Global, regional, and national burden of gastroesophageal reflux disease (1990-2021): age-period-cohort analysis and Bayesian projections

Abstract

Background: Gastroesophageal reflux disease (GERD) is a common chronic upper gastrointestinal disorder that causes discomfort and increases the risk of esophageal adenocarcinoma. The global burden of GERD has steadily increased, establishing it as a critical public health issue. This study systematically evaluated the global, regional, and national burden of GERD from 1990 to 2021, revealing epidemiological trends and regional disparities to inform targeted intervention strategies.

Methods: We utilized data from the 2021 Global Burden of Disease Study (GBD) to assess the prevalence, incidence, and years lived with disability (YLDs) of GERD. Key indicators included age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized YLDs rate (ASYR), and estimated annual percentage change (EAPC). Analyses were stratified by age, gender, and socio-demographic index (SDI). Age-period-cohort (APC) models were applied to examine trends in the 15-49 age group, and Bayesian APC models were used to project future trends.

Results: In 2021, global GERD prevalence reached 825.6 million (95% uncertainty interval: 732.99-925.56 million). From 1990 to 2021, incident cases, prevalent cases, and YLDs rose by 83.16, 80.06, and 82.46%, respectively. The ASIR, ASPR, and ASYR all showed upward trends, with EAPCs of 0.097, 0.076, and 0.083. The highest burden of ASIR, ASPR, and ASYR was observed in Tropical Latin America in 2021, while the lowest was in East Asia. Regions with lower SDI had higher ASIR, ASPR, and ASYR. In the 15-49 age group, the GERD burden increased with age across all SDI regions, with unfavorable period effects observed in high and high-middle SDI regions, as well as adverse cohort effects in high-middle and middle SDI regions. Projections indicate that by 2035, global GERD cases in this age group will reach 527.2 million (ASPR: 12,082.06/100,000), with 214.6 million incident cases (ASIR: 4,916.68/100,000) and 4.1 million YLDs (ASYR: 94.47/100,000).

Conclusion: GERD poses a growing global health challenge. Insights from these observed epidemiological patterns can assist policymakers in developing targeted measures to reduce its impact, particularly in high-risk regions and younger demographics.

Keywords: Bayesian projections; GBD; age-period-cohort; age-standardized rate; gastroesophageal reflux disease.

Figure 1

The prevalence numbers (A), incidence numbers (B), YLD numbers (C), ASPR (D), ASIR (E), and ASYR (F) of GERD in global and the five SDI regions from 1990 to 2021. SDI, sociodemographic Index, ASPR; ASIR, age-standardized incidence rate; ASYR, age-standardized years lived with disability; GERD, gastroesophageal reflux disease. ASPR, age-standardized prevalence rate; ASIR, age-standardized incidence rate; ASYR, age-standardized years lived with disability; EAPC, estimated annual percentage change; GERD, gastroesophageal reflux disease.

Figure 2

The ASPR (A), ASIR (B), and ASYR (C) due to GERD for 21 GBD regions by SDI from 1990 to 2021. The black line represents expected rates in 2021 based solely on SDI. Points from left to right show estimates from 1990 to 2021. The ASPR (D), ASIR (E), and ASYR (F) due to GERD for 204 countries in 2021. ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; ASYR, age-standardized YLD rate; GBD, Global Burden of Disease; GERD, gastroesophageal reflux disease; SDI, socio-demographic index.

Figure 3

The global burden of GERD in 204 countries and territories. (A) ASPR of GERD (per 100,000 population) in 2021. (B) ASIR of GERD (per 100,000 population) in 2021. (C) ASYR due to GERD (per 100,000 population) in 2021. (D) EAPC in ASPR for GERD from 1990 to 2021. (E) EAPC in ASIR for GERD from 1990 to 2021. (F) EAPC in ASYR for GERD from 1990 to 2021. ASPR, age-standardized prevalence rate; ASIR, age-standardized incidence rate; ASYR, age-standardized years lived with disability; EAPC, estimated annual percentage change; GERD, gastroesophageal reflux disease. ASPR, age-standardized prevalence rate; ASIR, age-standardized incidence rate; ASYR, age-standardized years lived with disability; EAPC, estimated annual percentage change; GERD, gastroesophageal reflux disease.

