Global, regional, and national burden of uterine fibroids in the last 30 years: Estimates from the 1990 to 2019 Global Burden of Disease Study

Abstract

Objective: To study specific information on trends in incidence, mortality, disability-adjusted life years (DALY) and the corresponding trends among five sociodemographic index regions, 21 regions, and 204 countries for decision-making, which would enable policymakers to distribute limited resources and devise policies more rationally.

Methods: Data on uterine fibroids (UNs) from 1990 to 2019, including incidence, mortality, and DALYs, were obtained from the 2019 Global Burden of Disease Study. An estimated annual percentage change (EAPC) was calculated to assess morbidity, mortality, and DALY trends.

Results: The incident cases of UFs increased from 5,769,658 (95%UI, 7,634,3995-4,274,824) incidences in 1990 to 9,643,336 (95%UI, 7,178,053-12,714,741) incidences in 2017, and the age-standardized incidence rate was steady at 225.67/100,000 persons (95%UI, 167.33-298.87) in 1990 to 241.18/100,000 persons (95%UI, 179,45-318.02) in 2019. The incidence ratio in the high sociodemographic index (SDI) region showed a unimodal distribution, with peaks in 2005. Between 2009 and 2017, the age-standardized death rate of UFs declined globally, especially in low-SDI and low-middle SDI regions. In contrast with 860,619 DALYs (95%UI, 473,067-1,505,289) in 1990, the number of DALYs was 1,378,497 (95%UI, 710,915-2,475,244) in 2019, which had increased significantly, whereas the age-standardized DALY rate decreased expressively with an EAPC of -1.93 (95%CI, from -2.16 to -1.71).

Conclusion: The global burden of UFs increased between 1990 and 2019, and the incidences and DALYs increased prominently worldwide, while the deaths from UFs had no evident growth. Lower SDI regions carried an incremental burden of UFs, while disease reduction was observed in higher SDI regions. It is high time we paid attention to the underprivileged regional quality of life and health protection.

Keywords: age-standardized rate; disability-adjusted life years; global burden of disease; socio-demographic index; uterine fibroids.

Figure 1

The change trends of age-standardized incidence, death, and DALY rate among different SDI quintiles. (A) Age-standardized incidence; (B) age-standardized death; (C) age-standardized DALYs.

Figure 2

The correlation between EAPC and UFs ASR [incidence (A), death (C), and DALY (E)] in 1990 and SDI [incidence (B), death (D), and DALY (F)] in 2019. The circles represent countries that were available on SDI data. The size of the circle represents the number of UFs patients, and one circle represents a specific country. The ρ indices Pearson's correlation coefficient and P-values were derived from Pearson's correlation analysis. ASR, age-standardized incidence/death/DALYs rate; EAPC, estimated annual percentage change; SDI, socio-demographic index.

Figure 3

The ASR rates of UFs per 100,000 population among regions based on SDI in 2019. (A) Age-standardized incidence; (B) age-standardized death; (C) age-standardized DALYs.

Figure 4

The global disease burden and EAPC of UFs in 204 countries. (A) The ASIR of UFs in 2019. (B) The EAPC of ASIR. (C) The ASDR of UFs in 2019. (D) The EAPC of ASDR. (E) The age-standardized DALY rate of UFs in 2019. (F) The EAPC of age-standardized DALY rate. ASIR, age-standardized incidence rate; ASDR, age-standardized death rate.

Figure 5

Annual percent changes of age-standardized UFs ASR rates in 204 countries and territories between 1990 and 2019. (A) Age-standardized incidence; (B) Age-standardized death; and (C) Age-standardized DALYs.

Figure 6

The proportion of the four age groups for incidences of UFs between 1990 and 2019. (A) Global. (B) High SDI. (C) High-middle SDI. (D) Middle SDI. (E) Low-middle. (F) Low SDI.

Figure 7

The proportion of four age groups for UFs incident cases globally and by region, contrasted in 1990 (A) and 2019 (B).