75) 1.68(1.04,2.63) -0.27(-0.32,-0.22) 90-94 years 5.61(3.36,8.82) 50.54(29.73,79.20) 1.83(1.10,2.87) 1.72(1.01,2.70) -0.29(-0.34,-0.24) 95+ years 0.80(0.41,1.46) 11.94(6.03,21.77) 1.98(1.00,3.60) 0.87(0.94,3.41) -0.27(-0.31,-0.23) Note:95% UI,95% uncertainty intervals.*, age-standardized of incidence rate; **, crude incidence rate in each age group, EAPC, estimated annual percentage change. Table 2. presents the number of cases and age-standardized prevalence rates (ASPR) of pulmonary arterial hypertension in China for the years 1990 and 2021, along with their temporal trends from 1990 to 2021. cases number Prevalence rate EAPC,95%CI （1990-2021） 1990,95%UI 2021,95%UI 1990,95%UI 2021,95%UI Both * 22027.91(17840.18,27321.46) 41135.19(32838.91,51357.25) 2.07(1.68,2.54) 2.24(1.81,2.75) 0.39(0.34,0.44) male * 9236.83(7510.66,11511.55) 17482.09(13972.87,21744.92) 1.70(1.37,2.09) 1.91(1.54,2.34) 0.56(0.51,0.62) female * 12791.08(10432.22,15798.13) 23653.10(18864.64,29535.98) 2.45(1.99,3.00) 2.57(2.08,3.18) 0.26(0.21,0.32) Age * * ＜5 years 266.46(192.056,365.66) 208.47(149.40,285.26) 0.24(0.17,0.33) 0.27(0.19,0.37) 0.29(0.23,0.36) 5-9 years 500.44(360.48,656.99) 493.40(355.25,650.62) 0.48(0.35,0.63) 0.52(0.37,0.68) 0.34(0.31,0.38) 10-14 years 669.69(446.07,957.53) 606.15(408.65,853.84) 0.66(0.44,0.94) 0.70(0.47,0.99) 0.33(0.28,0.37) 15-19 years 1141.72(658.80,1756.51) 712.923(418.45,1075.24) 0.90(0.52,1.39) 0.96(0.56,1.44) 0.30(0.25,0.34) 20-24 years 1610.51(1067.98,2398.08) 945.97(631.92,1386.88) 1.22(0.81,1.82) 1.29(0.86,1.90) 0.31(0.26,0.36) 25-29 years 1743.19(1157.94,2567.82) 1464.46(977.73,2140.53) 1.59(1.05,2.34) 1.69(1.13,2.48) 0.33(0.29,0.38) 30-34 years 1761.80(1110.00,2628.85) 2603.04(1670.21,3905.22) 2.00(1.26,2.98) 2.15(1.38,3.22) 0.34(0.30,0.37) 35-39 years 2184.36(1496.04,3080.35) 2734.65(1875.72,3865.12) 2.39(1.64,3.37) 2.58(1.77,3.65) 0.36(0.32,0.39) 40-44 years 1818.06(1213.67,2575.10) 2685.29(1806.42,3746.32) 2.71(1.81,3.84) 2.93(1.97,4.09) 0.39(0.34,0.44) 45-49 years 1561.69(977.01,2331.54) 3624.79(2305.10,5319.99) 3.03(1.89,4.52) 3.29(2.09,4.82) 0.42(0.36,0.48) 50-54 years 1684.38(1150.43,2394.31) 4642.16(3187.82,6592.07) 3.53(2.41,5.02) 3.84(2.64,5.45) 0.44(0.38,0.50) 55-59 years 1790.39(1195.29,2550.84) 4941.89(3345.14,7034.48) 4.13(2.76,5.88) 4.50(3.04,6.40) 0.45(0.39,0.50) 60-64 years 1676.82(1061.18,2488.21) 3777.42(2418.20,5571.49) 4.75(3.00,7.04) 5.17(3.31,7.63) 0.44(0.39,0.48) 65-69 years 1466.71(1031.55,2033.45) 4480.52(3147.24,6207.00) 5.38(3.78,7.45) 5.84(4.10,8.09) 0.42(0.37,0.46) 70-74 years 1124.36(777.65,1602.87) 3445.87(2394.75,4866.21) 5.98(4.13,8.52) 6.47(4.49,9.13) 0.39(0.34,0.44) 75-79 years 691.21(432.86,1078.55) 2180.29(1365.44,3332.07) 6.07(3.80,9.48) 6.58(4.12,10.06) 0.42(0.35,0.49) 80-84 years 260.43(172.03,374.47) 1063.65(704.08,1517.02) 4.92(3.25,7.07) 5.37(3.56,7.67) 0.52(0.42,0.61) 85-89 years 65.00(39.45,101.55) 403.86(246.95,625.85) 3.85(2.34,6.02) 4.24(2.59,6.57) 0.54(0.45,0.64) 90-94 years 9.60(5.52,15.51) 100.98(58.50,157.97) 3.13(1.80,5.06) 3.44(2.00,5.4) 0.53(0.43,0.63) 95+ years 1.11(0.56,2.06) 19.41(9.78,34.38) 2.75(1.39,5.10) 3.04(1.53,5.38) 0.54(0.42,0.65) Note:95% UI,95% uncertainty intervals. * , age-standardized prevalence rate; ** , crude incidence rate in each age group, EAPC, estimated annual percentage change. Table 3．presents the number of cases and age-standardized death rates (ASDR) of pulmonary arterial hypertension in China for the years 1990 and 2021, along with their temporal trends from 1990 to 2021. cases number Deaths rate EAPC,95%CI （1990-2021） 1990,95%UI 2021,95%UI 1990,95%UI 2021,95%UI Both * 0.35(0.26,0.43) 7317.95(4835.72,9075.75) 0.61(0.46,0.83) 0.42(0.28,0.51) -0.61(-1.00,-0.22) male * 0.33(0.235,0.478) 3682.53(2327.45,4754.29) 0.71(0.47,1.01) 0.49(0.31,0.62) -0.37(-0.85,0.12) female * 0.36(0.21,0.59) 3635.43(2240.14,4821.16) 0.55(0.34,0.91) 0.37(0.23,0.49) -0.87(-1.18,-0.57) Age ** ＜5 years 0.51(0.34,0.78) 74.84(45.21,111.63) 0.51(0.34,0.78) 0.10(0.06,0.14) -4.30(-4.78,-3.81) 5-9 years 0.04(0.02,0.05) 11.69(7.18,19.21) 0.04(0.02,0.05) 0.01(0.01,0.02) -2.34(-3.12,-1.56) 10-14 years 0.03(0.02,0.04) 10.80(7.01,17.49) 0.03(0.02,0.04) 0.01(0.01,0.02) -1.54(-2.26,-0.81) 15-19 years 0.05(0.04,0.07) 19.96(11.84,29.37) 0.05(0.04,0.07) 0.03(0.02,0.04) -1.76(-2.06,-1.45) 20-24 years 0.06(0.04,0.09) 30.00(19.14,43.64) 0.06(0.04,0.09) 0.04(0.03,0.06) -0.53(-1.03,-0.02) 25-29 years 0.07(0.05,0.10) 39.76(25.39,55.02) 0.07(0.05,0.10) 0.05(0.03,0.06) -0.40(-0.96,0.16) 30-34 years 0.08(0.06,0.12) 62.47(40.62,85.15) 0.08(0.06,0.12) 0.05(0.03,0.07) -0.70(-1.12,-0.28) 35-39 years 0.12(0.09,0.18) 83.88(51.11,116.96) 0.12(0.09,0.18) 0.08(0.05,0.11) -1.38(-1.60,-1.15) 40-44 years 0.21(0.16,0.29) 109.00(70.76,146.07) 0.21(0.16,0.29) 0.12(0.08,0.16) -1.45(-1.78,-1.11) 45-49 years 0.17(0.12,0.23) 102.36(67.29,141.78) 0.17(0.12,0.23) 0.09(0.06,0.13) -1.12(-1.60,-0.65) 50-54 years 0.31(0.23,0.43) 195.83(135.83,262.02) 0.31(0.23,0.43) 0.16(0.11,0.22) -1.65(-1.87,-1.43) 55-59 years 0.51(0.37,0.70) 354.00(203.44,481.54) 0.51(0.37,0.70) 0.32(0.19,0.44) -1.28(-1.54,-1.01) 60-64 years 0.71(0.52,0.97) 318.20(200.70,422.55) 0.71(0.52,0.97) 0.44(0.28,0.58) -0.70(-1.15,-0.24) 65-69 years 1.33(0.99,1.81) 661.90(435.80,865.48) 1.33(0.99,1.81) 0.86(0.57,1.13) -0.64(-1.05,-0.23) 70-74 years 2.54(1.85,3.50) 946.58(598.12,1192.15) 2.54(1.85,3.50) 1.78(1.12,2.24) -0.45(-0.86,-0.03) 75-79 years 4.69(3.31,6.60) 1114.49(666.59,1425.37) 4.69(3.31,6.60) 3.37(2.01,4.30) -0.34(-0.77,0.10) 80-84 years 8.61(5.90,13.05) 1291.43(859.32,1608.08) 8.61(5.90,13.05) 6.53(4.34,8.13) -0.26(-0.68,0.16) 85-89 years 15.70(10.87,22.53) 1179.16(793.78,1464.42) 15.70(10.87,22.53) 12.38(8.33,15.37) -0.23(-0.61,0.14) 90-94 years 23.30(15.81,34.59) 563.78(366.69,710.70) 23.30(15.81,34.59) 19.23(12.51,24.24) 0.05(-0.41,0.51) 95+ years 20.69(12.72,37.05) 147.83(95.91,207.68) 20.69(12.72,37.05) 23.13(15.01,32.50) 1.05(0.56,1.54) Note:95% UI,95% uncertainty intervals. * , age-standardized death rate; ** , crude incidence rate in each age group, EAPC, estimated annual percentage change. Table 4. presents the number of cases and age-standardized disability-adjusted life years of pulmonary arterial hypertension in China for the years 1990 and 2021, along with their temporal trends from 1990 to 2021. cases number DAYLs rate EAPC,95%CI （1990-2021） 1990,95%UI 2021,95%UI 1990,95%UI 2021,95%UI Both * 12.73(9.85,17.22) 150940.71(99583.31，186503.40) 16.18(12.63,21.60) 8.95(6.04,11.13) -1.38(-1.74,-1.01) male * 12.37(9.68,17.12) 75517.87(48308.12,98062.18) 17.09(12.91,23.32) 9.48(6.05,12.04) -1.17(-1.62,-0.72) female * 13.10(7.68,20.99) 75422.84(47178.85,104591.34) 15.80(9.38,25.61) 8.78(5.66,12.69) -1.56(-1.85,-1.27) Age ** ＜5 years 45.87(30.23,69.64) 6716.75(4072.71,9993.89) 45.87(30.23,69.64) 8.65(5.24,12.87) -4.28(-4.77,-3.80) 5-9 years 2.93(2.00,4.25) 1014.59(646.32,1633.79) 2.93(2.00,4.25) 1.06(0.68,1.71) -2.27(-3.03,-1.50) 10-14 years 2.04(1.44,2.97) 892.01(590.06,1407.19) 2.04(1.44,2.97) 1.04(0.69,1.63) -1.46(-2.15,-0.76) 15-19 years 3.79(2.70,5.31) 1512.99(930.11,2205.98) 3.79(2.70,5.31) 2.03(1.25,2.95) -1.70(-2.00,-1.40) 20-24 years 4.06(2.91,6.06) 2115.52(1378.67,3054.40) 4.06(2.91,6.06) 2.89(1.88,4.17) -0.50(-0.99,-0.01) 25-29 years 4.44(3.12,6.42) 2622.94(1723.80,3574.88) 4.44(3.12,6.42) 3.03(1.99,4.13) -0.38(-0.92,0.17) 30-34 years 4.86(3.39,7.22) 3837.34(2581.33,5136.88) 4.86(3.39,7.22) 3.17(2.13,4.24) -0.65(-1.05,-0.25) 35-39 years 6.75(4.84,9.53) 4684.11(2992.15,6411.03) 6.75(4.84,9.53) 4.42(2.82,6.05) -1.30(-1.52,-1.09) 40-44 years 10.29(7.67,14.01) 5457.32(3571.11,7250.93) 10.29(7.67,14.01) 5.96(3.90,7.92) -1.40(-1.72,-1.08) 45-49 years 7.35(5.38,10.26) 4717.28(3214.58,6438.44) 7.35(5.38,10.26) 4.28(2.91,5.84) -1.05(-1.50,-0.59) 50-54 years 12.22(9.13,16.64) 7890.60(5515.25,10361.60) 12.22(9.13,16.64) 6.53(4.56,8.57) -1.57(-1.78,-1.36) 55-59 years 17.42(12.94,23.82) 12334.77(7304.55,16688.40) 17.42(12.94,23.82) 11.22(6.64,15.18) -1.23(-1.48,-0.97) 60-64 years 20.99(15.49,28.52) 9507.08(6127.38,12496.60) 20.99(15.49,28.52) 13.02(8.39,17.12) -0.67(-1.12,-0.22) 65-69 years 32.73(24.44,44.48) 16458.81(10976.93,21324.74) 32.73(24.44,44.48) 21.46(14.31,27.80) -0.62(-1.02,-0.21) 70-74 years 51.33(37.52,70.57) 19235.97(12257.42,24197.57) 51.33(37.52,70.57) 36.09(23.00,45.40) -0.44(-0.85,-0.03) 75-79 years 75.76(53.63,106.36) 17970.33(10826.61,22948.90) 75.76(53.63,106.36) 54.26(32.69,69.29) -0.36(-0.78,0.07) 80-84 years 108.39(74.33,164.02) 16175.47(10777.87,20120.02) 108.39(74.33,164.02) 81.73(54.46,101.66) -0.28(-0.69,0.14) 85-89 years 157.37(108.88,225.59) 11712.77(7890.64,14535.96) 157.37(108.88,225.59) 122.96(82.84,152.60) -0.25(-0.62,0.12) 90-94 years 201.89(137.18,299.51) 4875.81(3172.21,6140.48) 201.89(137.18,299.51) 166.30(108.19,209.43) 0.04(-0.42,0.50) 95+ years 171.31(105.31,306.59) 1208.26(785.27,1693.75) 171.31(105.31,306.59) 189.06(122.87,265.02) 1.01(0.52,1.50) Note:95% UI,95% uncertainty intervals.DAYLs,disability-adjusted life years; * , age-standardized of rate; ** , crude incidence rate in each age group. EAPC, estimated annual percentage change. Additional Declarations No competing interests reported. Supplementary Files supplementalFiles.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 30 Jan, 2025 Editor assigned by journal 29 Jan, 2025 Submission checks completed at journal 29 Jan, 2025 First submitted to journal 25 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5904466","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":408934042,"identity":"27278b4d-0e09-4067-815c-e8890c63a121","order_by":0,"name":"Shuoshuo Wei","email":"","orcid":"","institution":"The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Shuoshuo","middleName":"","lastName":"Wei","suffix":""},{"id":408934043,"identity":"98c107b5-658d-4cc6-8ca8-fc04c194e858","order_by":1,"name":"Yonghui Han","email":"","orcid":"","institution":"The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Yonghui","middleName":"","lastName":"Han","suffix":""},{"id":408934044,"identity":"27343c60-3d6c-4d5b-a1e0-08a46f63f9c8","order_by":2,"name":"Min Liu","email":"","orcid":"","institution":"The Second People's Hospital of Wuhu","correspondingAuthor":false,"prefix":"","firstName":"Min","middleName":"","lastName":"Liu","suffix":""},{"id":408934045,"identity":"8b1dbcfc-551f-4e16-b54e-5c48cb78f7a8","order_by":3,"name":"Hanli Wang","email":"","orcid":"","institution":"The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Hanli","middleName":"","lastName":"Wang","suffix":""},{"id":408934048,"identity":"58de0f38-587e-4e72-a867-7572ebe02b34","order_by":4,"name":"Zhiwei Lu","email":"","orcid":"","institution":"The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Zhiwei","middleName":"","lastName":"Lu","suffix":""},{"id":408934049,"identity":"3dea3bf3-3369-4528-9607-97c9f4a78080","order_by":5,"name":"Yusheng Cheng","email":"","orcid":"","institution":"The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Yusheng","middleName":"","lastName":"Cheng","suffix":""},{"id":408934050,"identity":"888cd522-955a-4993-821a-0fa1b84921fc","order_by":6,"name":"Jun Guo","email":"","orcid":"","institution":"Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, Sichuan","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"Guo","suffix":""},{"id":408934051,"identity":"bb10a2b3-6312-4b5b-a2f0-47d65f6f4895","order_by":7,"name":"Lei Zha","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAw0lEQVRIiWNgGAWjYDACCQbGAwwGNgyMDSRoYQBqSSNZC8NhEtwlP7v5wYEPBecTm/vPmEkw1NhEE9TCOOeYwcEZBrcTG2fkALUcS8sl6EBmiQSDwzxgLTxmEowNhwlrYZNI/3D4j8G5xEaQw4jSwiORY3CYweBAYmNDDpFaJCRyCg72GCQbN85IK7ZIIMYv8jPSNz748cdOdmP/4Y03PtTYENYCA44bGzhMJBKIVQ4C9vIM7I8/kKJjFIyCUTAKRg4AAIjeQ7h24KiyAAAAAElFTkSuQmCC","orcid":"","institution":"The First Affiliated Hospital of Wannan Medical College, Yijishan Hospital of Wannan Medical College)","correspondingAuthor":true,"prefix":"","firstName":"Lei","middleName":"","lastName":"Zha","suffix":""}],"badges":[],"createdAt":"2025-01-26 04:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5904466/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5904466/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75188780,"identity":"85aa1b50-36dd-4bdc-bb7f-13df849ac161","added_by":"auto","created_at":"2025-01-31 18:02:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":264027,"visible":true,"origin":"","legend":"\u003cp\u003eIllustrates the incidence, prevalence, mortality, and disability-adjusted life years (DAYLs) associated with PAH in China for the year 2021, segmented by age and sex. Detailing the incidence (Panel A), prevalence (Panel B), mortality (Panel C), and Disability-Adjusted Life Years (DALYs) (Panel D) associated with the condition. Shading represents the upper and lower limits of the 95% uncertainty intervals (95% UIs).