Global burden and risk factors of peptic ulcer disease between 1990 and 2021: An analysis from the global burden of disease study 2021

Abstract

Background: Peptic ulcer disease (PUD) is a chronic gastrointestinal disorder that may present acutely due to complications and poses significant clinical and economic challenges. Understanding the global burden of PUD and its contributing risk factors is essential for developing targeted prevention strategies. Therefore, our research aimed to comprehensively evaluate the epidemiological characteristics and associated risk factors of PUD, thereby providing evidence to support policymakers in formulating appropriate health policies.

Methods: The data on PUD were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Incidence, prevalence, deaths and disability-adjusted life years (DALYs) were metrics used to measure PUD burden. The population attributable fractions (PAFs) were used to calculate the percentage contributions of primary potential risk factors to PUD deaths and DALYs.

Results: The global incidence and prevalence cases of PUD increased by 11.1% and 8.8%, respectively, between 1990 and 2021. In contrast, the number of deaths and DALYs decreased by 15.94% and 27.8%, respectively, during the same period. The global age-standardized rates (ASRs) for incidence, prevalence, deaths and DALYs associated with PUD decreased by 40.3%, 41.1%, 61.5%, and 63.1%, respectively, between 1990 and 2021. Men exhibited higher numbers and ASRs of incidence, prevalence, deaths, and DALYs associated with PUD than women across most age cohorts in 2021.The average annual percentage change (AAPC) in age-standardized incidence (ASIR), prevalence (ASPR), deaths (ASMR), and DALYs (ASDR) rates for PUD were -1.65 (95% confidence interval (CI): -1.69, -1.61), -1.69 (95% CI: -1.74, -1.63), -3.02 (95% CI: -3.13, -2.91) and -3.17 (95% CI: -3.24,-3.10), respectively, from 1990 to 2021 on a global scale. In 2021, negative associations were observed globally among the ASIR, ASPR, ASMR, ASDR and the Socio-Demographic Index (SDI). Based on the ARIMA model, we projected that the global ASIR, ASPR, ASMR, and ASDR for PUD will exhibit decreasing trends from 2022 to 2040 for both sexes. We also identified smoking as the primary risk factor associated with PUD-related DALYs and deaths in both sexes in 1990 and 2021.

Conclusion: Significant advancements have been noted in reducing the global burden of PUD. Nonetheless, significant geographical and gender disparities exist in PUD numbers and ASRs, suggesting that a substantial portion of the population still lacks access to quality healthcare or experiences variations in risk factors for PUD. Thus, precise prevention strategies are essential to mitigate the disease burden of PUD.

Fig 1. Age-specific numbers and rates of PUD globally in 2021 for both sexes.

(A) Age-specific incidence number. (B) Age-specific prevalence number. (C) Age-specific mortality number. (D) Age-specific DALYs number. (E) Age-specific incidence rate. (F) Age-specific prevalence rate. (G) Age-specific mortality rate. (H) Age-specific DALYs rate.

Fig 2. Trends in the all-age numbers and age-standardized incidence, prevalence, mortality and DALYs rates of PUD by sex from 1990 to 2021.

(A) Incidence number and rate. (B) Prevalence number and rate. (C) Mortality number and rate. (D) DALYs number and rate.

Fig 3. Joinpoint regression analysis of the sex-specific ASRs for PUD globally from 1990 to 2021.

(A) ASIR for males. (B) ASPR for males. (C) ASMR for males. (D) ASDR for males. (E) ASIR for females. (F) ASPR for females. (G) ASMR for females. (H) ASDR for females.

Fig 4. Age-standardized rates of PUD globally and for 21 GBD regions by SDI, 1990–2021.

(A) Age-standardized incidence rates. (B) Age-standardized prevalence rates. (C) Age-standardized mortality rates. (D) Age-standardized DALYs rates. (For each region, the points arranged from left to right represent estimates for each year from 1990 to 2021).

Fig 5. Age-standardized rates of PUD in 204 countries globally by SDI in 2021.

(A) Age-standardized incidence rates. (B) Age-standardized prevalence rates. (C) Age-standardized mortality rates. (D) Age-standardized DALYs rates. (The blank lines represent the expected ASRs based on the SDI).

Fig 6. Predicted trends in Age-standardized rates of PUD for both sexes globally over the next 19 years (2022-2040).

(A) ASIR for males. (B) ASPR for males. (C) ASMR for males. (D) ASDR for males. (E) ASIR for females. (F) ASPR for females. (G) ASMR for females. (H) ASDR for females. (The red lines illustrate the actual trend of PUD ASRs from 1990 to 2021, while the yellow dotted lines and shaded regions indicate the predicted trend along with its 95% CI).

Fig 7. Proportion of PUD DALYs and deaths attributable to smoking by gender, SDI quintile, and GBD region in 1990 and 2021.

(A) Proportion of PUD DALYs and deaths attributable to smoking for male by SDI quintile and GBD region in 1990. (B) Proportion of PUD DALYs and deaths attributable to smoking for female by SDI quintile and GBD region in 1990. (C) Proportion of PUD DALYs and deaths attributable to smoking for male by SDI quintile and GBD region in 2021. (D) Proportion of PUD DALYs and deaths attributable to smoking for female by SDI quintile and GBD region in 2021.