Global Trends in the Incidence of Anxiety Disorders From 1990 to 2019: Joinpoint and Age-Period-Cohort Analysis Study

Abstract

Background: Anxiety disorders (ADs) are the most common mental illness with high prevalence, chronicity, and comorbidity. Despite rapid economic and cultural development, the global incidence of ADs continues to increase, with predominance in male individuals.

Objective: To address the above issues, we analyzed the dynamic trends of the global incidence and disease burden of ADs from 1990 to 2019 and their different effects on age, period, and birth cohort and predicted the future trend of AD incidence.

Methods: The data were obtained from the Global Burden of Disease study in 2019. A joinpoint regression model was used to calculate the annual percent change in AD incidence, and age-period-cohort analysis was used to estimate the independent effects of age, period, and cohort. Nordpred age-period-cohort analysis was used to predict the incidence of ADs from 2020 to 2044.

Results: The age-standardized incidence rate of ADs increased by 1.06% for both sexes, and the age-standardized disability-adjusted life-year (DALY) rate (ASDR) decreased by 0.12%. Joinpoint regression indicated that increments in average annual percent changes in the age-standardized incidence rate (0.068 vs 0.012) and ASDR (0.035 vs -0.015) for ADs globally were higher among male individuals than female individuals. The age-period-cohort analyses revealed that the relative risk (RR) of the incidence and DALYs of ADs among people of different sexes increased with age in adolescence and middle age and then decreased. For the period effect, the RR of incidence decreased, whereas the RR of DALYs increased in both sexes. Moreover, the RR of the incidence gradually increased and DALYs slowly decreased with birth year for both male and female individuals. New cases of ADs in male individuals are predicted to increase in the coming 25 years.

Conclusions: This study provided the changing trend of the global incidence and disease burden of ADs in the past 3 decades, indicating that early prevention and effective control cannot be ignored. We analyzed the age-period-cohort effect of potential trends in ADs and predicted future incidence trends. The results suggest that we should take active intervention measures, focusing on high-risk groups and developing effective management and control policies to reduce the global burden of disease.

Keywords: DALYs; age-period-cohort analysis; anxiety disorders; disability-adjusted life-years; incidence; joinpoint regression model; prediction.

Figure 1

Trends in the sex-specific incidence and DALY rate of ADs globally during 1990-2019. (A) ASIR of ADs and (B) ASDR of ADs. AD: anxiety disorder; ASDR: age-standardized DALY rate; ASIR: age-standardized incidence rate; DALY: disability-adjusted life-year.

Figure 2

Joinpoint regression analysis of the sex-specific age-standardized incidence and disability-adjusted life years rate for ADs in global from 1990 to 2019. (A) Age-standardized incidence rate (ASIR) for males; (B) Age-standardized incidence rate (ASIR) for females; (C) Age-standardized DALYs rate (ASDR) for males; (D) Age-standardized DALYs rate (ASDR) for females. For a higher-resolution version of this figure, see Multimedia Appendix 1.

Figure 3

RRs of the incidence and disability-adjusted life-year (DALY) rate of anxiety disorders globally from 1990 to 2019 due to age, period, and cohort effects. (A) Age effects on incidence, (B) age effects on DALY rate, (C) period effects on incidence, (D) period effects on DALY rate, (E) cohort effects on incidence, and (F) cohort effects on DALY rate. RR: relative risk.

Figure 4

Predicted trends of anxiety disorders in 2020 to 2044: observed (solid lines) and predicted rates (dashed lines). ASIR: age-standardized incidence rate.