\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5904466/v1/97fcc5f60a68d402d65f94f0.png"},{"id":75188782,"identity":"344ab6fb-e7f4-4919-9c7c-581c108054ab","added_by":"auto","created_at":"2025-01-31 18:02:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":290814,"visible":true,"origin":"","legend":"\u003cp\u003eAverage Annual Percentage Changes (AAPCs) in Pulmonary Arterial Hypertension Metrics in China (1990-2021). Panel A: Trends in age-standardized incidence rate；Panel B: Trends in age-standardized prevalence rate；Panel C: Trends in age-standardized mortality rate；Panel D: Trends in age-standardized disability-adjusted life years (DALYs).\u003c/p\u003e\n\u003cp\u003eAbbreviations: ASIR, age-standardized incidence rates; ASPR, age-standardized prevalence rates; ASDR, age-standardized death rates;ASYR, age-standardized disability-adjusted life year; APC, annual percent change.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-5904466/v1/de4330831a70bc58a3141579.png"},{"id":75188781,"identity":"3c8c5a16-84f9-4920-9f74-0f7faf7ad5e8","added_by":"auto","created_at":"2025-01-31 18:02:19","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":132160,"visible":true,"origin":"","legend":"\u003cp\u003eAge, Period, and Cohort Effects on Pulmonary Arterial Hypertension Incidence and Mortality in China: Relative Risk Analysis. Panel A: Age effects on incidence relative risk; Panel B: Period effects on incidence relative risk; Panel C: Cohort effects on incidence relative risk; Panel D: Age effects on mortality relative risk;Panel E: Period effects on mortality relative risk; Panel F: Cohort effects on mortality relative risk.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-5904466/v1/931a00fc54be124a1440afc9.png"},{"id":75188791,"identity":"764e7b0c-915f-45fd-84cf-5627e3635e45","added_by":"auto","created_at":"2025-01-31 18:02:19","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":142534,"visible":true,"origin":"","legend":"\u003cp\u003eTemporal Trends and Projections of Pulmonary Arterial Hypertension Burden in China, 1990-2050.Panel A: Projected age-standardized incidence rate; Panel B: Projected age-standardized prevalence rate; Panel C: Projected age-standardized mortality rate; Panel D: Projected age-standardized disability-adjusted life years (DALY). Red dot lines and blue shaded regions represent the predicted trend and 95% CI.\u003c/p\u003e\n\u003cp\u003eAbbreviations: ASIR, age-standardized incidence rates;ASPR:age-standardized prevalence rates;ASDR:age-standardized death rates ; ASYR,age-standardized disability-adjusted life year.CI, confidence interval.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-5904466/v1/e3e8e4d95d1408aac3658f77.png"},{"id":75191178,"identity":"bbc1af43-db25-4369-a36c-48268e5b8556","added_by":"auto","created_at":"2025-01-31 18:18:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1994552,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5904466/v1/08c15711-ef05-4a1c-9df1-85bd322d753b.pdf"},{"id":75188779,"identity":"dfab0430-50b1-4ed6-9c46-7effa507fbdb","added_by":"auto","created_at":"2025-01-31 18:02:18","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":70227,"visible":true,"origin":"","legend":"","description":"","filename":"supplementalFiles.docx","url":"https://assets-eu.researchsquare.com/files/rs-5904466/v1/38bd2df4abfb7e37a52ff14c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Burden of Pulmonary Arterial Hypertension in China from 1990 to 2021, with Projections to 2050: An Analysis of Data from the Global Burden of Disease Study 2021","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePulmonary arterial hypertension (PAH), a severe and life-threatening subtype of pulmonary hypertension (PH), is characterized by significant remodeling of the pulmonary vasculature\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. This remodeling process leads to a progressive increase in pulmonary vascular resistance, imposing a substantial workload on the right ventricle\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. The resulting ventricular strain induces hypertrophy and remodeling, ultimately compromising cardiac function and contributing to disease-related morbidity and mortality\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Globally, PAH represents a significant public health challenge affecting all age groups\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, substantially impacting patients' quality of life and placing considerable burdens on healthcare systems and economies\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePAH is the Group 1 subtype of pulmonary hypertension which encompasses various etiologies, including idiopathic origins, heritable connective tissue diseases, congenital heart defects, portal hypertension, HIV infection, drug and toxin exposure, and multifactorial causes. Idiopathic PAH (IPAH) represents the predominant subtype, accounting for 50\u0026ndash;60% of cases\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. The disease presents with nonspecific symptoms that develop insidiously, including exertional dyspnea, fatigue, chest pain, syncope, palpitations, and peripheral edema\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR8\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. These manifestations significantly impact patients' physical mobility and emotional well-being, compromising their health-related quality of life\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Despite advances in targeted therapies improving outcomes and quality of life, the five-year survival rate remains relatively low at approximately 60%\u003csup\u003e6,12\u003c/sup\u003e. Significant challenges persist, including ongoing disability and and extensive healthcare needs, which impose substantial financial burdens on patients, healthcare systems, and society\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eGlobal epidemiological data on PAH primarily derives from registry-based studies\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Prevalence rates vary geographically, ranging from 15 to 50 cases per million in the US and Europe\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, with the US reporting approximately 25 cases per million\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e and Central Australia showing a higher prevalence of 48 per million\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. The Global Burden of Diseases (GBD) study recently provided comprehensive global data, reporting an age-standardized prevalence of 2.28 per 100,000 and an age-standardized mortality rate of 0.27 deaths per 100,000 population in 2021, with women and elderly populations disproportionately affected\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. In China, the epidemiological landscape differs notably, with congenital heart disease (CHD)-associated PAH being most prevalent\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, and a higher proportion of systemic lupus Erythematosus(SLE)-associated PAH in connective tissue diseases(CTD)\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. However, comprehensive epidemiological data for China remains limited\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Available studies suggests lower incidence and survival rates compared to Western countries; however, the prevalence may be underestimated due to diagnostic challenges and underreported cases\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan additionalcitationids=\"CR26\" citationid=\"CR26\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWith the comprehensive data provided by GBD 2021, which integrates multiple sources through advanced statistical modeling\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e, we have a unique opportunity to conduct an in-depth assessment of the PAH disease burden in China. Our analysis encompasses trends in prevalence, incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021, with projections extending to 2050, focusing exclusively on Group 1 PAH. This assessment aims to provide crucial insights for developing targeted prevention and treatment strategies that address the evolving healthcare needs of the Chinese population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eOverview\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis is a population study based on a publicly available database that utilized data from the Global Burden of Disease (GBD) 2021 study, accessible at http://ghdx.healthdata.org/gbd-results-tool. GBD 2021, the project\u0026apos;s latest iteration, assessed the burden of 371 diseases, injuries and 88 risk factors for 204 countries and territories from 1990\u0026ndash;2021\u003csup\u003e28\u003c/sup\u003e. The GBD database employs advanced statistical methods to address missing data and adjust for confounding factors. Detailed descriptions of the GBD study design and methodologies are available in the existing literature\u003csup\u003e28\u003c/sup\u003e. Furthermore, the GBD Study adheres to the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) Statement \u003csup\u003e29\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData acquisition and download\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe GBD study provides a comprehensive assessment of disease burden by cause, age, sex, year, and location, enabling direct comparisons across populations, time periods, and regions. This study specifically focused on the burden of PAH. From the GBD 2021 database, we extracted data on PAH for all ages, including age-standardized, age-specific, and sex-specific prevalence, incidence, mortality, and DALYs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs), with 95% uncertainty intervals (UIs) derived from the 25th and 95th values of 1,000 statistical draws\u003csup\u003e30\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe current hemodynamic definition of PAH includes three key criteria obtained through right heart catheterization: a resting mean pulmonary arterial pressure exceeding 20 mm Hg, a pulmonary capillary wedge pressure below 15 mm Hg, and a pulmonary vascular resistance of at least 2 Wood units\u003csup\u003e31\u003c/sup\u003e. In resource-limited settings, echocardiography is often used to estimate pulmonary arterial pressure, although this method can impact the sensitivity and specificity of the diagnosis. The GBD study applied a standardized case definition requiring a physician diagnosis of PAH, supported by evidence from either right heart catheterization or echocardiography. Vital registration records were mapped to the GBD cause hierarchy using specific ICD codes: 416.0 (ICD-9) and I27.0 (ICD-10). To ensure the most accurate and conservative estimates of PAH burden, the analysis was restricted to deaths coded as I27.0 after the introduction of I27.2, with all input data from affected locations prior to I27.2 implementation excluded. This study focused exclusively on Group 1 PAH, excluding other forms of pulmonary hypertension.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA comprehensive assessment was conducted to quantify the burden of PAH in China in 2021, including prevalence, incidence, mortality, and DALYs. The analysis also examined the distribution of the disease burden across different age groups and genders. To evaluate time trends in prevalence, incidence, mortality, and DALY rates from 1990 to 2021, we calculated the average annual percent changes (AAPCs) with corresponding 95% confidence intervals (CIs) using joinpoint regression analysis\u003csup\u003e32\u003c/sup\u003e. We also employed age-period-cohort (APC) modeling to assess the associations between age, period, birth cohort, and PAH mortality\u003csup\u003e33\u003c/sup\u003e. APC and AAPC were considered statistically significant if the 95% CI did not overlap with zero and the \u003cem\u003eP\u003c/em\u003e \u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003eBayesian Age-Period-Cohort (BAPC) models were used to project future trends, utilizing integrated nested Laplace approximations (INLA) for full Bayesian inference. Critical features of BAPC models include the generation of age-specific and age-standardized projected rates and the automatic incorporation of Poisson noise for predictive distributions \u003csup\u003e34\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e35\u003c/sup\u003e. The preceding BAPC analysis is based on the R package \u0026quot;BAPC\u0026quot; (version 0.0.36) and \u0026quot;INLA\u0026quot; (version 24.02.09)\u003csup\u003e36\u003c/sup\u003e. All statistical analyses and visualizations were conducted using the R statistical software program (version 4.4.3) and JD_GBDR (V2.31, Jing ding Medical Technology Co.Ltd).