Introduction: Peripheral arterial disease (PAD) is a common condition among older adults. While many patients are asymptomatic, a substantial proportion experience intermittent claudication or critical limb ischemia and require revascularization or bypass surgery. PAD has also been associated with higher rates of cardiovascular and all-cause mortality. Estimates of the prevalence of PAD are essential to a complete understanding of the burden of atherosclerotic disease. We produced national and global estimates of PAD as part of the Global Burden of Disease 2016 Study.
Methods: We used national health surveys which assessed ankle-brachial index, commercial insurance claims databases, and published literature on population-based studies as input data. Our analyses corrected for readmission rates and variation in the use of diagnosis codes. Geospatial disease meta-regression software (DisMod-MR 2.1) was used to generate models separately by sex, location, and year to produce consistent estimates of prevalence. Uncertainty intervals (UI) were estimated using 1000 draws from the posterior distribution of each model. A country-level socio-demographic index (SDI), combining national income per capita, mean years of schooling, and total fertility rate, was used to examine disease burden by level of development.
Results: In 1990, there were an estimated 395 (95%UI: 345 to 453) million prevalent cases of PAD globally in women and 265 (95%UI: 231 to 307) million cases in men. By 2016, these numbers had increased to 695 (95%UI: 613 to 797) million cases in women and 506 (95%UI: 444 to 583) million cases in men. Age-standardized global rates in 1990 were 2106 (95%UI 1847 to 2415) per 100,000 and 1773 (95%UI: 1561 to 2037) per 100,000 in women and men, respectively. In 2016, these rates were 1930 (95%UI: 1702 to 2202) per 100,000 for women and 1658 (95%UI: 1457 to 1900) per 100,000 for men. The largest change in total number of prevalent cases from 1990 to 2016 was seen in middle-SDI countries with a 136% (95%UI: 131% to 137%) change in women and 140% (95%UI: 137% to 143%) change in men, indicating that the overall atherosclerotic burden in these countries is increasing. Comparisons indicate that these changes are largely being driven by population aging in high-SDI countries and by population growth in other locations.
Conclusions: The prevalence of PAD is increasing worldwide, with large increases in low- and middle-SDI countries in particular. These estimates of prevalence provide important estimates of the number of people who may benefit from medical therapies to reduce cardiovascular events.