Global burden and future trends of inguinal, femoral, and abdominal hernia in older adults: A systematic analysis from the Global Burden of Disease Study 2021

Abstract

Objective: This study aims to comprehensively evaluate the global, regional, and national burden, trends, and health inequalities of inguinal, femoral, and abdominal hernias among older adults from 1990 to 2021, conduct predictive analyses, and provide insights to inform future public health strategies.

Methods: A secondary analysis was conducted using the Global Burden of Disease 2021, focusing on the temporal trends, health inequality, and predictive development of inguinal, femoral, and abdominal hernia burden among older adults.

Results: Globally, the number of incident cases of inguinal, femoral, and abdominal hernias among older adults continuously increased from 1990 to 2021, along with the decline in age-standardized rates, prevalence, and Disability-Adjusted Life Years (DALYs). Older males exhibited higher incidence rates, prevalence, and DALYs for hernias relative to females. In terms of the Socio-Demographic Index (SDI) from 1990 to 2021, the Age-Standardized Prevalence Rate (ASPR) and Age-Standardized Rate of Disability-Adjusted Life Years (ASDR) remained the highest in low-middle and low SDI regions, while the Age-Standardized Incidence Rate (ASIR) was the highest in high SDI regions. At the national level, 10 countries experienced a significant increase in ASDR and ASPR, and 15 countries in ASIR. Among these, the highest increase was observed for ASIR in China, ASPR in Georgia, and ASDR in American Samoa. The projections to the year 2035 indicate an increase in the incidence and prevalence of hernias, with older males remaining predominant. However, the DALY rate is expected a declining trend.

Conclusions: In spite of the progress in reducing the burden of inguinal, femoral, and abdominal hernias in older adults, the overall burden tends to rise. In particular, countries such as India, China, and Georgia are experiencing an increasing burden. It is crucial to implement targeted medical interventions, especially for older males in these regions.

Fig 1. Number of incident cases (A), DALYs (B), and prevalent cases (C) among older adults (by male and female, and in combination), and ASR of incidence (A), DALYs (B), and prevalence (C) related to inguinal, femoral, and abdominal hernias on global scale and at SDI level from 1990 to 2021.

This figure displays the number of incident cases, DALYs, and prevalent cases among older adults by gender, and ASR of incidence, DALYs, and prevalence related to inguinal, femoral, and abdominal hernias on global scale and at SDI level from 1990 to 2021. DALYs: Disability-Adjusted Life Years; SDI: Sociodemographic Index; ASIR: age-standardized Incidence rate; ASDR: age-standardized disability-adjusted life years rate; ASPR: age-standardized prevalence rate.

Fig 2. Global trends in inguinal, femoral, and abdominal hernias among older adults from 1990 to 2021 using joinpoint regression analysis.

This figure displays the age-standardized rates of incidence, prevalence, and DALYs for inguinal, femoral, and abdominal hernias among older adults globally from 1990 to 2021. From top to bottom: ASDR for both sexes (A), males (D), and females (G). ASDR for both sexes (B), males (E), and females (H). ASDR for both sexes (C), males (F), and females (I). ASIR: Age-Standardized Incidence Rate; ASPR: Age-Standardized Prevalence Rate; DALYs: Disability-Adjusted Life Years; ASDR: Age-Standardized Disability-Adjusted Life Year Rate; APC: Annual Percentage Change; AAPC: Average Annual Percentage Change; SDI: Sociodemographic Index.

Fig 3. Burden trends of inguinal, femoral, and abdominal hernias among older adults across regions stratified by socio-demographic index.

This figure displays the correlation of regions to SDI and the age-standardized incidence, prevalence, and DALYs of inguinal, femoral, and abdominal hernia among older adults. From top to bottom: ASIR for both sexes (A), males (B), and females (C). ASPR for both sexes (D), males (E), and females (F). ASDR for both sexes (G), males (H), and females (I). ASIR: Age-Standardized Incidence Rate; ASPR: Age-Standardized Prevalence Rate; DALYs: Disability-Adjusted Life Years; ASDR: Age-Standardized Disability-Adjusted Life Year Rate; SDI: Sociodemographic Index.

