The global burden of polycystic ovary syndrome, endometriosis, uterine fibroids, cervical cancer, uterine cancer, and ovarian cancer from 1990 to 2021

Abstract

Background: Globally, common gynecological disorders such as Polycystic Ovary Syndrome (PCOS), endometriosis, uterine fibroids (non-malignant gynecological diseases), as well as cervical cancer, uterine cancer, and ovarian cancer (gynecological cancers), profoundly impact women's physical and mental health. The burden of these diseases exhibits significant geographical disparities across different countries and regions, making a comprehensive and precise assessment of the global burden of gynecological diseases particularly crucial. Such an assessment will facilitate the development of region-specific prevention and treatment strategies, contributing to a more effective response to these health challenges.

Methods: Incidence, prevalence, mortality rates, and Disability-Adjusted Life Years (DALYs) data for the aforementioned gynecological conditions were obtained from the 2021 Global Burden of Disease (GBD) study and analyzed by age, location, and year. The burden associated with gynecological diseases was analyzed based on the Socio-demographic Index (SDI) and attributable risk factors. The Estimated Annual Percentage Change (EAPC) and its 95% Confidence Interval (CI) were used to assess temporal trends in burden.

Results: In 2021, uterine fibroids were the leading non-malignant gynecological condition contributing to the highest Age-Standardized Incidence Rate (ASIR) and Age-Standardized Prevalence Rate (ASPR), with rates of 250.93 and 2841.07 per 100,000, respectively. Cervical cancer was the main contributor to the Age-Standardized Mortality Rate (ASMR) and Age-Standardized Disability Rate (ASDR) among the eight selected gynecological diseases, with rates of 6.62 and 226.28 per 100,000, respectively. From 1990 to 2021, the ASIR and ASPR for non-malignant gynecological conditions, such as PCOS and uterine fibroids, increased, while the ASDR for PCOS also rose. Among gynecological cancers, the ASIR for uterine cancer increased, while the ASPR for cervical cancer rose. However, the ASIR for cervical and ovarian cancers decreased, along with reductions in the ASMR and ASDR for these cancers and uterine cancer. There were notable regional disparities based on the SDI. In 2021, lower SDI regions had higher incidence, prevalence, mortality rates, and DALYs for endometriosis and cervical cancer, whereas higher SDI regions saw higher rates for PCOS, uterine fibroids, ovarian cancer, and uterine cancer, with more significant mortality and DALYs for ovarian and uterine cancers. The age distribution of these conditions varied. Non-malignant gynecological conditions, such as PCOS and uterine fibroids, primarily affect women aged 30-34 and 40-69. Endometriosis is most common in women aged 20-34, particularly between 25 and 29. Gynecological cancers, including cervical, uterine, and ovarian cancers, predominantly affect women over 35, especially between 40 and 69, with cervical cancer peaking at ages 50-54. Regarding attributable risk factors globally, 1% of cervical cancer deaths were linked to unsafe sexual behaviors, while a high Body Mass Index(BMI) contributed to 0.09% of ovarian cancer deaths and 0.34% of uterine cancer deaths.

Conclusion: The global burden of these six gynecological conditions poses a significant public health challenge. There is an urgent need for international collaboration to advance the development of age and regionally differentiated management strategies for gynecological diseases, including the development of effective diagnostic screening tools and the implementation of high-quality, targeted prevention and treatment strategies.

Keywords: Burden of disease; Cervical cancer; Disability-adjusted life-years (DALYs); Endometriosis; Ovarian cancer; Polycystic ovary syndrome; Uterine cancer; Uterine fibroids.

Fig. 1

ASIR for six gynecological diseases in 2021: (A) PCOS, (B) Endometriosis, (C) Uterine Fibroids, (D) Cervical Cancer, (E) Ovarian Cancer, (F) Uterine Cancer

Fig. 2

EAPC of ASIR for six gynecological diseases globally and across 21 regions

Fig. 3

SDI and its association with ASIR for six gynecological diseases across 204 countries and territories

Fig. 4

Incidence rates of gynecological diseases by different age-etiologic compositions in 1990 and 2021, and the global incidence rates of six gynecological diseases by age in 2021