Increasing burden of lower extremity peripheral arterial disease in Sub-Saharan Africa, 1990-2021 - results from the global burden of disease study 2021.

Objective: Lower extremity peripheral artery disease (PAD) is a growing public health challenge in sub-Saharan Africa (SSA), yet epidemiological data remain scarce compared to high-income regions. This study addresses this gap by analyzing trends in PAD burden across SSA from 1990 to 2021, leveraging the Global Burden of Disease (GBD) dataset to inform targeted interventions. Methods: Using GBD 2021 data, we assessed PAD incidence, prevalence, disability-adjusted life years (DALYs), mortality, and associated risk factors across 46 SSA countries. Age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) were calculated, stratified by sex, age, and Socio-Demographic Index (SDI). Results: From 1990 to 2021, SSA experienced sharp increases in PAD burden: incidence (≥132.7 %), prevalence (≥132.8 %), DALYs (≥202.9 %), and mortality (≥231.5 %), contrasting with global declines. These trends oppose global declines reported in recent studies, underscoring SSA's unique vulnerability to a diabetes-driven PAD burden. Age-standardized rates rose significantly (EAPCs: 0.12-2.24), with the highest DALY rates in Gabon (57.2/100,000) and Southern SSA. Diabetes accounted for 30.8 % of PAD-related DALYs (male-to-female ratio: 1.8:1), while aging (≥80 years) contributed to 33.9 % of deaths. Conclusions: The divergent rise of PAD in SSA, which contrasts with global trends, demands region-specific solutions: (1) integrating PAD screening into diabetes programs, (2) aging-focused care, and (3) improved local data to address disparities in Gabon (highest DALYs) and conflict zones.