Trends in Peripheral Arterial Disease Incidence and Mortality in EU15+ Countries 1990-2017

Abstract

Introduction: Ischaemic heart disease and cerebrovascular disease mortality rates have reduced over recent decades in Europe and the United States. We assessed whether mortality rates from peripheral arterial disease (PAD) - the third leading cause of atherosclerotic cardiovascular morbidity - showed similar trends. Methods: PAD age-standardised mortality and incidence rates were extracted from the Global Burden of Disease Study database for European Union(EU)15+ countries for the years 1990-2017. Annual mortality-to-incidence indices were calculated for each EU15+ country to provide a population based indicator of changes in disease burden. Results: Between 1990 and 2017, the incidence of PAD was observed to be down-trending in all 19 EU15+ countries for females, and in 18 of 19 countries for males: Increasing PAD incidence was observed only for males in the United States (+1.4%) (Figure 1). In 2017, the highest incidence rates were observed in Denmark and the United States for males (213.6 and 202.3 per 100,000, respectively) and in the United States and Canada for females (194.8 and 171.1 per 100,000, respectively). There was a concomitant overall trend for increasing age-standardised mortality rates in all EU15+ countries for females, and in 16 of 19 EU15+ countries for males over the same time period (Figure 2). Italy (-25.1%), Portugal (-1.9%) and Sweden (-0.6%) were the only countries with reducing mortality rates in males. The largest increases in mortality rates were observed in the United Kingdom (males +140.4%, females +158.0%) and the United States (males +125.7%, females +131.2%). We observed an overall upward trend for mortality-to-incidence indices between 1990-2017 in all EU15+ countries for females, and in 18 of 19 EU15+ countries for males. The mortality-to-incidence trend was reducing only for males in Italy. Conclusion: We identify shifting burden of PAD in EU15+ countries, with increasing mortality rates despite reducing incidence over the past 27-years. Strong evidence supports goal-directed medical therapy in reducing PAD mortality, however inadequate compliance with medical therapy has been reported: population-wide strategies to improve compliance are called for. [Trends in PAD incidence. Squares indicate males; and circles, females] [Trends in PAD mortality. Squares indicate males; and circles, females] Disclosure: Nothing to disclose