\u003cem\u003e\u0026nbsp;P\u003c/em\u003e\u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBurden of Pulmonary Arterial Hypertension in 2021\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe burden of PAH was measured through incidence, prevalence, mortality, and DALYs, along with their age-standardized rates for all ages in 2021. In China, there were 9257 incidence cases (95%UI:7349.72,11507.74) of PAH, with an age-standard incidence rate (ASIR) of 0.50 per 100,000, comprising 4,569 males and 4,688 females (\u003cstrong\u003eTable 1\u003c/strong\u003e). The prevalence reached 41,135 cases (95% UI: 32,838.91,51,357.25) with an age-standardized prevalence rate (ASPR) of 2.24 per 100,000, with females accounting for nearly 58% of cases (\u003cstrong\u003eTable 2\u003c/strong\u003e). PAH contributes to 7318 deaths (95%UI:4835.72,9075.75) with an age-standard death rate (ASDR) of 0.42 per 100,000, including 3683 males and 3635 females (\u003cstrong\u003eTable 3\u003c/strong\u003e). The DALYs attributed to \u0026nbsp;150941 (95%UI: 99583.31,186503.40) with an age-standardized DALY rate of 8.95(95%UI:6.04,11.13) per 100,000 person-years (\u003cstrong\u003eTable 4\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnalysis of age-specific patterns revealed distinct distributions across different measures and metrics (\u003cstrong\u003eFigure 1\u003c/strong\u003e). The highest number of incident cases was observed in the 65-69 age group (1135 cases), while the peak crude incidence rate occurred in the 75-79 age group (1.83 per 100,000) (\u003cstrong\u003eFigure 1A\u003c/strong\u003e). For prevalence, the highest number of cases was recorded in the 55-59 age group (4,942 cases), while the highest crude prevalence rate was observed in the 75-79 age group (6.58 per 100,000) \u003cstrong\u003e(Figure 1B).\u0026nbsp;\u003c/strong\u003eBy contrast to prevalence, the greatest number of deaths occurred in the 80-84 age group (1,291 cases), while the highest crude death rate was observed in individuals aged 95+ years (23.13 per 100,000)\u0026nbsp;(\u003cstrong\u003eFigure 1C\u003c/strong\u003e). The 70-74 age group had the largest number of DALYs (19236 cases), with the highest DALYs rate occurring in the 95+ age group (189.06 per 100,000) (\u003cstrong\u003eFigure 1D\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eGender-specific analysis revealed distinct trends in the burden of PAH. Among individuals younger than 50-54 years, the number of incident cases was higher in males than in females. However, starting from the 55\u0026ndash;59 age group, the number of incident cases in females gradually surpassed that of males. The highest number of incident cases in females was observed in the 65-69 age group (579 cases), while the peak incidence rate was observed in the 95+ age group (1.90 per 100,000) (\u003cstrong\u003eFigure 1A, Supplementary eTable 1\u003c/strong\u003e). Prevalence was consistently higher in females across all age groups. The largest number of prevalent cases in females was recorded in the 55-59 years age group (2869 cases), while the highest prevalence rate occurred in the 75-79 years age group (7.38/100,000) (\u003cstrong\u003eFigure 1B, Supplementary eTable 2\u003c/strong\u003e).\u0026nbsp;Mortality data showed that males aged 55-94 years had higher death cases compared to females in the same age range.\u0026nbsp;Among females, the highest number of deaths occurred in the 80-84 age group (634 cases), while the highest death rate was observed in the 90-94 age group (29.86 per 100,000) (\u003cstrong\u003eFigure 1C, Supplementary eTable 3\u003c/strong\u003e).\u0026nbsp;For DAYLs, males had higher rates than females starting from the 50-54 age group, except in the 95+ age group. The DAYLs rate peaked at 258.70 per 100,1000 in males aged 90-94 years and at 193.40 per 100,000 in females aged 95+ years (\u003cstrong\u003eFigure 1D, Supplementary eTable 4\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrends of Pulmonary Arterial Hypertension from 1990 to 2021\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom 1990 to 2021, the ASIR of PAH per 100,000 decreased slightly from 0.51 (95% UI: 0.41,0.62) to 0.50 (95% UI: 0.40,0.60), with an estimated annual percent changes(EAPC) of -0.12 (95% CI: -0.17,-0.08). The decline in ASIR was more pronounced in females (-0.21, 95% CI: -0.26, -0.17) compared to males (-0.03, 95% CI: -0.09, 0.02) (\u003cstrong\u003eTable 1\u003c/strong\u003e). In contrast, the ASPR per 100,000 increased from 2.07(95%UI:1.68,2.54) in 1990 to 2.24(95%UI:1.81,2.75) in 2021, with an EAPC of 0.39(95% CI:0.34,0.44). The increase in ASPR was faster in males at 0.56(95%CI:0.51,0.62) than in females at 0.26(0.21,0.32) (\u003cstrong\u003eTable 2\u003c/strong\u003e). The ASDR per 100,000 decreased from 0.61 (95% UI: 0.46\u0026ndash;0.83) in 1990 to 0.42 (95% UI: 0.28, 0.51) in 2021, with an EAPC of -0.61 (95% UI: -1.00 to, 0.22). The decline in ASDR was more pronounced in females (-0.87, 95% CI: -1.18,-0.57) compared to males (-0.37, 95% CI: -0.85, 0.12) (\u003cstrong\u003eTable 3\u003c/strong\u003e). Similarly, the age-standardized DALY rate per 100,000 declined significantly from 16.18(95%UI:12.63,21.60) in 1990 to 8.95(95%UI:6.04,11.13) in 2021 with an EAPC of -1.38(95%CI: -1.74,-1.01). The decline in DAYL rates was faster in females (-1.56,95%CI:-1.85,-1.27) compared to males (-1.17,95%CI:-1.62,-0.72) (\u003cstrong\u003eTable 4)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTemporal Trends of Pulmonary Arterial Hypertension Burdens in China\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing Joinpoint models, the age-standard incidence rate (ASIR) of PAH showed three declining phases followed by a significant increase. From 1990 to 2000, the ASIR declined at an annual percentage change (APC) of -0.444%, followed by a slower decline from 2000 to 2008 (APC = -0.050%) and a moderate decline from 2008 to 2016 (APC = -0.223%). However, from 2016 to 2021, the ASIR significantly increased with an APC of 0.712%. Over the entire study period, the average annual percent change (AAPC) was 0 \u003cstrong\u003e(Figure 2A).\u0026nbsp;\u003c/strong\u003eThe \u0026nbsp;age-standard prevalence rate (ASPR) showed a steady increase from 1990 to 2013, with APCs of 0.287% (1990-1995) and 0.531% (1995-2013). From 2013 to 2019, the prevalence trend increased moderately (APC = 0.068%), but from 2019 to 2021, the ASPR declined significantly (APC = -1.471%). The overall AAPC for the study period was 0.005% (95%CI: 0.005% to 0.006%, \u003cem\u003eP\u003c/em\u003e＜0.05) (\u003cstrong\u003eFigure 2B\u003c/strong\u003e).\u0026nbsp;The ASDR decreased significantly by -2.548% per year from 1990 to 2001, followed by a slower decline from 2001 to 2006 (APC = -0.303%). The death rate increased from 2006 to 2010 (APC = -6.684%), but declined rapidly from 2010 to 2021 (APC = -3.852%). The overall AAPC for the study period was -0.007% (95%CI: -0.008% to 0.007%, \u003cem\u003eP\u003c/em\u003e＞0.05) (\u003cstrong\u003eFigure 2C\u003c/strong\u003e). By contrast, the age-standardized DAYL rate decreased significantly from 1990 to 2004 (APC= -3.096%), followed by an increase from 2004 to 2011(APC = 4.519%). From 2011 to 2021, the DAYL rate decreased again, with APCs of -4.867% (2011-2017) and -2.574% (2017-2021). The overall AAPC of DAYL for the study period was -0.257% (95%CI:-0.268% to 0.247%, \u003cem\u003eP\u003c/em\u003e＜0.05) (\u003cstrong\u003eFigure 2D\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAge, Period, and Cohort Effects on Incidence and Death Rates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAge Effect\u003c/p\u003e\n\u003cp\u003eThe age-period-cohort (APC) analysis revealed distinct PAH incidence and mortality patterns. After controlling for period and cohort effects, the age effect showed that incidence rate risk substantially increased with age, reaching a peak in the 75-79 age group, followed by a slight decrease before rising again in the 95+ age group (\u003cstrong\u003eFigure 3A, Supplementary eTable\u003c/strong\u003e \u003cstrong\u003e5)\u003c/strong\u003e. From age groups＜5 years to 75-79 years, the incidence increased by 10.81-fold. The PAH death rate showed a continuous increase with advancing age from the 70-74 age group, with the death rate in the 95+ age group being approximately 38.81 times higher than in the\u0026nbsp;＜5 age group（\u003cstrong\u003eFigure 3D, Supplementary eTable 5\u003c/strong\u003e）.\u003c/p\u003e\n\u003cp\u003ePeriod Effect\u003c/p\u003e\n\u003cp\u003eThe period effect analysis revealed that incidence risk gradually declined from 1995 (RR = 1.03, 95% CI: 0.99 to 1.07) to 2015 (RR = 0.98, 95% CI: 0.95 to 1.02), followed by a slight increase from 2015 to 2020 (RR = 1.00, 95% CI: 0.96 to 1.04) \u003cstrong\u003e(Figure 3B, Supplementary eTable 5).\u003c/strong\u003e Mortality rates showed a decline from 1995 (RR = 1.31, 95% CI: 1.25 to 1.37) to 2005 (RR = 1.09, 95% CI: 1.04 to 1.14), followed by an increase from 2005 to 2010 (RR = 1.23, 95% CI: 1.18 to 1.28), and then another decline from 2010 to 2020 (RR = 0.91, 95% CI: 0.87 to 0.95) \u003cstrong\u003e(Figure 3E, Supplementary eTable 5).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCohort Effect\u003c/p\u003e\n\u003cp\u003eThe cohort effects analysis of incidence risk (\u003cstrong\u003eFigure 3C, Supplementary eTable 5\u003c/strong\u003e) revealed an inverse relationship between birth cohort and risk levels. The 1895-1899 cohort exhibited the highest incidence risk (\u003cem\u003eRR\u003c/em\u003e=1.11, 95% CI: 0.14-8.13). A distinct pattern emerged: cohorts from 1895-1955 showed elevated incidence rate ratios (\u003cem\u003eRR\u003c/em\u003e \u0026gt;1), while cohorts from 1981-2021 demonstrated reduced ratios (\u003cem\u003eRR\u003c/em\u003e \u0026lt;1). Overall, the incidence rate ratio displayed a declining trend. For mortality risk, the cohort effects analysis (\u003cstrong\u003eFigure 3F, Supplementary eTable 5\u003c/strong\u003e) showed that cohorts born between 1895-1919 experienced elevated death rate ratios (\u003cem\u003eRR\u003c/em\u003e \u0026gt;1), peaking in the 1915-1919 cohort (\u003cem\u003eRR\u003c/em\u003e=1.29, 95% CI: 1.18-1.41). From 1920 onward, death rate ratios steadily declined, with the most pronounced decrease observed in cohorts 1991-2021.