Trends in Mortality and Health-related Quality of Life of Pulmonary Arterial Hypertension Across Three North American Countries: A 1990-2019 Global Burden of Disease Study
Bibliographic record
Abstract
Abstract Introduction: Pulmonary arterial hypertension (PAH) has an estimated global prevalence of 15-50 cases per million, with significant regional variation based on different registries. [1] However, the true incidence and prevalence of PAH in North America remains unclear [2]. PAH outcomes are influenced by factors such as environmental, gender, and racial disparities, as well as access to healthcare [3]. Yet, there remains a lack of robust data on mortality trends and Health-Related Quality of Life (HRQoL) given the conflicting epidemiological findings [4-6]. This study aimed to evaluate trends in PAH mortality and HRQoL over the past three decades across 3 North American Countries. Methods: Mortality and HRQoL trends of PAH between 1990-2019 across the USA, Canada, and Mexico were analyzed from the Global Burden of Diseases 2019 database. Statistical analysis was performed using DATAtab (2024, Graz, Austria). Age standardized mortality rate (ASMR) was reported per 100,000 patients. Trends were assessed using Average Annual Percentage Change (AAPC) and calculated via JoinPoint Regression (2024, National Cancer Institute, USA). Results: An estimated 45,518 deaths due to PAH were reported, with 85.3% occurring in the USA. Female mortality accounted for 71.1% of deaths in the USA, 68.1% in Canada, and 58.3% in Mexico. The highest ASMR was observed in the USA (0.31; SD 0.01), followed by Canada (0.29; SD 0.12) and Mexico (0.13; SD 0.02), with significant differences among countries (ANOVA F(58,2)=68; p<.001) (Table 1). Statistically significant negative ASMR trends were observed in Canada (AAPC -2.3%; 95% CI -2.45 to -2.19; p<.001) and Mexico (AAPC -1.77%; 95% CI -1.96 to -1.61; p<.001). The USA showed minimal ASMR change (AAPC -0.02%; 95% CI -0.06 to 0.02; p=.27) (Figure 1). Analysis of age-standardized years lived with disability (YLD) indicated a significant positive trend in Mexico (AAPC 0.81%; 95% CI 0.78 to 0.84; p<.001), while negative trends were observed in Canada (AAPC -0.69%; 95% CI -0.70 to -0.67; p<.001) and the USA (AAPC -0.26%; 95% CI -0.27 to -0.25; p<.001). Disability-adjusted life years (DALY) trends indicated significant reductions in all countries, with Canada showing the most pronounced decrease (AAPC -2.69%; 95% CI -2.79 to -2.58; p<.001). The AAPCs for Mexico and the USA were -1.95% (95% CI -2.12 to -1.79; p<.001) and -0.61% (95% CI -0.65 to -0.57; p<.001), respectively. Conclusion: Our findings suggest discordant trends in mortality and HRQoL between the USA, Canada, and Mexico. Further studies are required to evaluate factors contributing such variability in outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".