PS-BPP04-5: BURDEN AND TRENDS OF HYPERTENSIVE HEART DISEASES IN SOUTH ASIA, 1990 TO 2019: ANALYSIS FROM THE GLOBAL BURDEN OF DISEASES

Background: There is lack of comprehensive population based studies on the burden of hypertensive heart diseases (HHD) in South Asia and its trends over time. We aimed to explore the burden of HHD, and how it changed over time from 1990 to 2019 in South Asia. Methods: We performed a systematic analysis of burden of hypertensive heart disease using the Global Burden of Disease (GBD) study data from South Asia, including Bangladesh, Bhutan, India, Pakistan, and Nepal. GBD data sources included surveillance and survey data, published, and unpublished research articles and reports, vital registration and hospital data. We assessed the prevalence, mortality, disability adjusted life years (DALY), years lived with disability (YLD) and years of life lost (YLL) attributable to HHD between 1990 and 2019 in South Asia. Data were presented as point estimates with their corresponding 95% uncertainty intervals (UI). Results: From 1990 to 2019 the age standardized prevalence for HHD in South Asia increased from 110.2 (95% UI, 77.4 - 156.8) to 111.8 (78.3 - 159.0) per 100,000 population, and from 8.7 (5.2 - 13.7) to 8.8 (5.2 - 13.9) for YLDs, in both genders, respectively. The prevalence increased with age and was higher among females. The age standardized rate decreased from 334.1 (206.3 - 452.4) to 229.2 (166.1 - 296.9) for DALYs, and from 19.0 (12.1 - 26.7) to 13.2 (9.3 - 17.4) for death, respectively. In 2019, HHD prevalence was highest in Pakistan (138.6, 95% UI, 96.2 to 196.9), and lowest in Nepal (69.9, 49.5 to 98.3). Countries with the biggest increase in YLDs were Bangladesh (8.3%, 95% UI, -3.9% to 22.8%), followed by India (5.0%, 2.4% to 7.7%), Bhutan (4.0%, -8.7% to 18.3%), Pakistan (3.4%, -3.5% to 10.8%), and Nepal (1.0%, -11.5% to 15.5%). The age standardized DALYs decreased from 334.1 (95% UI, 206.3 to 452.4) in 1990 to 229.2 (95% UI, 166.1 to 296.9) in 2019 with the highest significant percentage change in the India (-34.1%, 95% UI, -48.3% to -9.5%), followed by Bangladesh, Bhutan and Nepal. Deaths due to HHD significantly declined in all countries except Pakistan with a small increase (0.3%, -24.6% to 26.8%) and in Nepal with a decrease (-8.6, -38.8% to 36.8%), respectively. Conclusion: HHD remains a significant cause of disease burden in South Asian countries. The increased prevalence amongst older people and females warrants particular attention. Policies focusing on preventing modifiable risk factors and access to essential medicines is warranted.