Fig 4. Burden trends of inguinal, femoral, and abdominal hernias among older adults in countries stratified by socio-demographic index.

This image displays the correlation of countries to SDI and the age-standardized incidence, prevalence, and DALYs of inguinal, femoral, and abdominal hernias among older adults. From top to bottom: ASIR for both sexes (A), males (B), and females (C). ASPR for both sexes (D), males (E), and females (F). ASDR for both sexes (G), males (H), and females (I). ASIR: Age-Standardized Incidence Rate; ASPR: Age-Standardized Prevalence Rate; DALYs: Disability-Adjusted Life Years; ASDR: Age-Standardized Disability-Adjusted Life Year Rate; SDI: Sociodemographic Index.

Fig 5. Trends in AAPC of inguinal, femoral, and abdominal hernias among older adults in countries stratified by socio-demographic index.

This figure displays the correlation of countries to SDI and AAPC in the age-standardized incidence, prevalence, and DALYs of inguinal, femoral, and abdominal hernias among older adults. From top to bottom: AAPC in ASIR for both sexes (A), males (B), and females (C). AAPC in ASPR for both sexes (D), males (E), and females (F). AAPC in ASDR for both sexes (G), males (H), and females (I). ASIR: Age-Standardized Incidence Rate; ASPR: Age-Standardized Prevalence Rate; DALYs: Disability-Adjusted Life Years; ASDR: Age-Standardized Disability-Adjusted Life Year Rate; SDI: Sociodemographic Index; AAPC: Average Annual Percentage Change.

Fig 6. Absolute healthy inequality (A, C, E) and relative healthy inequality (B, D, F) for age-standardized DALYs, incidence, and prevalence rates of inguinal, femoral, and abdominal hernias among older adults on global scale in 1990 and 2021.

The slope index of inequality, shown as the slope of the regression line, represents the absolute difference in inguinal, femoral, and abdominal hernia burden among older adults between countries or territories with the highest and lowest SDI. The concentration index, calculated as twice the area between the 45° diagonal line and the Lorenz curve, represents the relative extent to which the inguinal, femoral, and abdominal hernias burden among older adults concentrated among the poor (negative value) or the rich countries (positive value). ASIR: Age-Standardized Incidence Rate; ASPR: Age-Standardized Prevalence Rate; DALYs: Disability-Adjusted Life Years; ASDR: Age-Standardized Disability-Adjusted Life Year Rate; SDI: Sociodemographic Index.

Fig 7. Projections of inguinal, femoral, and abdominal hernia burden among older adults on global scale from 1990 to 2035.

This figure presents the observed and projected development of inguinal, femoral, and abdominal hernia burden among older adults globally from 1990 to 2035. The projections include ASR of incidence, prevalence, and DALYs, as well as the number of incident cases, prevalent cases, and DALYs sorted by gender. A: ASDR. B: Number of DALYs. C: ASPR. D: Number of prevalence cases. E: ASIR. F: Number of incidence cases. ASIR: Age-Standardized Incidence Rate; ASPR: Age-Standardized Prevalence Rate; DALYs: Disability-Adjusted Life Years; ASDR: Age-Standardized Disability-Adjusted Life Year Rate.

Fig 8. Projections of inguinal, femoral, and abdominal hernias burden in global older adults population (male and female) from 1990 to 2035.

This figure presents the observed and projected development of inguinal, femoral, and abdominal hernia burden among older adults globally from 1990 to 2035. The projections include ASR of incidence, prevalence, and DALYs as well as the number of incident cases, prevalent cases, and DALYs, sorted by gender. A: ASDR. B: Number of DALYs. C: ASPR. D: Number of prevalence cases. E: ASIR. F: Number of incidence cases. ASIR: Age-Standardized Incidence Rate; ASPR: Age-Standardized Prevalence Rate; DALYs: Disability-Adjusted Life Years; ASDR: Age-Standardized Disability-Adjusted Life Year Rate.