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProjected Burden of Pulmonary Arterial Hypertension from 2021 to 2050\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing data from the GBD database (1990-2021), we employed the Bayesian Age-Period-Cohort (BAPC) model to project the future burden of PAH in China through 2050. The ASIR for China\u0026apos;s total population is projected to decline modestly from 0.493 per 100,000 in 2021 to 0.486 per 100,000 by 2050, representing a 1.42% decrease\u003cstrong\u003e\u0026nbsp;(Figure 4A)\u003c/strong\u003e. Regarding gender-specific ASIR, the projections showing an increase in male from 0.488 to 0.493 per 100,000 and a decrease in female from 0.493 to 0.475 per 100,000\u003cstrong\u003e\u0026nbsp;(Supplementary eTable 6)\u003c/strong\u003e. In contrast, the ASPR is expected to reach 2.443 per 100,000 by 2050, representing an 8.29% increase from 2021 levels \u003cstrong\u003e(Figure 4B)\u003c/strong\u003e, with male rising from 1.907 to 2.163 per 100,000 and female increasing from 2.573 to 2.725 per 100,000, respectively \u003cstrong\u003e(Supplementary eTable 6)\u003c/strong\u003e. The ASDR shows a substantial projected decline for the total population, decreasing from 0.418 per 100,000 to 0.236 per 100,000 by 2050, representing a 43.54% reduction \u003cstrong\u003e(Figure 4C)\u003c/strong\u003e, with male decreasing from 0.498 to 0.283 per 100,000 and female declining from 0.374 to 0.211 per 100,000\u003cstrong\u003e\u0026nbsp;(Supplementary eTable 6)\u003c/strong\u003e. The age-standardized DALY rate is projected to demonstrate the most substantial improvement, with a remarkable decrease of 49.69%, reaching 4.370 per 100,000 by 2050\u0026nbsp;(\u003cstrong\u003eFigure 4D\u003c/strong\u003e)/ Specfically, the rate for males is expected to decline\u0026nbsp;to 4.942 per 100,000, while the rate for female will decrease to 4.067 per 100,000 (\u003cstrong\u003eSupplementary eTable 6\u003c/strong\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study represents the first comprehensive analysis of PAH disease burden in China based on the GBD 2021 data, providing crucial epidemiological insights from 1990 to 2021. Our findings reveal that in 2021, the burden of PAH in China experienced an incidence rate of 0.51 per 100,000 population, a prevalence rate of 2.24 per 100,000, a mortality rate of 0.42 per 100,000, and a DALY rate of 8.95 per 100,000. Compared to 1990, while the incidence, mortality, and DALYs have declined, the prevalence has increased. The observed prevalence increase might be attributed to several factors: improved early diagnostic techniques, an aging population, increased exposure to risk factors (including tobacco smoke, drug abuse, and environmental pollutants), and lacking awareness among healthcare providers and the public\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan additionalcitationids=\"CR38 CR39 CR40 CR41\" citationid=\"CR38\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. Our findings align with previous registry-based studies. The French registry (2002\u0026ndash;2003) reported an incidence of 0.24 and a prevalence of 1.5 per 100,000\u003csup\u003e15\u003c/sup\u003e, while the US REVEAL registry (2006\u0026ndash;2007) documented an incidence of 0.20 and a prevalence of 1.06 per 100,000\u003csup\u003e43\u003c/sup\u003e. The current global GBD estimate of 2.28 prevalent cases per 100,000 in 2021 closely matches our finding of 2.24 per 100,000 in China\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, validating the reliability of GBD data for PAH surveillance. Nevertherless, the mortality rate of PAH in China (0.42 per 100,000) exceeds the average death rate globally (0.27 per 100,000). This disparity likely stems from unbalanced medical resource distribution and delayed diagnosis, particularly in rural areas, leading to more advanced-stage diagnoses when treatment efficacy is reduced\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan additionalcitationids=\"CR45\" citationid=\"CR45\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. Therefore, in the future, efforts should focus on improving access to medical resources and early diagnosis in rural areas.\u003c/p\u003e \u003cp\u003eGender-specific analysis reveals higher incidence (0.50 vs 0.49 per 100,000) and prevalence (2.57 vs 1.97 per 100,000) in females compared to males. However, males experience higher mortality (0.49 vs 0.37 per 100,000) and DALY rates (9.48 vs 8.78 per 100,000). These discrepancies align with findings from previous studies, which indicate that while females are more susceptible to developing PAH, they tend to exhibit better right ventricular (RV) function and higher survival rates compared to males\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan additionalcitationids=\"CR48\" citationid=\"CR48\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e. This phenomenon, often referred to as the \"estrogen paradox\" or \"estrogen puzzle,\" is partly attributed to the protective effects of estrogen on vascular and RV function\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e50\u003c/span\u003e,\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e. Additionally, females are more likely to respond positively to treatment with prostacyclin analogs, which may contribute to their lower mortality rates. These factors affirm the long-standing recognition that PAH is more prevalent in females but often more severe in males\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHistorically, PAH was believed to have a higher incidence among younger individuals, particularly younger females\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e49\u003c/span\u003e,\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e53\u003c/span\u003e,\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e. This view arose from studies focused on specific types of PAH, which are more common in younger populations. However, as research has advanced, it has become evident that PAH incidence increases significantly in older adults. Our study shows that the peak age-standardized incidence and prevalence occur in the 75\u0026ndash;79 age group, while mortality rates increase with advancing age. These findings are consistent with global GBD estimates\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, suggesting that the growing recognition of PAH in older populations may be due to the availability of PAH-specific therapies and the widespread use of Doppler echocardiography\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e, improving the diagnosis in older adults.\u003c/p\u003e \u003cp\u003eLooking ahead, our 30-year projections suggest declining overall incidence and mortality. This trend is likely driven by advancements in PAH management, including the use of endothelin receptor antagonists (ERAs), phosphodiesterase-5 inhibitors (PDE5is), prostacyclin analogs, and novel therapeutic strategies such as initial combination therapy, exercise training, and psychological support\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan additionalcitationids=\"CR56\" citationid=\"CR56\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e. These treatments have demonstrably improved symptoms, slowed disease progression, and extended survival, contributing to reduced mortality and morbidity. However, the prevalence rate is projected to rise, which might be driven by the aging population, unhealthy lifestyle factors (e.g., smoking, obesity, and physical inactivity), and environmental pollution\u003csup\u003e\u003cspan additionalcitationids=\"CR59 CR60\" citationid=\"CR59\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e. Additionally, advancements in diagnostic tools, including echocardiography, CT, MRI, hemodynamic variables (e.g., right atrial pressure, cardiac index, and venous oxygen saturation), and biomarker utilization could also increase the number of diagnosed cases\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan additionalcitationids=\"CR63 CR64 CR65\" citationid=\"CR63\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u003c/sup\u003e. This increase should not be interpreted as a genuine rise in incidence but rather as a result of improved diagnostic accuracy. These findings underscore the need for continued surveillance, targeted interventions, and further research to address the complex epidemiological trends of PAH in China. Future studies should focus on quantifying the impact of various risk factors and developing effective public health strategies to manage this challenging condition.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, it focuses exclusively on group 1 PAH and does not include groups 2\u0026ndash;5 pulmonary hypertension, which limits the scope of our findings. Second, the diagnosis of PAH is complex, and many primary medical institutions may lack the necessary diagnostic equipment and trained professionals. This can lead to a high prevalence of missed or misdiagnosed cases, potentially resulting in an underestimation of PAH cases in the GBD database. Third, we could not obtain data on pulmonary hypertension across different provinces in China, preventing us from analyzing regional and urban-rural disparities in the burden of pulmonary hypertension. Future research should prioritize large-scale, high-quality epidemiological studies that integrate multiple data sources to more accurately assess the epidemiological characteristics of PAH in China. Furthermore, improving PAH diagnostic and reporting systems is crucial for enhancing data quality. These advancements will facilitate better utilization of the GBD database and other resources, enabling a more precise evaluation of the PAH disease burden in China. However, despite these limitaitons, this study still could offer valuable insights into the temporal trends and overall burden of PAH in China, providing an important foundation for future research and public health planning.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003ePAH remains a significant public health challenge in China, with an estimated 41,135 individuals affected in 2021, leading to 7,318 deaths and 150,941 DALYs. The burden is particularly pronounced among women and older adults, underscoring the need for gender- and age-specific strategies to address this condition. While projections indicate a continued decline in PAH incidence and mortality rates, the prevalence of PAH is expected to rise, driven by demographic shifts and persistent risk factors. These findings emphasize the urgent need for sustained efforts to enhance early detection, expand access to specialized care, and implement targeted public health interventions to mitigate the growing burden of PAH in China. Future research should prioritize addressing regional disparities, quantifying the influence of risk factors, and developing innovative strategies to reduce the disease burden and improve patient outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePAH, pulmonary arterial hypertension; PH, pulmonary hypertension, IPAH, idiopathic pulmonary hypertension; GBD,Global Burden of Diseases; CHD, congenital heart disease SLE, systemic lupus erythematosus;CTD,connective tissue diseases; DAYLs,disability adjusted life years; GATHER,Guidelines for Accurate and Transparent Health Estimates Reporting; UI,uncertainty intervals; AAPC, average annual percent change; CI,confidence interval; APC,age-period-cohort; BAPC, BayesianAge-Period-Cohort; INLA,integrated\u0026nbsp; nested laplace approximation; ASIR,age-standard incidence rate ; ASPR, age-standardized prevalence rate; ASDR,age-standard death rate; EAPC, estimated annual percent changes, APC, age-period-cohort;RR,rate ratio; RV, right ventricular; ERA,endothelin receptor antagonist; PDE5i,phosphodiesterase-5 inhibitor.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data from this study can be accessed openly through the GBD 2021 online database, as outlined in the Methods sections,and also can be obtained by contacting the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors hereby attest that they do not have any conflicts of interest related to this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Key Research Project of Health Commission of Anhui Province (No. AHWJ2023A10132); Key Project of Natural Science Foundation of Universities of Anhui Province (No.KJ2021A0834); Wannan Medical College High-Level Talent Introduction Program (No.GCCRCJB202320)；Special Research Start-Up Fund for Talent Introduction (YR202450).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLZ conceptualised the study. SSW completed the first draft of the manuscript. ML,YHH and HLW contributed to the study methodology. YSC and ZWL was involved in the interpretation of the data. YSC, JG and LZ provided critical comments on drafts of the manuscript. LZ was responsible for the decision to submit the manuscript. All authors participated in the review of the manuscript and read and approved the final manuscript. All authors had access to the data in the study and had final responsibility to submit for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the exceptional contributions made by the collaborators of the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. We sincerely appreciate the IHME institution for providing the GBD data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHassoun PM. 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Prevalence of Pulmonary Hypertension in the General Population: The Rotterdam Study. \u003cem\u003ePLoS One. \u003c/em\u003e2015;10(6):e0130072. \u003c/li\u003e\n\u003cli\u003eSchiess R, Senn O, Fischler M, et al. Tobacco smoke: a risk factor for pulmonary arterial hypertension? A case-control study. \u003cem\u003eChest. \u003c/em\u003e2010;138(5):1086-1092. \u003c/li\u003e\n\u003cli\u003eKolaitis NA, Saggar R, De Marco T. Methamphetamine-associated pulmonary arterial hypertension. \u003cem\u003eCurr Opin Pulm Med. \u003c/em\u003e2022;28(5):352-360. \u003c/li\u003e\n\u003cli\u003eSavale L, Chaumais MC, Cottin V, et al. Pulmonary hypertension associated with benfluorex exposure. \u003cem\u003eEur Respir J. \u003c/em\u003e2012;40(5):1164-1172.