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Females, Older Adults Have Higher PAH Prevalence Vs. Males, Younger Adults In 2021

April 28, 2025

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Researchers reported a global PAH prevalence estimate of 192,000 cases in 2021, with females behind a higher number of cases vs. Males.

As individuals grew older, PAH prevalence went up.

In 2021, a greater number of global pulmonary arterial hypertension cases occurred in females vs. Males, and disease prevalence reached its highest point at age 75 to 79 years, according to data published in The Lancet Respiratory Medicine.

"Greater understanding of global epidemiology can direct resources and research towards locations, sexes and age groups most in need, and could identify emerging exposures that might cause PAH in the future," Peter J. Leary, MD, PhD, director of the pulmonary vascular disease program at the University of Washington Medical Center, and colleagues wrote.

Data were derived from GBD 2021 Pulmonary Arterial Hypertension Collaborators, et al. Lancet Respir Med. 2024;doi:10.1016/S2213-2600(24)00295-9.

In this systematic analysis, Leary and colleagues evaluated 204 countries and territories to determine the burden of PAH between 1990 and 2021 on a global scale via epidemiological and vital registry data on PAH.

As Healio previously reported, among adults with PAH, patient characteristics, mortality and treatment varied across four U.S. Census regions.

Researchers reported a global PAH prevalence estimate of 192,000 cases in 2021 (age-standardized, 2.28 cases per 100,000 population), with females behind a higher number of cases vs. Males (119,000 cases [2.75 cases per 100,000 females] vs. 73,100 cases [1.78 cases per 100,000 males]).

Comparing the age-standardized PAH prevalences from 2021 and 1990 (2.3 cases per 100,000 population) revealed little change in this measure with time, researchers wrote.

As individuals grew older, the prevalence of PAH went up. According to the study, the 7.99 PAH cases per 100,000 population in those aged 75 to 79 years was the age group with the greatest prevalence.

When assessing the fatal burden of PAH, researchers observed a global PAH mortality rate of 22,000 deaths in 2021 (age-standardized, 0.27 deaths per 100,000 population), with females having a comparable number of PAH deaths to males (0.28 deaths per 100,000 females vs. 0.27 deaths per 100,000 males).

Comparing the age-standardized PAH mortality rates from 2021 and 1990 (0.35 deaths per 100,000 population) revealed improvement in this measure with time.

Based on age-standardized years of life lost (YLLs), the study noted that the most recent year assessed has shown more improvement in this measure vs. The earliest year assessed (change of 38.2%).

The global YLLs due to PAH in 2021 totaled 624,000. Notably, researchers highlighted YLLs due to chronic myeloid leukemia, multiple sclerosis and Crohn's disease because of their similarity to those due to PAH.

"Moving forward, ongoing attention to straightforward disease definitions, advances in testing and screening, and stronger reporting systems remain vitally important to ensure that countries are consistently capturing the same disease entity when PAH is diagnosed and approximating the full burden from this condition," Leary and colleagues wrote.

Sources/DisclosuresCollapse Disclosures: Cardiovascular Medical Research and Education Fund and the Bill & Melinda Gates Foundation funded this study. Leary reports the following relevant financial disclosures, all outside the submitted work: receiving grants or contracts from the National Heart, Lung, and Blood Institute (NHLBI) through payments to them and their institution (R33/R61: Famotidine RCT; R01: Multi-omics; R33/R61: Valsartan; R01: Methamphetamine PAH), from Bayer through payments to their institution (mentor on a mentored award about FDG-uptake in PAH; no honoraria or salary support), from the Cystic Fibrosis Foundation Therapeutic Development Network through payments to them and their institution, and from Janssen Pharmaceuticals through payments to a third party for data acquisition and analysis; receiving consulting fees from Sumitomo Pharma as personal payments; participating on a data safety monitoring board with the NHLBI; having a leadership or fiduciary role, unpaid, with the Pulmonary Hypertension Association Scientific Leadership Council and the Team Phenomenal Hope Steering Committee; and receiving medical writing support and collation of co-author feedback on a big-data locations of care project (under review) from Janssen Pharmaceuticals. Please see the study for all other authors' relevant financial disclosures.

