Epidemiological Trends of Vascular Intestinal Disease in the Elderly (1990–2021): A Study on Its Causal Relationship With Hypertension

OBJECTIVE: To estimate the disability-adjusted life-years (DALYs) and incidence of vascular intestinal disease (VID) in individuals aged 65 years and above and identify its causal relationship with hypertension. METHODS: Analysis of VID burden focused on the incidence and DALYs in individuals aged 65 years and above. Socioeconomic inequalities were evaluated using the slope and concentration indices. Temporal trends of VID were evaluated with age-period-cohort (APC) modeling and Bayesian projections. Mendelian randomization (MR) analysis was employed to investigate the causal relationship between hypertension and VID. RESULTS: From 1990 to 2021, the global age-standardized DALYs rate (ASDR) and age-standardized incidence rate (ASIR) for VID declined, while the absolute number of incident cases increased. In 2021, the incident cases and DALYs reached 789 979 (95% uncertainty interval [UI] 615 343-978 593) and 1 116 683 (95% UI 996 036-1 210 921), with ASIR and ASDR of 105.59 per 100 000 (95% UI [82.43-130.50] per 100 000) and 151.66 per 100 000 (95% UI [134.58-164.67] per 100 000), respectively. Eastern Europe showed the highest DALYs rates. Bayesian APC projections indicated declining age-standardized rates but rising absolute numbers by 2040. MR analysis revealed hypertension as a significant causal risk factor for VID, with an odds ratio of 2.817 for inverse-variance-weighted and 3.618 for weighted median methods. CONCLUSION: Although VID burden remains high in high-income regions, its overall ASDR and ASIR have been declining. Meanwhile, hypertension is a causal factor for VID.