Global, regional, and national burden of endometriosis among women of childbearing age from 1990 to 2021: a cross-sectional analysis from the 2021 global burden of disease study

Abstract

Background: Endometriosis is a major contributor to infertility and pelvic pain, which brings a significant burden on family and society. Although the data of endometriosis in Global Burden of Disease (GBD) 2019 was reviewed, no updated analysis has been conducted using GBD 2021, and the disease burden across different age groups has not been analyzed. The aim of this cross-sectional analysis was to provide an up-to-date assessment of the prevalence, incidence, and disability-adjusted life-years (DALYs) of endometriosis from 1990 to 2021 at the global, national, and regional levels.

Material and methods: We obtained data on the prevalence, incidence, and DALYs of endometriosis from GBD 2021. These data were analyzed to provide an overview of the epidemiological trends and disease burden of endometriosis in 204 countries and regions worldwide from 1990 to 2021, and we projected trends through 2040. Health inequality analysis, joinpoint regression analysis, and decomposition analysis were applied to data assessment.

Results: In 2021, the global burden of endometriosis remained substantial, with a total of 22.28 million cases (95% UI: 13.67, 33.69), corresponding to an age-standardized prevalence rate (ASPR) of 1023.8 per 100 000 (95% UI: 627.36, 1549.77). The age-standardized incidence rates (ASIR) was 162.71 (95% UI: 85.21, 265.35) per 100 000, while the age-standardized DALY rate (ASDR) was 94.25 (95% UI: 50.82, 157.73) per 100 000. Regionally, areas with low sociodemographic index (SDI) experienced the highest ASPR, ASIR, and ASDR, while high SDI regions exhibited the lowest rates. Geospatially, Oceania and Eastern Europe displayed the highest ASPR, ASIR, and ASDR. Among countries, Niger had both the highest ASPR and ASDR, and Solomon Islands had the highest ASIR. Women aged 25-29 years emerged as the most affected group, suggesting that this cohort should be a key focus for interventions. By 2040, the global ASPR of endometriosis is projected decline to 887.89 per 100 000 (95% CI: 530.79, 1245), representing a decrease of 13.28% from 2021. Decomposition analysis showed population growth was the major contributing factor, followed by epidemiologic change.

Conclusion: While the burden of endometriosis has decreased globally from 1990 to 2021, significant disparities remain, especially in low SDI regions. It is necessary to develop better policies and preventive measures to effectively address the range of problems associated with endometriosis.

Keywords: crosssectional study; disability-adjusted life years; endometriosis; global burden of disease study 2021; incidence; prevalence.

Figure 1.

Temporal trend changes in ASPR (A), ASIR (B), and ASDR (C) for endometriosis globally and in various SDI regions from 1990 to 2021 based on the Joinpoint regression model.

Figure 2.

The rate of prevalence (A), incidence (B), and DALYs (C) of endometriosis in 1990 and 2021 at different age, and the rate of prevalence (D), incidence (E), and DALYs (F) of endometriosis over time by age category..

Figure 3.

Change in prevalence (A), incidence (B), and DALYs (C) of endometriosis decomposed by three population-level determinants: aging, population and epidemiological change at the global level, five regions, and and 21 GBD regions.

Figure 4.

Health inequality regression curves and concentration curves for the prevalence (A–B), incidence (C–D), and DALYs (E–F) of endometriosis.

Figure 5.

Trend in ASPR (A), ASIR (B), and ASDR (C) of endometriosis from 2022 to 2040. The purple line represents the predicted trend, and the gray-shaded area represents the 95% CI of the predicted values; the gray-dotted vertical line divides the data into real values (1990–2021) and predicted values (2022–2040).