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Abortion Bans Have Affected Pulmonary/Critical Care Delivery

Abortion bans in the United States have led to delayed and restricted care for patients of pulmonary and critical care physicians, especially among patients with limited resources, according to study findings published in Chest.

Study findings were based on interviews with 29 physicians working in pulmonary or critical care medicine. Researchers hypothesized that these physicians would be affected given that abortion ban laws "limit pregnant persons' access to abortion-related care until serious harm to their health or death is imminent — when they have, by definition, become critically ill." The researchers conducted semi-structured interviews (median length, 30 minutes; range, 19-51 minutes) with clinicians from October 2022 to July 2024.

Participating physicians (16 women, 19 White) worked in California, Georgia, Idaho, Illinois, Indiana, Kentucky, Louisiana, Missouri, Mississippi, Ohio, Oklahoma, South Carolina, Tennessee, Texas, and Wisconsin, with 27 from states with abortion bans and 2 from neighboring states. They had a median of 7 years of experience.

Survey respondents stated that clinical care was hindered for patients with critical illness such as sepsis and for those with chronic pulmonary conditions such as pulmonary hypertension or sarcoidosis after the abortion bans were implemented. Respondents said that some of their patients could no longer access termination services; such patients included those with conditions not perceived as actively life-threatening; those who had medication-related fetal anomalies; and those whose own treatment, including end-of-life care, would endanger their pregnancy.

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Our results suggest laws that circumscribe physicians' abilities to make patient-centered, evidence-based treatment decisions contribute to distress and burnout.

In cases involving life-threatening pregnancies, where the laws allowed abortion access, the laws nevertheless caused delays in care. For example, patients were required to wait until they had significant clinical decline before termination-related treatment could be provided, according to the respondents. Abortion bans also led to delays in care because more individuals were involved in decision-making or determining legality.

Delays in care also occurred when physicians transferred patients to other facilities or states. Respondents who mentioned this problem often highlighted the inequities faced by patients with limited resources, who were more constrained by the time and resources needed to seek care elsewhere. Some respondents worried that laws restricting abortion care might also restrict providers from having conversations about prohibited care, thus creating a liability risk for providers.

All of the pulmonary hypertension specialists from states with abortion bans responded that their patients' access to care had been constrained, and half experienced the death of at least 1 patient resulting from complications of pregnancy or childbirth.

Physicians surveyed also said that the bans affected their well-being and led to moral distress and burnout. In the face of a situation where the physician needed to help a patient terminate a pregnancy, respondents anticipated having varying levels of support from their institutions. Also, some physicians stated that they had considered leaving positions in states with abortion bans and moving elsewhere.

The respondents also sought to minimize the harms that they experienced, and none perceived that their actions had violated their state's laws. Some, however, reported that they had not or would not change the way they practiced, including prioritizing making urgent care decisions. A few reported that they would help individuals access abortion care in a personal role.

The responding clinicians developed approaches for transferring patients who needed emergent termination services and for pre-emptive transfers. Some physicians reported that they were newly politically active by participating in rallies, contacting state legislators, and raising money and awareness for changes.

The investigators noted that the sensitive nature of their research could have dissuaded individuals from responding, and the population included only 1 Hispanic physician and no Black physicians.

"Our results suggest laws that circumscribe physicians' abilities to make patient-centered, evidence-based treatment decisions contribute to distress and burnout, particularly salient in critical care medicine, where burnout is already highly prevalent," the study authors stated. "They further suggest that these laws may worsen disparities in care, including in access to care broadly for populations already living in or near care deserts."

