Global and regional trends in the burden of surgically confirmed endometriosis from 1990 to 2021

Abstract

Background: endometriosis as a common gynecologic finding significantly affects the quality of life of many women. An accurate understanding of the epidemiological characteristics of endometriosis is essential for disease control and prevention. We aimed to use the latest data from the Global Burden of Disease (GBD) 2021 to comprehensively analyze the various epidemiological indicators of surgically confirmed endometriosis and their changing trends to better measure the disease burden and help improve health management.

Methods: We delineated incidence, prevalence, and years lived with disability (YLDs) of surgically confirmed endometriosis at the global, regional, and national levels. The estimated annual percentage change (EAPC) was calculated to assess temporal trends in the age-standardized rate (ASR). In addition, we used joinpoint regression models to describe local trends in these indicators, assessed the correlation between disease burden and Socio-demographic index (SDI) levels, and used decomposition analysis to quantitatively analyze the driving factors leading to changes in disease burden.

Results: Globally, the age-standardized rate of incidence, prevalence, and YLDs of surgically confirmed endometriosis all showed a decreasing trend from 1990 to 2021. The burden of surgically confirmed endometriosis is mainly concentrated in women aged 20-30 years and declines with increasing SDI levels. The results of the decomposition analysis indicated that population growth is the main driving factor for the upward in the number of incidence, prevalence, and YLDs cases of endometriosis worldwide.

Conclusions: The overall burden of endometriosis has decreased globally from 1990 to 2021, but there are regional disparities. Managing this condition remains a major challenge, and more refined policies and interventions are needed to effectively address the burden of endometriosis.

Keywords: Disease burden; Endometriosis; Estimated annual percentage change; Incidence; Prevalence.

Fig. 1

The EAPC for ASIR, ASPR, and Age Standardized YLDs Rate at the regional level. EAPC, estimated annual percentage change; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; YLDs, years lived with disability

Fig. 2

The ASIR of endometriosis in 204 countries and territories in 2021. ASIR, age-standardized incidence rate

Fig. 3

Joinpoint regression analysis in ASIR of endometriosis from 1990 to 2021 by SDI region. ASIR, age-standardized incidence rate; SDI, socio-demographic index; APC, annual percentage change; * P < 0.05

Fig. 4

Age-specific burdens on incidence (A), prevalence (B), and YLDs (C) of endometriosis in 2021. YLDs, years lived with disability. The y-axis of Fig. 4B and C: “e” represents “multiply by a power of 10”. For example, in 2e + 05, 2 is the base (valid numeric part), and e + 05 means “multiply by 5 powers of 10”, i.e. 2e + 05 = 2 × 100,000 = 200,000

Fig. 5

Coevolution of ASIR with SDI globally and for GBD regions of endometriosis, 1990–2021. Colored lines show global and regional values for age-standardized burden estimate rates. Each point in a line represents 1 year starting in 1990 and ending in 2021. The black line represents the average expected relationship between SDI and burden estimate rates for endometriosis based on values from each region. Regions above the solid line have higher than expected burdens, while those below the line have lower than expected burdens

Fig. 6

Changes in endometriosis incidence, decomposed by three population-level determinants: aging, population and epidemiological change