Background: Aortic aneurysm (AA) is a life-threatening disease with significant global burden. Objectives: This study aims to evaluate epidemiological trends and risk factors for AA-related mortality from 1990 to 2021 across regions, considering age, sex, and socio-economic factors. Methods: Using Global Burden of Disease (GBD) Study 2021, we analyzed AA-related death, death rates, and the age-standardized AA-related death rate (ASDR) per 100,000, along with risk factors. Trends from 1990 to 2021 were compared across global regions and countries by socio-demographic index, health systems, and income. We also examined the impact and trend changes of age, sex, and risk factors on AA. Results: In 2021, global AA-related deaths reached 153,927 (95% uncertainty intervals (UI): 138,413 -165,738), a 74.2% increase from 1990. However, accounting for changes in population size and age, ASDR declined from 2.54 (95%UI: 2.35-2.69) to 1.86 (95%UI: 1.67-2.00) deaths per 100,000 people. Europe and America experienced ASDR reductions of 24.81% and 47.4%, while Asia saw a 38.61% increase. AA mortality remained high in regions with high income, advanced health system and high socio-demographic index, especially in aged population. In 2021, Japan reported the most AA-related deaths (23,815, 95% UI: 19,180-26,463) and Armenia had the highest ASDR (9.16 per 100,000, 95% UI: 7.61-10.81). Our results highlight significant sex differences in AA-related mortality. Men had nearly twice the ASDR of women, though the gap narrowed over time. The impact varied by age and region. ASDR declined more in men in Europe and America, especially in Sweden, Norway and Denmark. However, in Russa, Japan and Nauru, women saw greater increase, influencing overall AA-caused mortality. AA-related risk factors differ by sex: smoking is prima for men, while high systolic blood pressure is more significant for women. Other risk factors include high body-mass index, diets low in fruits and vegetables, increased sodium intake and lead exposure. Importantly, the relative contribution of these risk factors has shifted over time, reflecting changes in lifestyle, public health policies, and healthcare access. Conclusion: AA-related mortality remains a global burden with regional and sex disparities. Declines of AA-related ASDR in Western Europe and the America suggest effective interventions, while increases in Eastern Europe, Central and South Asia, and Japan, especially among women, highlight emerging challenges. Smoking, hypertension, and obesity are key contributors, emphasizing the need for targeted prevention, screening and healthcare access.

The authors have declared no competing interest.

This work was supported by grants from Karolinska Institute′s Research Foundations, Berth von Kantzows Foundation, Erik Mattssons Foundation, Rolf Luft Foundation, the Chengdu Science and Technology Program (2023-GH02-00083-HZ); the Sichuan Science and Technology Program (2025HJRC0028); The Ministry of Human Resources and Social Security (MOHRSS) of the People′s Republic of China foreign expert project (H20240709); the Center of Excellence-International Collaboration Initiative Grant of West China Hospital (139220062).

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All data used in this study were only sourced from the Global Burden of Disease (GBD) Study 2021, conducted by the Institute for Health Metrics and Evaluation (IHME). The data were accessed via the GBD Results tool, openly available at: https://vizhub.healthdata.org/gbd-results/ , accessed in March 2025.

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All data used and produced in this study were sourced from the Global Burden of Disease (GBD) Study 2021, available at: https://vizhub.healthdata.org/gbd-results/ , accessed in March 2025. All raw data used to make the figures are presented in Supplemental Digital Content (SDC).

https://vizhub.healthdata.org/gbd-results/