Global temporal trends in maternal hypertensive disorders incidence and mortality from 1990 to 2021 based on the global burden of disease study

Maternal hypertensive disorders (MHD) remain a significant global health challenge. This study aims to provide a comprehensive analysis of the global burden of MHD from 1990 to 2021, focusing on incidence and mortality trends across different sociodemographic index (SDI) regions and age groups. We utilized Global Burden of Disease (GBD) study methodologies to analyze MHD incidence and mortality. Temporal trends were examined using Joinpoint regression to calculate annual percentage changes and average annual percentage changes with 95% confidence interval (CI). Age-period-cohort models were applied to analyze trends across different age groups, time periods, and birth cohorts, with particular attention to SDI regions. Globally, the age-standardized incidence rate (ASIR) of MHD decreased from 554.35 (95% Uncertainty Interval [UI]: 461.38t o 675.43) per 100,000 in 1990 to 461.94 (95% UI: 392.73 to 551.65) in 2021, with an average annual percent change (AAPC) of - 0.6% (95% CI: -0.67% to - 0.53%). The age-standardized death rate (ASDR) declined from 1.94 (95% UI: 1.71-2.15) per 100,000 in 1990 to 0.97 (95% UI: 0.81-1.18) in 2021 (AAPC - 2.18%; 95% CI: -2.3% to - 2.06%). Low SDI regions faced the highest burden. Age-period-cohort analyses revealed heterogeneous trends across age groups and SDI regions, with younger age groups (particularly ages 15-19 years) showing the most substantial improvements, demonstrated by the steepest declines in both incidence (-1.62% per year) and mortality rates (-2.57% per year). More recent birth cohorts demonstrated greater improvements, with declining risks of both incidence and mortality compared to earlier birth cohorts. Despite global reductions in MHD incidence and mortality over the past three decades, substantial disparities persist across regions and age groups. Targeted interventions, particularly in low SDI regions and among high-risk age groups, are crucial for further reducing the global burden of MHD.