\u003c/li\u003e\n\u003cli\u003eMcGee M, Whitehead N, Martin J, Collins N. Drug-associated pulmonary arterial hypertension. \u003cem\u003eClin Toxicol (Phila). \u003c/em\u003e2018;56(9):801-809. \u003c/li\u003e\n\u003cli\u003eLiu Q, Yang Y, Wu M, et al. Hub gene ELK3-mediated reprogramming lipid metabolism regulates phenotypic switching of pulmonary artery smooth muscle cells to develop pulmonary arterial hypertension induced by PM(2.5). \u003cem\u003eJ Hazard Mater. \u003c/em\u003e2024;465:133190. \u003c/li\u003e\n\u003cli\u003eBadesch DB, Raskob GE, Elliott CG, et al. Pulmonary arterial hypertension: baseline characteristics from the REVEAL Registry. \u003cem\u003eChest. \u003c/em\u003e2010;137(2):376-387. \u003c/li\u003e\n\u003cli\u003eSong S, Yuan B, Zhang L, et al. Increased Inequalities in Health Resource and Access to Health Care in Rural China. \u003cem\u003eInt J Environ Res Public Health. \u003c/em\u003e2018;16(1). \u003c/li\u003e\n\u003cli\u003eQuan R, Zhang G, Yu Z, et al. Characteristics, goal-oriented treatments and survival of pulmonary arterial hypertension in China: Insights from a national multicentre prospective registry. \u003cem\u003eRespirology. \u003c/em\u003e2022;27(7):517-528.\u003c/li\u003e\n\u003cli\u003eDuBrock HM, Germack HD, Gauthier-Loiselle M, et al. Economic Burden of Delayed Diagnosis in Patients with Pulmonary Arterial Hypertension (PAH). \u003cem\u003ePharmacoecon Open. \u003c/em\u003e2024;8(1):133-146.\u003c/li\u003e\n\u003cli\u003eSong S, Lee SE, Oh SK, et al. Demographics, treatment trends, and survival rate in incident pulmonary artery hypertension in Korea: A nationwide study based on the health insurance review and assessment service database. \u003cem\u003ePLoS One. \u003c/em\u003e2018;13(12):e0209148. \u003c/li\u003e\n\u003cli\u003eEmmons-Bell S, Johnson C, Boon-Dooley A, et al. Prevalence, incidence, and survival of pulmonary arterial hypertension: A systematic review for the global burden of disease 2020 study. \u003cem\u003ePulm Circ. \u003c/em\u003e2022;12(1):e12020.\u003c/li\u003e\n\u003cli\u003eD\u0026apos;Alonzo GE, Barst RJ, Ayres SM, et al. Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. \u003cem\u003eAnn Intern Med. \u003c/em\u003e1991;115(5):343-349.\u003c/li\u003e\n\u003cli\u003eSweeney L, Voelkel NF. Estrogen exposure, obesity and thyroid disease in women with severe pulmonary hypertension. \u003cem\u003eEur J Med Res. \u003c/em\u003e2009;14(10):433-442. \u003c/li\u003e\n\u003cli\u003eHester J, Ventetuolo C, Lahm T. Sex, Gender, and Sex Hormones in Pulmonary Hypertension and Right Ventricular Failure. \u003cem\u003eCompr Physiol. \u003c/em\u003e2019;10(1):125-170. \u003c/li\u003e\n\u003cli\u003eFrantz RP, Schilz RJ, Chakinala MM, et al. Hospitalization and survival in patients using epoprostenol for injection in the PROSPECT observational study. \u003cem\u003eChest. \u003c/em\u003e2015;147(2):484-494.\u003c/li\u003e\n\u003cli\u003eThenappan T, Shah SJ, Rich S, Tian L, Archer SL, Gomberg-Maitland M. Survival in pulmonary arterial hypertension: a reappraisal of the NIH risk stratification equation. \u003cem\u003eEur Respir J. \u003c/em\u003e2010;35(5):1079-1087.\u003c/li\u003e\n\u003cli\u003eD\u0026apos;Agostino A, Guindani P, Scaglione G, et al. Sex- and Gender-Related Aspects in Pulmonary Hypertension. \u003cem\u003eHeart Fail Clin. \u003c/em\u003e2023;19(1):11-24.\u003c/li\u003e\n\u003cli\u003eMaron BA, Abman SH, Elliott CG, et al. Pulmonary Arterial Hypertension: Diagnosis, Treatment, and Novel Advances. \u003cem\u003eAm J Respir Crit Care Med. \u003c/em\u003e2021;203(12):1472-1487.\u003c/li\u003e\n\u003cli\u003eRuopp NF, Cockrill BA. Diagnosis and Treatment of Pulmonary Arterial Hypertension: A Review. \u003cem\u003eJama. \u003c/em\u003e2022;327(14):1379-1391.\u003c/li\u003e\n\u003cli\u003eMoutchia J, McClelland RL, Al-Naamani N, et al. Pulmonary arterial hypertension treatment: an individual participant data network meta-analysis. \u003cem\u003eEur Heart J. \u003c/em\u003e2024;45(21):1937-1952.\u003c/li\u003e\n\u003cli\u003eFrost AE, Zhao C, Farber HW, et al. Smoking history and pulmonary arterial hypertension: Demographics, onset, and outcomes. \u003cem\u003eJ Heart Lung Transplant. \u003c/em\u003e2023;42(3):377-389. \u003c/li\u003e\n\u003cli\u003eMair KM, Harvey KY, Henry AD, Hillyard DZ, Nilsen M, MacLean MR. Obesity alters oestrogen metabolism and contributes to pulmonary arterial hypertension. \u003cem\u003eEur Respir J. \u003c/em\u003e2019;53(6).\u003c/li\u003e\n\u003cli\u003eSofianopoulou E, Kaptoge S, Gr\u0026auml;f S, et al. Traffic exposures, air pollution and outcomes in pulmonary arterial hypertension: a UK cohort study analysis. \u003cem\u003eEur Respir J. \u003c/em\u003e2019;53(5). \u003c/li\u003e\n\u003cli\u003eLichtblau M, Reimann L, Piccari L. Pulmonary vascular disease, environmental pollution, and climate change. \u003cem\u003ePulm Circ. \u003c/em\u003e2024;14(2):e12394.\u003c/li\u003e\n\u003cli\u003eLuna-L\u0026oacute;pez R, Ruiz Mart\u0026iacute;n A, Escribano Sub\u0026iacute;as P. Pulmonary arterial hypertension. \u003cem\u003eMed Clin (Barc). \u003c/em\u003e2022;158(12):622-629.\u003c/li\u003e\n\u003cli\u003eHumbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. \u003cem\u003eEur Respir J. \u003c/em\u003e2023;61(1). \u003c/li\u003e\n\u003cli\u003eHumbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. \u003cem\u003eEur Heart J. \u003c/em\u003e2022;43(38):3618-3731. \u003c/li\u003e\n\u003cli\u003eBoucly A, Weatherald J, Savale L, et al. External validation of a refined four-stratum risk assessment score from the French pulmonary hypertension registry. \u003cem\u003eEur Respir J. \u003c/em\u003e2022;59(6).\u003c/li\u003e\n\u003cli\u003eHoeper MM, Pausch C, Olsson KM, et al. COMPERA 2.0: a refined four-stratum risk assessment model for pulmonary arterial hypertension. Eur Respir J. 2022;60(1). \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. presents the number of cases and age-standardized incidence rates (ASIR) of pulmonary arterial hypertension in China for the years 1990 and 2021, along with their temporal trends from 1990 to 2021.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 359px;\"\u003e\n \u003cp\u003ecases number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 226px;\"\u003e\n \u003cp\u003eIncidence rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 127px;\"\u003e\n \u003cp\u003eEAPC,95%CI\u003c/p\u003e\n \u003cp\u003e（1990-2021）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e1990,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e2021,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1990,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2021,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003eBoth\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e5125.86(4139.32,6211.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e9257.24(7349.72,11507.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.51(0.41,0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.50(0.40,0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.12(-0.17,-0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003emale\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e2537.10(2041.82,3071.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e4568.97(3611.35,5721.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.50(0.40,0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.49(0.40,0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.03(-0.09,0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003efemale\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e2588.76(2094.71,3127.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e4688.27(3732.05,5864.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.52(0.42,0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.50(0.40,0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.21(-0.26,-0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003csup\u003e*\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e＜5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e176.44(131.22,237.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e121.76(90.00,163.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.16(0.12,0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.16(0.12,0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.04(-0.07,-0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e5-9 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e162.51(118.03,215.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e147.78(107.22,195.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.16(0.11,0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.15(0.11,0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.05(-0.09,-0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e10-14 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e158.27(93.34,247.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e130.84(76.82,203.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.16(0.09,0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.15(0.09,0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.07(-0.11,-0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e15-19 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e225.55(143.95,346.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e129.85(82.26,199.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.18(0.11,0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.17(0.11,0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.10(-0.16,-0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e20-24 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e296.07(189.33,437.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e160.68(101.82,238.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.22(0.14,0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.22(0.14,0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.12(-0.17,-0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e25-29 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e296.52(163.33,468.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e229.92(126.26,367.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.27(0.15,0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.27(0.15,0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.11(-0.15,-0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e30-34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e300.47(193.36,442.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e408.11(260.97,602.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.34(0.22,0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.34(0.22,0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.09(-0.13,-0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e35-39 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e401.42(267.91，583.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e457.30(303.38,668.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.44(0.29,0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.43(0.29,0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.09(-0.13,-0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e40-44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e360.93(198.05,57.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e482.46(266.99,763.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.54(0.30,0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.53(0.29,0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.09(-0.13,-0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e45-49 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e350.49(219.298,51.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e732.86(457.18,1072.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.68(0.43,0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.66(0.41,0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.11(-0.16,-0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e50-54 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e408.95(272.40,598.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e1013.69(675.03,1485.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.86(0.57,1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.84(0.56,1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.13(-0.19,-0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e55-59 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e448.25(265.48,708.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e1113.16(659.85,1770.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.03(0.61,1.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.01(0.60,1.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.14(-0.19,-0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e60-64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e443.14(291.02,648.