Figure 4

Age patterns by sex of the total number and age-specific prevalence rate (A), incidence rate (B), and YLD rate (C) for GERD in 1990, and age patterns by sex of the total number and age-specific prevalence rate (D), incidence rate (E), and YLD rate (F) for GERD in 2021. Error bars indicate the 95% uncertainty interval (UI) for the number of cases, and shading represents the 95% UI for the rates. GERD, gastroesophageal reflux disease. ASPR, age-standardized prevalence rate; ASIR, age-standardized incidence rate; ASYR, age-standardized years lived with disability; EAPC, estimated annual percentage change; GERD, gastroesophageal reflux disease.

Figure 5

Age, period, and birth cohort effects on GERD prevalence among 15–49 year olds by APC models. (A) Age effect, longitudinal age-specific rates adjusted for cohort and period variations. (B) Period effect, relative risk of GERD prevalence between 1992 and 1996 and 2017–2021, with 1992–1996 as the baseline. (C) Local drift and age distribution of GERD prevalence from 1992 to 2021 across SDI quintiles. (D) Birth cohort effect, relative risk of prevalence, calculated as the ratio of rates from the 1942–1951 to the 1997–2006 cohort, with 1972–1981 as the reference. Dots and shaded areas represent rates or rate ratios with 95% CIs. ASPR, age-standardized prevalence rate; ASIR, age-standardized incidence rate; ASYR, age-standardized years lived with disability; EAPC, estimated annual percentage change; GERD, gastroesophageal reflux disease.

Figure 6

Age, period, and birth cohort effects on GERD incidence among 15–49 year olds by APC models. (A) Age effect: longitudinal age-specific rates adjusted for cohort and period variations. (B) Period effect: relative risk of GERD incidence between 1992–1996 and 2017–2021, with 1992–1996 as the baseline. (C) Local drift and age distribution of GERD incidence from 1992 to 2021 across SDI quintiles. (D) Birth cohort effect: relative risk of incidence, calculated as the ratio of rates from the 1942–1951 to the 1997–2006 cohort, with 1972–1981 as the reference. Dots and shaded areas represent rates or rate ratios with 95% CIs. ASPR, age-standardized prevalence rate; ASIR, age-standardized incidence rate; ASYR, age-standardized years lived with disability; EAPC, estimated annual percentage change; GERD, gastroesophageal reflux disease.

Figure 7

Age, period, and birth cohort effects on GERD YLDs among 15–49 year olds by APC models. (A) Age effect: longitudinal age-specific rates adjusted for cohort and period variations. (B) Period effect: relative risk of GERD YLDs between 1992–1996 and 2017–2021, with 1992–1996 as the baseline. (C) Local drift and age distribution of GERD YLDs from 1992 to 2021 across SDI quintiles. (D) Birth cohort effect: relative risk of YLDs, calculated as the ratio of rates from the 1942–1951 to the 1997–2006 cohort, with 1972–1981 as the reference. Dots and shaded areas represent rates or rate ratios with 95% CIs. ASPR, age-standardized prevalence rate; ASIR, age-standardized incidence rate; ASYR, age-standardized years lived with disability; EAPC, estimated annual percentage change; GERD, gastroesophageal reflux disease.

Figure 8

Future forecast of global ASIR, ASPR and ASYR of GERD. ASPR, age-standardized prevalence rate; ASIR, age-standardized incidence rate; ASYR, age-standardized years lived with disability; EAPC, estimated annual percentage change; GERD, gastroesophageal reflux disease.