PH, PAH Prevalence Higher In Medicaid With Racial, Ethnic Disparities

Medicaid beneficiaries face higher rates of pulmonary hypertension, with significant economic burdens and racial disparities in prevalence and costs.

There were disparities in the prevalence of pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH) and in economic burden among the Medicaid population.

Image credit: Kiattisak - stock.Adobe.Com

Pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH) are significantly more prevalent among Medicaid beneficiaries compared with the general population, with pronounced disparities among racial and ethnic groups.

The economic burden of these conditions is particularly high for American Indian and Alaska Native patients, raising concerns about health care access and treatment equity in vulnerable populations, according to a study published in Pulmonary Circulation.1

"PH and PAH are often diagnosed at a late stage due to their nonspecific symptoms," the authors wrote. "When diagnosed at a late stage these conditions, particularly PAH, portend a poor prognosis."

The cost of PAH medications, the debilitating nature of the disease, the resources needed to support daily living, and the costs related to inpatient care all place a great economic burden on society. In addition, the lack of a straightforward test to diagnose PAH causes delayed diagnosis of the disease, which in turn increases the economic burden on payers, employers, and society at large.2

The researchers analyzed data from the Medicaid Analytic Extract file for the years 2009 to 2012 to evaluate the baseline prevalence and economic burden of PH and PAH among Medicaid beneficiaries.

In 2012, the PH prevalence was 1.0 per 1000 people, and PAH prevalence was 0.2 per 1000 people. As patients' ages increased, the prevalence of the diseases increased drastically, with the greatest prevalence in the group of individuals aged 55 to 64 years.

Black patients had the highest prevalence at 1.6 per 1000 people for PH and 0.3 per 1000 people for PAH. In contrast, Hispanic patients had the lowest prevalences at 0.4 per 1000 people for PH and 0.1 per 1000 people for PAH. In addition, patients from large metro areas had slightly lower PH prevalence compared with those from small metro or rural areas. However, PAH prevalence was similar for the different areas.

"The reason for the racial and ethnic differences in prevalence is uncertain but may be related to racial disparities in the co‐morbidities that predispose to PH/PAH (such as hypertension, left heart failure, HIV, and sickle cell disease) and/or disparities in access to health care," the authors noted.

This increased prevalence among Black patients is important given previous research has shown Black women have the highest mortality rates among patients with PAH.3

In general, patients with PH or PAH had significantly more hospital bed days and Medicaid costs than those without PH or PAH. Black patients with PH or PAH had the highest average hospital bed days and the highest Medicaid cost compared with other racial groups in 2012, with similar results observed for 2009, 2010, and 2011. The mean Medicaid cost for Black patients was $8437 in 2012. In comparison, Hispanic patients had the lowest cost, with a mean of $3862 in 2012.

The use of International Classification of Diseases codes to identify individuals with diagnosed PH and PAH may have limited the accuracy of the study, the authors noted.

"Given the higher prevalence of PH/PAH noted among Blacks and the high economic burden attributed to PH/PAH, greater attention should be given to addressing the co‐morbidities related to PH/PAH among Blacks to prevent progression to PH/PAH," they concluded. " A critical component of addressing the burden of PH/PAH involves raising awareness of the need to screen for PH/PAH among Blacks/African Americans."

References

1. King MH, Li C, Bond VC, Ford D, Baltrus P, Farber HW. Prevalence and economic burden of pulmonary hypertension and pulmonary arterial hypertension among the Medicaid population. Pulm Circ. 2025;15(2):e70060. Doi:10.1002/pul2.70060

2. McCormick B. Delayed PAH diagnosis increased economic burden, study says. AJMC®. December 19, 2023. Accessed April 28, 2025. Https://www.Ajmc.Com/view/delayed-pah-diagnosis-increased-economic-burden-study-says

3. Al-Naamani N, Paulus JK, Roberts KR, et al. Racial and ethnic differences in pulmonary arterial hypertension. Pulm Circ. 2017;7(4):793-796. Doi:10.1177/2045893217732213

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