Comparison of the burden of maternal hypertensive disorders between China and the globe from 1990 to 2023: epidemiological trends and age-period-cohort analysis

OBJECTIVE: To compare epidemiological trends and burden of maternal hypertensive disorders (MHD) between China and the globe from 1990 to 2023 and project future trends through 2035. METHODS: Based on Global Burden of Disease (GBD) 2023 data, temporal trends and age-period-cohort effects were analyzed using Joinpoint regression, Age-Period-Cohort (APC) models, and Nordpred forecasting. RESULTS: From 1990 to 2023, China's MHD incident cases and disability-adjusted life years (DALYs) decreased by 79.73% and 95.33%, respectively. China's age-standardized incidence rate (ASIR) and age-standardized DALY rate (ASDR) remained consistently lower than global averages with a greater magnitude of decline. Joinpoint analysis showed China's ASIR fluctuated, while ASDR declined steadily. APC models revealed an incidence increase among Chinese females aged 35-54, particularly in the 45-49 group (local drift: 3.28%/year), while global incidence declined across all ages. In China, incidence risk was lowest in 2009-2013, with birth cohort risk peaking in 1972-1976. Overall MHD burden is projected to continue declining by 2035. CONCLUSION: Despite overall progress, the rising risk among older pregnant women in China remains a key challenge, necessitating enhanced age-based screening and specialized perinatal care.