Global, regional, and national burden of early-onset OA attributable to high BMI: 1990-2021 estimates and 2036 projections from the global burden of disease study

Abstract

Objective: High BMI is a critical risk factor for early-onset OA (diagnosed before age 55). This study aimed to analyze global trends in the age-standardized disability-adjusted life years rates (ASDR) attributable to high BMI from 1990 to 2021.

Methods: Data from the Global Burden of Disease 2021 (GBD 2021) study were analyzed to assess early-onset OA attributable to high BMI across 204 countries, 21 GBD regions, and 5 Socio-Demographic Index (SDI) tiers. Temporal trends in ASDR were quantified using the estimated annual percentage change (EAPC) and Joinpoint regression. Age-period-cohort models and decomposition analysis identified drivers of burden, while inequality was assessed using the Slope Index of Inequality (SII) and Concentration Index (CI). ARIMA models projected trends to 2036.

Results: The disease burden of early-onset OA attributable to high BMI increased significantly between 1990 and 2021. The DALYs for early-onset knee and hip OA rose by 203.01% and 170.12%, respectively, with average annual percentage changes (AAPC) of 1.39% and 1.40%. The age-period-cohort analysis indicated that DALYs risk increased with age and period, and later birth cohorts experienced a higher burden of early-onset OA attributable to high BMI. Decomposition analysis revealed that population growth was the primary driver of the rising disease burden. There were significant absolute and relative inequalities in the burden of early-onset OA attributable to high BMI, as measured by the SDI. Countries with higher SDI bore a greater burden. The SII demonstrated that the ASDR gap between countries with the highest and lowest SDI widened steadily from 1990 to 2021. Predictive analysis suggested that the burden of early-onset OA attributable to high BMI will continue to increase over the next 15 years.

Conclusion: From 1990 to 2021, the global burden of early-onset OA attributable to high BMI showed a consistent upward trend, with significant inequalities across countries. The disease burden is projected to grow further in the future.

Fig 1. The trends in ASDR of early-onset OA attributable to high BMI globally and across five SDI regions from 1990 to 2021.

Note: A-C, Early-onset knee OA attributable to high BMI; D-F, Early-onset hip OA attributable to high BMI. Abbreviations: SDI, Sociodemographic Index; ASDR, age-standardized disability-adjusted life years rate; BMI, Body mass index.

Fig 2. Global burden of disease for early-onset OA attributable to high BMI by year and sex.

Note: A, Early-onset knee OA attributable to high BMI; B, Early-onset hip OA attributable to high BMI. Abbreviations: BMI, Body mass index.

Fig 3. The ASDR of early-onset OA attributable to high BMI per 100,000 population in 1990 and 2021, by country, along with ASDR trends from 1990 to 2021 as measured by the EAPC.

Note: A, The ASDR of early-onset knee OA attributable to high BMI in 1990, by country; B, The ASDR of early-onset knee OA attributable to high BMI in 2021, by country; C, The trend in ASDR of early-onset knee OA attributable to high BMI from 1990 to 2021; D, The ASDR of early-onset hip OA attributable to high BMI in 1990, by country; E, The ASDR of early-onset hip OA attributable to high BMI in 2021, by country; F, The trend in ASDR of early-onset hip OA attributable to high BMI from 1990 to 2021. Abbreviations: BMI, Body mass index; EAPC, estimated annual percentage change; ASDR, age-standardized disability-adjusted life years rate.

Fig 4. Joinpoint regression analysis was conducted on the ASDR for early-onset OA attributable to high BMI.

Note: A, The joinpoint regression analysis for the ASDR of early-onset knee OA attributable to high BMI for all genders; B, The joinpoint regression analysis for the ASDR of early-onset knee OA attributable to high BMI for female; C, The joinpoint regression analysis for the ASDR of early-onset knee OA attributable to high BMI for male; D, The joinpoint regression analysis for the ASDR of early-onset hip OA attributable to high BMI for all genders; E, The joinpoint regression analysis for the ASDR of early-onset hip OA attributable to high BMI for female; F, The joinpoint regression analysis for the ASDR of early-onset hip OA attributable to high BMI for male. Abbreviations: BMI, Body mass index; ASDR, age-standardized disability-adjusted life years rate.

Fig 5. The effects of age, period, and birth cohort on the relative risk of DALYs for early-onset OA attributable to high BMI.

Note: A-C, Early-onset knee OA attributable to high BMI; D-F, Early-onset hip OA attributable to high BMI. Abbreviations: BMI, Body mass index; DALYs, Disability-adjusted life years.

Fig 6. Decomposition analysis of changes in the DALYs of early-onset OA attributable to high BMI, stratified by gender from 1990 to 2021.

Note: A, Early-onset knee OA attributable to high BMI; B, Early-onset hip OA attributable to high BMI. Abbreviations: BMI, Body mass index; DALYs, Disability-adjusted life years.

Fig 7. The associations between the SDI and the ASDR of early-onset OA attributable to high BMI across 21 GBD regions.

Note: The ASDR of early-onset OA attributable to high BMI across 21 GBD regions from 1990 to 2021, categorized by the SDI. Each region is represented by 32 points, illustrating the observed ASDR trends over time. The solid line represents the expected ASDR values based on the SDI and overall disease incidence across all regions. Regions positioned above the solid line indicate a higher-than-expected burden, while those below the line indicate a lower-than-expected burden. A, early-onset knee OA attributable to high BMI; B, early-onset hip OA attributable to high BMI. Abbreviations: BMI, Body mass index; ASDR, age-standardized disability-adjusted life years rate; GBD, Global Burden of Disease; SDI, Sociodemographic Index.

Fig 8. The associations between the SDI and the ASDR of early-onset OA attributable to high BMI across 204 countries.

Note: A, The association between the SDI and the ASDR of early-onset knee OA attributable to high BMI across 204 countries in 1990; B, The association between the SDI and the ASDR of early-onset knee OA attributable to high BMI across 204 countries in 2021; C, The association between the SDI and the ASDR of early-onset hip OA attributable to high BMI across 204 countries in 1990; D, The association between the SDI and the ASDR of early-onset hip OA attributable to high BMI across 204 countries in 2021. Abbreviations: BMI, Body mass index; ASDR, age-standardized disability-adjusted life years rate; GBD, Global Burden of Disease; SDI, Sociodemographic Index.

Fig 9. The projected ASDR of early-onset OA attributable to high BMI over the next 15 years.

Note: A, The projected ASDR of early-onset knee OA attributable to high BMI for all genders; B, The projected ASDR of early-onset knee OA attributable to high BMI for female; C, The projected ASDR of early-onset knee OA attributable to high BMI for male; D, The projected ASDR of early-onset hip OA attributable to high BMI for all genders. E, The projected ASDR of early-onset hip OA attributable to high BMI for female; F, The projected ASDR of early-onset hip OA attributable to high BMI for male. Abbreviations: BMI, Body mass index; ASDR, age-standardized disability-adjusted life years rate.