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e892.68(590.18,1305.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.25(0.82,1.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.22(0.81,1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.14(-0.18,-0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e65-69 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e414.14(296.59,559.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e1134.91(817.91,1527.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.52(1.09,2.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.48(1.07,1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.14(-0.18,-0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e70-74 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e335.19(220.43,489.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e925.00(607.86,1346.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.78(1.17,2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.74(1.14,2.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.14(-0.18,-0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e75-79 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e214.48(141.65,307.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e605.56(397.95,866.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.89(1.25,2.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.83(1.20,2.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.17(-0.21,-0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e80-84 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e96.67(69.00,132.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e347.82(248.73,475.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.83(1.30,2.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.76(1.26,2.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.22(-0.27,-0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e85-89 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e29.99(18.49,46.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e160.39(98.87,250.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.78(1.10,2.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.68(1.04,2.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.27(-0.32,-0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e90-94 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e5.61(3.36,8.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e50.54(29.73,79.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.83(1.10,2.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.72(1.01,2.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.29(-0.34,-0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e95+ years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e0.80(0.41,1.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e11.94(6.03,21.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.98(1.00,3.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.87(0.94,3.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.27(-0.31,-0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote:95% UI,95% uncertainty intervals.*, age-standardized of incidence rate; **, crude incidence rate in each age group, EAPC, estimated annual percentage change.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. presents the number of cases and age-standardized prevalence rates (ASPR) of pulmonary arterial hypertension in China for the years 1990 and 2021, along with their temporal trends from 1990 to 2021.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 397px;\"\u003e\n \u003cp\u003ecases number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 236px;\"\u003e\n \u003cp\u003ePrevalence rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 161px;\"\u003e\n \u003cp\u003eEAPC,95%CI\u003c/p\u003e\n \u003cp\u003e（1990-2021）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1990,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e2021,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1990,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2021,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eBoth\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e22027.91(17840.18,27321.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e41135.19(32838.91,51357.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2.07(1.68,2.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2.24(1.81,2.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.39(0.34,0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003emale\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e9236.83(7510.66,11511.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e17482.09(13972.87,21744.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1.70(1.37,2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.91(1.54,2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.56(0.51,0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003efemale\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e12791.08(10432.22,15798.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e23653.10(18864.64,29535.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2.45(1.99,3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2.57(2.08,3.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.26(0.21,0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003csup\u003e*\u003c/sup\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e＜5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e266.46(192.056,365.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e208.47(149.40,285.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.24(0.17,0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.27(0.19,0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.29(0.23,0.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e5-9 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e500.44(360.48,656.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e493.40(355.25,650.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.48(0.35,0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.52(0.37,0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.34(0.31,0.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e10-14 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e669.69(446.07,957.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e606.15(408.65,853.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.66(0.44,0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.70(0.47,0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.33(0.28,0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e15-19 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1141.72(658.80,1756.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e712.923(418.45,1075.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e0.90(0.52,1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0.96(0.56,1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.30(0.25,0.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e20-24 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1610.51(1067.98,2398.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e945.97(631.92,1386.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1.22(0.81,1.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.29(0.86,1.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.31(0.26,0.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e25-29 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1743.19(1157.94,2567.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1464.46(977.73,2140.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1.59(1.05,2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e1.69(1.13,2.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.33(0.29,0.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e30-34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1761.80(1110.00,2628.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e2603.04(1670.21,3905.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2.00(1.26,2.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2.15(1.38,3.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.34(0.30,0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e35-39 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e2184.36(1496.04,3080.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e2734.65(1875.72,3865.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2.39(1.64,3.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2.58(1.77,3.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.36(0.32,0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e40-44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1818.06(1213.67,2575.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e2685.29(1806.42,3746.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2.71(1.81,3.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e2.93(1.97,4.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.39(0.34,0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e45-49 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1561.69(977.01,2331.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e3624.79(2305.10,5319.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3.03(1.89,4.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e3.29(2.09,4.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.42(0.36,0.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e50-54 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1684.38(1150.43,2394.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e4642.16(3187.82,6592.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3.53(2.41,5.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e3.84(2.64,5.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.44(0.38,0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e55-59 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1790.39(1195.29,2550.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e4941.89(3345.14,7034.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e4.13(2.76,5.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e4.50(3.04,6.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.45(0.39,0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e60-64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1676.82(1061.18,2488.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e3777.42(2418.20,5571.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e4.75(3.00,7.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e5.17(3.31,7.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.44(0.39,0.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e65-69 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1466.71(1031.55,2033.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e4480.52(3147.24,6207.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5.38(3.78,7.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e5.84(4.10,8.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.42(0.37,0.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e70-74 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1124.36(777.65,1602.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e3445.87(2394.75,4866.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5.98(4.13,8.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e6.47(4.49,9.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.39(0.34,0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e75-79 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e691.21(432.86,1078.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e2180.29(1365.44,3332.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e6.07(3.80,9.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e6.58(4.12,10.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.42(0.35,0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e80-84 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e260.43(172.03,374.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1063.65(704.08,1517.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e4.92(3.25,7.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e5.37(3.56,7.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.52(0.42,0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e85-89 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e65.00(39.45,101.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e403.86(246.95,625.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3.85(2.34,6.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e4.24(2.59,6.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.54(0.45,0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e90-94 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e9.60(5.52,15.