Shifting burden of inflammatory bowel disease in women of childbearing age: from high-income to low-income countries (1990-2021).

Abstract

Data on health inequalities in inflammatory bowel disease (IBD) among women of childbearing age (WCBA, 15-49 years) across different countries are lacking. We aimed to assess the global incidence, disability-adjusted life year (DALY) burden and cross-country inequalities of IBD in WCBA from 1990 to 2021. Observational study. Data were extracted from the Global Burden of Disease Study 2021. Women aged 15-49 years diagnosed with IBD. The primary outcomes were the total numbers and age-standardised rates of incidence and DALYs. Secondary outcomes included (1) temporal trends, assessed using estimated annual percentage change (EAPC); (2) periods of significant change identified through joinpoint regression analysis and (3) health inequalities by sociodemographic index (SDI), assessed using the slope index of inequality (SII) and the concentration index. Globally, from 1990 to 2021, the number of incident IBD cases among WCBA increased from 60 926 (95% uncertainty interval (UI) 50 342 to 74 910) to 98 975 (95% UI 80 568 to 124 089), and DALYs increased from 193 091 (95% UI 145 850 to 245 244) to 281 580 (95% UI 223 989 to 349 966). During the same period, the age-standardised incidence rate (ASIR) increased significantly (EAPC 0.22, 95% UI 0.1 to 0.34), whereas the age-standardised DALY rate (ASDR) decreased significantly (EAPC -0.28, 95% UI -0.35 to -0.21). In 2021, the highest ASIR (14.93 per 100 000, 95% UI 11.52 to 18.97) and ASDR (27.94 per 100 000, 95% UI 19.97 to 37.87) were observed in high-SDI regions. In contrast, the fastest increase in ASIR (EAPC 1.69, 95% UI 1.48 to 1.90) occurred in middle-SDI regions. High-middle-SDI regions exhibited the most pronounced decrease in ASDR (EAPC -0.8, 95% UI -0.92 to -0.67), whereas a notable upward trend in ASDR was found solely in low-SDI regions (EAPC 0.14, 95% UI 0.07 to 0.21). The SII for ASIR increased from 4.83 (95% CI 3.63 to 6.03) in 1990 to 6.26 (95% CI 4.90 to 7.63) in 2021, whereas the concentration index decreased from 0.35 (95% CI 0.25 to 0.44) to 0.24 (95% CI 0.16 to 0.33). The SII for ASDR decreased from 7.37 (95% CI 2.07 to 12.67) in 1990 to 5.97 (95% CI 1.38 to 10.56) in 2021, and the concentration index shifted from 0.13 (95% CI 0.06 to 0.2) in 1990 to -0.03 (95% CI -0.1 to 0.05) in 2021. In 2021, the global incidence and ASDR burden remained concentrated in high-SDI countries, with significant regional disparities. From 1990 to 2021, health inequality in DALYs gradually shifted from high-income to low-income countries.