Abstract
Peripheral artery disease is a major cardiovascular disease that affected 202 million people worldwide in 2010. In the past decade, new epidemiological data on peripheral artery disease have emerged, enabling us to provide updated estimates of the prevalence and risk factors for peripheral artery disease globally and regionally and, for the first time, nationally. For this systematic review and analysis, we did a comprehensive literature search for studies reporting on the prevalence of peripheral artery disease in the general population that were published between Jan 1, 2011, and April 30, 2019, in PubMed, MEDLINE, Embase, the Global Health database, CINAHL, the Global Health Library, the Allied and Complementary Medicine Database, and ProQuest Dissertations and Theses Global. We also included the Global Peripheral Artery Disease Study of 2013 and the China Peripheral Artery Disease Study as sources. Peripheral artery disease had to be defined as an ankle-brachial index lower than or equal to 0·90. With a purpose-built data collection form, data on study characteristics, sample characteristics, prevalence, and risk factors were abstracted from all the included studies identified from the sources. Age-specific and sex-specific prevalence of peripheral artery disease was estimated in both high-income countries (HICs) and low-income and middle-income countries (LMICs). We also did random-effects meta-analyses to pool the odds ratios of 30 risk factors for peripheral artery disease in HICs and LMICs. UN population data were used to generate the number of people affected by the disease in 2015. Finally, we derived the regional and national numbers of people with peripheral artery disease on the basis of a risk factor-based model. We included 118 articles for systematic review and analysis. The prevalence of peripheral artery disease increased consistently with age. At younger ages, prevalence was slightly higher in LMICs than HICs (4·32%, 95% CI 3·01-6·29, vs 3·54%, 1·17-10·24, at 40-44 years), but the increase with age was greater in HICs than LMICs, leading to a higher prevalence in HICs than LMICs at older ages (21·24%, 15·22-28·90, vs 12·04%, 8·67-16·60, at 80-84 years). In HICs, prevalence was slightly higher in women than in men up to age 75 years (eg, 7·81%, 3·97-14·77, vs 6·60%, 3·74-11·38, at 55-59 years), whereas in LMICs little difference was found between women and men (eg, 6·40%, 5·06-8·05, vs 6·37%, 4·74-8·49, at 55-59 years). Overall, the global prevalence of peripheral artery disease in people aged 25 years and older was 5·56%, 3·79-8·55, and the prevalence estimate was higher in HICs than that in LMICs (7·37%, 4·35-13·66, vs 5·09%, 3·64-7·24). Smoking, diabetes, hypertension, and hypercholesterolaemia were major risk factors for peripheral artery disease. Globally, a total of 236·62 million people aged 25 years and older were living with peripheral artery disease in 2015, among whom 72·91% were in LMICs. The Western Pacific Region had the most peripheral artery disease cases (74·08 million), whereas the Eastern Mediterranean Region had the least (14·67 million). More than two thirds of the global peripheral artery disease cases were concentrated in 15 individual countries in 2015. Peripheral artery disease continues to become an increasingly serious public health problem, especially in LMICs. With the demographic trend towards ageing and projected rise in important risk factors, a larger burden of peripheral artery disease is to be expected in the foreseeable future. None.
Highlights
Study approach Similar to the Global Peripheral Artery Disease Study of 2013,10 our study approach can be classified into seven stages: identification of studies that reported peripheral artery disease prevalence in the general population using multiple sources; extraction of data on peripheral artery disease prevalence and risk factors for peripheral artery disease; modelling age-specific and sex-specific prevalence of peripheral artery disease in high-income countries (HICs) and low-income and middle-income countries (LMICs) on the basis of the extracted prevalence data; estimation of the number of people with peripheral artery disease in HICs and LMICs in 2015 by multiplying e1021 www.thelancet.com/lancetgh Vol 7 August 2019
The age-specific and sex-specific prevalence estimates according to the corresponding demographic data derived from the UN Population Division (UNPD);[18] assessment of the associations of major risk factors with peripheral artery disease in HICs and LMICs on the basis of the extracted data on risk factors; distribution of the number of people with peripheral artery disease into different world regions using a risk factor-based model; and generation of the number of people living with peripheral artery disease in 201 countries and territories by the aforementioned risk factor-based model
In the updated literature search, we identified a total of 14 719 records from bibliographic databases
Summary
The specific aims of this study were to estimate the age-specific and sexspecific prevalence of peripheral artery disease in highincome countries (HICs) and LMICs, to investigate major risk factors for peripheral artery disease in HICs and LMICs, and to establish the number of people with peripheral artery disease worldwide, in different geographical and income regions and in different countries and territories in 2015
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