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e100.98(58.50,157.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e3.13(1.80,5.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e3.44(2.00,5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.53(0.43,0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e95+ years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e1.11(0.56,2.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 198px;\"\u003e\n \u003cp\u003e19.41(9.78,34.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2.75(1.39,5.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e3.04(1.53,5.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003e0.54(0.42,0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Note:95% UI,95% uncertainty intervals.\u003csup\u003e*\u003c/sup\u003e, age-standardized prevalence rate; \u003csup\u003e**\u003c/sup\u003e, crude incidence rate in each age group, EAPC, estimated annual percentage change.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3．presents the number of cases and age-standardized death rates (ASDR) of pulmonary arterial hypertension in China for the years 1990 and 2021, along with their temporal trends from 1990 to 2021.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 345px;\"\u003e\n \u003cp\u003ecases number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 293px;\"\u003e\n \u003cp\u003eDeaths rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 132px;\"\u003e\n \u003cp\u003eEAPC,95%CI\u003c/p\u003e\n \u003cp\u003e（1990-2021）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e1990,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e2021,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e1990,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e2021,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eBoth\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.35(0.26,0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e7317.95(4835.72,9075.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.61(0.46,0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.42(0.28,0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.61(-1.00,-0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003emale\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.33(0.235,0.478)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e3682.53(2327.45,4754.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.71(0.47,1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.49(0.31,0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.37(-0.85,0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003efemale\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.36(0.21,0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e3635.43(2240.14,4821.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.55(0.34,0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.37(0.23,0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.87(-1.18,-0.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eAge\u003csup\u003e**\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e＜5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.51(0.34,0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e74.84(45.21,111.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.51(0.34,0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.10(0.06,0.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-4.30(-4.78,-3.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e5-9 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.04(0.02,0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e11.69(7.18,19.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.04(0.02,0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.01(0.01,0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-2.34(-3.12,-1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e10-14 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.03(0.02,0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e10.80(7.01,17.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.03(0.02,0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.01(0.01,0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-1.54(-2.26,-0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e15-19 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.05(0.04,0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e19.96(11.84,29.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.05(0.04,0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.03(0.02,0.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-1.76(-2.06,-1.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e20-24 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.06(0.04,0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e30.00(19.14,43.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.06(0.04,0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.04(0.03,0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.53(-1.03,-0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e25-29 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.07(0.05,0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e39.76(25.39,55.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.07(0.05,0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.05(0.03,0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.40(-0.96,0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e30-34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.08(0.06,0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e62.47(40.62,85.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.08(0.06,0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.05(0.03,0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.70(-1.12,-0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e35-39 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.12(0.09,0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e83.88(51.11,116.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.12(0.09,0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.08(0.05,0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-1.38(-1.60,-1.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e40-44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.21(0.16,0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e109.00(70.76,146.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.21(0.16,0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.12(0.08,0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-1.45(-1.78,-1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e45-49 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.17(0.12,0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e102.36(67.29,141.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.17(0.12,0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.09(0.06,0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-1.12(-1.60,-0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e50-54 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.31(0.23,0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e195.83(135.83,262.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.31(0.23,0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.16(0.11,0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-1.65(-1.87,-1.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e55-59 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.51(0.37,0.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e354.00(203.44,481.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.51(0.37,0.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.32(0.19,0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-1.28(-1.54,-1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e60-64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e0.71(0.52,0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e318.20(200.70,422.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.71(0.52,0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.44(0.28,0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.70(-1.15,-0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e65-69 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e1.33(0.99,1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e661.90(435.80,865.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e1.33(0.99,1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.86(0.57,1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.64(-1.05,-0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e70-74 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e2.54(1.85,3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e946.58(598.12,1192.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e2.54(1.85,3.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e1.78(1.12,2.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.45(-0.86,-0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e75-79 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e4.69(3.31,6.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e1114.49(666.59,1425.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e4.69(3.31,6.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e3.37(2.01,4.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.34(-0.77,0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e80-84 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e8.61(5.90,13.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e1291.43(859.32,1608.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e8.61(5.90,13.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e6.53(4.34,8.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.26(-0.68,0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e85-89 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e15.70(10.87,22.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e1179.16(793.78,1464.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e15.70(10.87,22.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e12.38(8.33,15.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e-0.23(-0.61,0.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e90-94 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e23.30(15.81,34.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e563.78(366.69,710.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e23.30(15.81,34.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e19.23(12.51,24.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e0.05(-0.41,0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e95+ years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 166px;\"\u003e\n \u003cp\u003e20.69(12.72,37.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e147.83(95.91,207.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e20.69(12.72,37.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e23.13(15.01,32.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.05(0.56,1.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Note:95% UI,95% uncertainty intervals.\u003csup\u003e*\u003c/sup\u003e, age-standardized death rate; \u003csup\u003e**\u003c/sup\u003e, crude incidence rate in each age group, EAPC, estimated annual percentage change.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4. presents the number of cases and age-standardized disability-adjusted life years of pulmonary arterial hypertension in China for the years 1990 and 2021, along with their temporal trends from 1990 to 2021.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 351px;\"\u003e\n \u003cp\u003ecases number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 297px;\"\u003e\n \u003cp\u003eDAYLs rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 127px;\"\u003e\n \u003cp\u003eEAPC,95%CI\u003c/p\u003e\n \u003cp\u003e（1990-2021）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e1990,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e2021,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e1990,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e2021,95%UI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eBoth\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e12.73(9.85,17.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e150940.71(99583.31，186503.40)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e16.18(12.63,21.60)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e8.95(6.04,11.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-1.38(-1.74,-1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003emale\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e12.37(9.68,17.12)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e75517.87(48308.12,98062.