Analysis of burden and equality of lower extremity peripheral artery disease in people aged 40 and above in the Belt and Road partner countries from 1990 to 2021.

Objectives: To analyze the disease burden and inequalities of lower extremity peripheral artery disorders (LEPAD) among people aged 40 and above in the Belt and Road partner countries from 1990 to 2021.

Methods: Data were retrieved from the Global Burden of Disease 2021 database. The age-standardized prevalence rates, mortality rates, and the annual rate of years lived with disability (YLDs) of LEPAD were analyzed. Trends were measured using the estimated annual percentage change (EAPC), and the slope index of inequality (SII) and concentration index were used to quantify the absolute and relative inequalities.

Results: In 2021, the age-standardized prevalence and mortality rates of LEPAD were 3168.26/10⁵ and 3.09/10⁵, increasing by 4.30% and 19.31% compared to 1990, and YLDs rates decreased by 4.00%. Females had higher age-standardized prevalence and YLDs rates, while males had higher mortality rates. The EAPC for prevalence rates was slightly higher in males (0.22%) than in females (0.17%); while the EAPC of age-standardized mortality rate was 2.02% for females, compared to 1.45% for males. From 1990 to 2021, the age-standardized YLDs rates decreased from 16.23/10⁵ to 15.58/10⁵, with a faster decline in females (－0.12%) than in males (－0.06%). LEPAD prevalence varied across countries, with higher burdens in Europe and faster growth in Gulf states. Higher socio-demographic index countries had higher prevalence. Inequity improved, with the SII at 52.90/10⁵ and concentration index at 0.038 in 2021. Gender disparities persisted, with concentration index rising to 0.058 in females and falling to －0.026 in males.

Conclusions: LEPAD prevalence and mortality among people aged 40 and above in the Belt and Road partner countries were risen, while YLDs rates were decreased from 1990 to 2021. Significant differences exist among peoples with different gender and countries, highlighting the need for enhanced screening, health education, and shared public health strategies across the Belt and Road partner countries.