Liu Jingchun, Han Wuyue, Wang Haoyu, Wang Zhi, Li Bingshu, Hong Li
Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, China.
J Pers Med. 2023 Aug 22;13(9):1284. doi: 10.3390/jpm13091284.
Endometriosis is a common nonfatal gynecological disease, and infertility is one of its main dangers. Endometriosis-related infertility causes serious damage to women's health and places a burden on women of reproductive age. The aim of this study was to describe the current burden of endometriosis-associated infertility and to analyze its spatiotemporal trends.
Age-standardized prevalence rate (ASPR) data from 1990 to 2019 for Endometriosis-related primary infertility (ERPI) and secondary infertility (ERSI) were obtained from the Global Burden of Disease Study (GBD) 2019. These data spanning three decades cover the global, sociodemographic index (SDI) regions, GBD regions, and 204 countries and territories. Spatiotemporal trends were analyzed by calculating the estimated annual percentage change (EAPC) and using a time-period-cohort model.
Globally, the ASPR of ERPI and ERSI showed a weak downward trend from 1990 to 2019, with EAPCs of -1.25 (95% CI: -1.39 to -1.11) and -0.6 (95% CI: -0.67 to -0.53), respectively. The spatiotemporal trends in ERPI and ERSI varied substantially between regions and age groups. When endometriosis-related infertility burden was linked to SDI values, a strong negative correlation was observed between the ASPR of ERSI and its EAPC and SDI values. When modeling with age-period-cohort, ERPI burden was found to be highest at ages 20-25 years, while ERSI burden was persistently higher at ages 20-45 years. Using 2000-2004 as the reference period, both ERPI and ERSI burden decreased with each year among women. Significant variability in burden between regions was found for the birth cohort factor.
The global burden of endometriosis-related infertility declined minimally from 1990 to 2019. However, this burden varied considerably across regions, age groups, periods, and birth cohorts. The results of this study reflect spatiotemporal trends in the burden of endometriosis-related infertility over the study period and may be used to help improve health management, develop timely and effective prevention and control strategies, and provide epidemiologic theoretical evidence for reducing the burden for endometriosis-related infertility.
子宫内膜异位症是一种常见的非致命性妇科疾病，不孕是其主要危害之一。子宫内膜异位症相关不孕对女性健康造成严重损害，并给育龄女性带来负担。本研究的目的是描述子宫内膜异位症相关不孕的当前负担，并分析其时空趋势。
从《2019年全球疾病负担研究》（GBD 2019）中获取1990年至2019年子宫内膜异位症相关原发性不孕（ERPI）和继发性不孕（ERSI）的年龄标准化患病率（ASPR）数据。这些跨越三十年的数据涵盖全球、社会人口指数（SDI）区域、GBD区域以及204个国家和地区。通过计算估计年百分比变化（EAPC）并使用时期队列模型分析时空趋势。
在全球范围内，1990年至2019年期间，ERPI和ERSI的ASPR呈微弱下降趋势，EAPC分别为-1.25（95%CI：-1.39至-1.11）和-0.6（95%CI：-0.67至-0.53）。ERPI和ERSI的时空趋势在不同区域和年龄组之间存在很大差异。当将子宫内膜异位症相关不孕负担与SDI值相关联时，观察到ERSI的ASPR与其EAPC和SDI值之间存在很强的负相关性。在进行年龄-时期-队列建模时，发现ERPI负担在20至25岁年龄组最高，而ERSI负担在20至45岁年龄组持续较高。以2000-2004年为参考期，女性中ERPI和ERSI负担均逐年下降。发现出生队列因素在各区域之间的负担存在显著差异。
1990年至2019年期间，全球子宫内膜异位症相关不孕负担略有下降。然而，这种负担在不同区域、年龄组、时期和出生队列之间存在很大差异。本研究结果反映了研究期间子宫内膜异位症相关不孕负担的时空趋势，可用于帮助改善健康管理、制定及时有效的预防和控制策略，并为减轻子宫内膜异位症相关不孕负担提供流行病学理论依据。