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e17.09(12.91,23.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e9.48(6.05,12.04)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-1.17(-1.62,-0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003efemale\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e13.10(7.68,20.99)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e75422.84(47178.85,104591.34)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e15.80(9.38,25.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e8.78(5.66,12.69)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-1.56(-1.85,-1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003eAge\u003csup\u003e**\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e＜5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e45.87(30.23,69.64)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e6716.75(4072.71,9993.89)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e45.87(30.23,69.64)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e8.65(5.24,12.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-4.28(-4.77,-3.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e5-9 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e2.93(2.00,4.25)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e1014.59(646.32,1633.79)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;2.93(2.00,4.25)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;1.06(0.68,1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-2.27(-3.03,-1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e10-14 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e2.04(1.44,2.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e892.01(590.06,1407.19)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;2.04(1.44,2.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e1.04(0.69,1.63)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-1.46(-2.15,-0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e15-19 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e3.79(2.70,5.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e1512.99(930.11,2205.98)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e3.79(2.70,5.31)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;2.03(1.25,2.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-1.70(-2.00,-1.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e20-24 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;4.06(2.91,6.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e2115.52(1378.67,3054.40)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e4.06(2.91,6.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e2.89(1.88,4.17)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.50(-0.99,-0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e25-29 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e4.44(3.12,6.42)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e2622.94(1723.80,3574.88)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e4.44(3.12,6.42)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e3.03(1.99,4.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.38(-0.92,0.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e30-34 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;4.86(3.39,7.22)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e3837.34(2581.33,5136.88)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e4.86(3.39,7.22)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e3.17(2.13,4.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.65(-1.05,-0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e35-39 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;6.75(4.84,9.53)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e4684.11(2992.15,6411.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e6.75(4.84,9.53)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e4.42(2.82,6.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-1.30(-1.52,-1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e40-44 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e10.29(7.67,14.01)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e\u0026nbsp;5457.32(3571.11,7250.93)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;10.29(7.67,14.01)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e5.96(3.90,7.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-1.40(-1.72,-1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e45-49 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e7.35(5.38,10.26)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e4717.28(3214.58,6438.44)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e7.35(5.38,10.26)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e4.28(2.91,5.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-1.05(-1.50,-0.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e50-54 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;12.22(9.13,16.64)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e7890.60(5515.25,10361.60)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e12.22(9.13,16.64)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e6.53(4.56,8.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-1.57(-1.78,-1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e55-59 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;17.42(12.94,23.82)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e12334.77(7304.55,16688.40)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;17.42(12.94,23.82)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e11.22(6.64,15.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-1.23(-1.48,-0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e60-64 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e20.99(15.49,28.52)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e9507.08(6127.38,12496.60)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;20.99(15.49,28.52)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e13.02(8.39,17.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.67(-1.12,-0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e65-69 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e32.73(24.44,44.48)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e16458.81(10976.93,21324.74)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;32.73(24.44,44.48)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e21.46(14.31,27.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.62(-1.02,-0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e70-74 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;51.33(37.52,70.57)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e19235.97(12257.42,24197.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;51.33(37.52,70.57)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e36.09(23.00,45.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.44(-0.85,-0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e75-79 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e75.76(53.63,106.36)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e17970.33(10826.61,22948.90)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;75.76(53.63,106.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e54.26(32.69,69.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.36(-0.78,0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e80-84 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e108.39(74.33,164.02)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e16175.47(10777.87,20120.02)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;108.39(74.33,164.02)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e81.73(54.46,101.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.28(-0.69,0.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e85-89 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e157.37(108.88,225.59)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e11712.77(7890.64,14535.96)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e157.37(108.88,225.59)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e122.96(82.84,152.60)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e-0.25(-0.62,0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e90-94 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e\u0026nbsp;201.89(137.18,299.51)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e4875.81(3172.21,6140.48)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e201.89(137.18,299.51)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e166.30(108.19,209.43)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e0.04(-0.42,0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 83px;\"\u003e\n \u003cp\u003e95+ years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 146px;\"\u003e\n \u003cp\u003e171.31(105.31,306.59)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 205px;\"\u003e\n \u003cp\u003e1208.26(785.27,1693.75)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;171.31(105.31,306.59)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 140px;\"\u003e\n \u003cp\u003e189.06(122.87,265.02)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e1.01(0.52,1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote:95% UI,95% uncertainty intervals.DAYLs,disability-adjusted life years;\u003csup\u003e*\u003c/sup\u003e, age-standardized of rate; \u003csup\u003e**\u003c/sup\u003e, crude incidence rate in each age group. EAPC, estimated annual percentage change.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pulmonary arterial hypertension, disease burden, epidemiology, Global Burden of Disease, China","lastPublishedDoi":"10.21203/rs.3.rs-5904466/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5904466/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePulmonary arterial hypertension (PAH) is a severe condition with high morbidity and mortality, yet its epidemiology in China remains poorly understood. This study aims to assess the burden of PAH in China from 1990 to 2021 and project trends to 2050, providing insights for effective management and prevention strategies.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eData from the Global Burden of Disease (GBD) Study 2021 were analyzed, focusing exclusively on PAH. Key metrics included incidence, prevalence, mortality, and disability-adjusted life years (DALYs), along with their corresponding age-standardized rates (ASRs). Average annual percent changes (AAPCs) were calculated using joinpoint regression analysis, and a Bayesian age-period-cohort model was employed to project trends through 2050.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn 2021, there were 41,135 estimated prevalent cases of PAH (95% UI: 32,838.91 to 51,357.25) in China, with an age-standardized prevalence rate (ASPR) of 2.24 per 100,000. Females accounted for approximately 58% of cases. PAH caused 7,318 deaths (95% UI: 4,835.72 to 9,075.75; 3,683 males, 3,635 females), with an age-standardized death rate (ASDR) of 0.42 per 100,000. From 1990 to 2021, the ASPR increased slightly from 2.07 (95% UI: 1.68 to 2.54) to 2.24 (95% UI: 1.81 to 2.75), while the ASDR decreased from 0.61 (95% UI: 0.46 to 0.83) to 0.42 (95% UI: 0.28 to 0.51). Projections suggest declining trends in both ASPR and ASDR, although the overall prevalence of PAH is expected to rise over the next 30 years.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePAH imposes a significant disease burden in China, particularly among women and older adults. These findings highlight the urgent need to enhance diagnostic capabilities and develop improved treatment strategies to address this challenging condition in the Chinese population.\u003c/p\u003e","manuscriptTitle":"Burden of Pulmonary Arterial Hypertension in China from 1990 to 2021, with Projections to 2050: An Analysis of Data from the Global Burden of Disease Study 2021","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-31 18:02:14","doi":"10.21203/rs.3.rs-5904466/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-30T06:19:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-29T10:05:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-29T10:04:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-01-26T04:10:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"466b6174-7edb-4bb9-930a-164cea023902","owner":[],"postedDate":"January 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-02-03T15:53:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-31 18:02:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5904466","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5904466","identity":"rs-5904466","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}