The Global Burden of Aortic Aneurysm and Its Attributable Risk Factors, 1990–2021: Results from the Global Burden of Disease Study 2021

Background and Aims: Aortic aneurysm (AA) is a potentially fatal aortic disorder, particularly when complicated by rupture. Using Global Burden of Disease 2021 estimates, this study reported worldwide changes in AA mortality, disability-adjusted life years (DALYs), and modeled risk-attributable burden from 1990 to 2021. Methods: We reported Global Burden of Disease 2021 estimates and summarized findings using counts, percentages, and age-standardized rates. Results: In 2021, the global age-standardized death rate for AA was 1.9 per 100,000, representing a 26.7% decrease since 1990. The global age-standardized DALY rate was 36.5 per 100,000, reflecting a 25.1% reduction. The highest national DALY rates per 100,000 were estimated in Armenia (192.8), Montenegro (178.9), and Nauru (114.5), while the lowest were in Saudi Arabia (5.1), Tajikistan (5.7), and Sri Lanka (6.7). The largest increases in age-standardized DALY rates occurred in Georgia (357.4%), Uzbekistan (320.6%), and Sudan (209.4%), whereas the greatest decreases occurred in Australia (-70.6%), Bermuda (-66.6%), and Canada (-65.9%). For both sexes, DALY rates were highest in the 95+ years group, indicating concentration of fatal burden at advanced age. Smoking, high systolic blood pressure, and high body mass index were the leading modeled contributors to global AA DALYs, accounting for 37.3%, 17.1%, and 8.0%, respectively. Conclusion: This report identified marked variation in AA burden, potentially related to differences in screening, diagnosis, treatment access, and broader health-system capacity. The results support targeted prevention, risk-factor control, and improved vascular care, especially in resource-limited settings. Reducing smoking and high systolic blood pressure may help lessen the future AA burden.