Dai Fangyi, Cai Yuzhou, Luo Huayou, Shu Ruo, Zhang Tong, Dai Yong
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Kunming Medical University, Yun Nan, 650032, China.
Department of Hepatobiliary Surgery, The Affiliated Hospital of Qinghai University, Qing Hai, 810006, China.
BMC Gastroenterol. 2025 Apr 25;25(1):296. doi: 10.1186/s12876-025-03916-w.
Inguinal, femoral, and abdominal wall hernias represent significant health and economic burdens globally, particularly among adults aged 45 and older. In 2021, the Global Burden of Disease Study reported 1.72 million new cases, 6.75 million prevalent cases, and over 41,000 deaths in this population. While age-standardized rates have declined with improved healthcare, absolute burden continues to rise due to population growth and aging. Gender disparities remain pronounced, with men experiencing sevenfold higher incidence than women. This study analyzes global hernia trends, determinants, future projections, and the association between health workforce distribution and hernia burden to inform targeted interventions.
Using data from the Global Burden of Disease Study 2021, we analyzed incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for inguinal, femoral, and abdominal wall hernias. Long-term trends were assessed using average annual percentage change (EAPC), with decomposition analyses exploring factors influencing disease burden changes. Spatial and temporal patterns were examined using age-period-cohort and frontier analyses. We conducted health inequality analyses and utilized eight time-series machine learning models to project disease burden from 2022 to 2050. Additionally, we analyzed correlations between health workforce distribution and hernia burden across 204 countries and territories for 1990 and 2019.
In 2021, global incidence of hernias was 1,720,177, with 6,748,203 prevalent cases and 41,834 deaths among individuals aged 45 years and older. Although age-standardized incidence rate (ASIR) decreased from 153.98/100,000 in 1990 to 112.29/100,000 in 2021 (EAPC = -0.83%, 95% CI: -0.95% to -0.70%), and age-standardized mortality rate (ASMR) decreased from 3.19/100,000 to 1.86/100,000 (EAPC = -1.77%, 95% CI: -1.94% to -1.59%), absolute burden continued increasing. Socioeconomic differences were significant, with higher ASIR in high SDI areas (141.94/100,000) than low SDI areas (104.60/100,000) in 2021, but much higher ASMR in low SDI areas (4.14/100,000) than high SDI areas (1.23/100,000). Decomposition analysis revealed population growth as the main driver of increased disease burden, contributing 173.80% to incidence increases. Age-period-cohort analysis showed incidence peaked in the 65-69 age group (RR = 1.43, 95% CI: 1.42-1.43). Male ASIR in 2021 (203.41/100,000) was approximately 7.3 times higher than female ASIR (27.94/100,000). Correlation analyses revealed significant negative associations between pharmaceutical personnel density and hernia disease burden, with correlation coefficients strengthening from 1990 (DALYs: r = -0.39, p < 0.001) to 2019 (DALYs: r = -0.57, p < 0.001). Similar trends were observed for dentistry personnel (DALYs: r = -0.26 in 1990 to r = -0.47 in 2019, p < 0.001). Countries with high hernia burden (Guatemala, Paraguay, Indonesia) consistently demonstrated lower health workforce density compared to low-burden countries. ARIMA model projections showed that by 2050, ASIR would increase slightly from 112.32/100,000 in 2022 to 112.64/100,000, with absolute new cases increasing by 19.70%. ASMR is projected to increase from 1.84/100,000 to 2.11/100,000, with deaths increasing by 8.50%.
Despite declining age-standardized rates for inguinal, femoral, and abdominal wall hernias, absolute disease burden continues increasing due to demographic factors. Socioeconomic development significantly impacts disease patterns, with higher morbidity but lower mortality in high SDI areas. The strong negative correlation between pharmaceutical and dentistry personnel density and hernia burden suggests potential protective effects of healthcare workforce investment, particularly in resource-constrained settings. Future projections indicate growing absolute burden despite relatively stable age-standardized rates, highlighting the urgent need to strengthen preventive measures, improve treatments, and strategically allocate health workforce resources to address this growing public health challenge.
腹股沟疝、股疝和腹壁疝在全球范围内造成了重大的健康和经济负担，在45岁及以上的成年人中尤为突出。2021年，全球疾病负担研究报告显示，该年龄段人群中有172万新发病例、675万现患病例以及超过4.1万例死亡。尽管随着医疗保健水平的提高，年龄标准化发病率有所下降，但由于人口增长和老龄化，绝对负担仍在上升。性别差异依然显著，男性的发病率比女性高7倍。本研究分析了全球疝病的趋势、决定因素、未来预测以及卫生人力分布与疝病负担之间的关联，以为针对性干预措施提供依据。
利用2021年全球疾病负担研究的数据，我们分析了腹股沟疝、股疝和腹壁疝的发病率、患病率、死亡率和伤残调整生命年（DALYs）。使用平均年度百分比变化（EAPC）评估长期趋势，并通过分解分析探讨影响疾病负担变化的因素。使用年龄-时期-队列分析和前沿分析研究空间和时间模式。我们进行了健康不平等分析，并利用八个时间序列机器学习模型预测了2022年至2050年的疾病负担。此外，我们分析了1990年和2019年204个国家和地区卫生人力分布与疝病负担之间的相关性。
2021年，全球45岁及以上人群中疝病的发病率为1720177例，现患病例为6748203例，死亡41834例。尽管年龄标准化发病率（ASIR）从1990年的153.98/10万降至2021年的112.29/10万（EAPC = -0.83%，95% CI：-0.95%至-0.70%），年龄标准化死亡率（ASMR）从3.19/10万降至1.86/10万（EAPC = -1.77%，95% CI：-1.94%至-1.59%），但绝对负担仍在增加。社会经济差异显著，2021年高社会人口指数（SDI）地区的ASIR（141.94/10万）高于低SDI地区（104.60/10万），但低SDI地区的ASMR（4.14/10万）远高于高SDI地区（1.23/10万）。分解分析表明，人口增长是疾病负担增加的主要驱动因素，对发病率增加的贡献率为173.80%。年龄-时期-队列分析显示，发病率在65-69岁年龄组达到峰值（RR = 1.43，95% CI：1.42-1.43）。2021年男性的ASIR（203.41/10万）约为女性ASIR（27.94/10万）的7.3倍。相关性分析显示，药剂人员密度与疝病疾病负担之间存在显著的负相关，相关系数从1990年（DALYs：r = -0.39，p < 0.001）到2019年（DALYs：r = -0.57，p < 0.001）不断增强。牙科人员也呈现类似趋势（DALYs：1990年r = - .26至2019年r = -0.47，p < 0.001）。与低负担国家相比，疝病负担高的国家（危地马拉、巴拉圭、印度尼西亚）卫生人力密度始终较低。自回归整合移动平均（ARIMA）模型预测显示，到2050年，ASIR将从2022年的112.32/10万略有增加至112.64/10万，新增病例绝对数将增加19.70%。ASMR预计将从1.84/10万增至2.11/10万，死亡人数将增加8.50%。
尽管腹股沟疝、股疝和腹壁疝的年龄标准化发病率有所下降，但由于人口因素，疾病的绝对负担仍在增加。社会经济发展对疾病模式有显著影响，高SDI地区发病率较高但死亡率较低。药剂和牙科人员密度与疝病负担之间的强负相关表明，投资卫生人力可能具有潜在的保护作用，特别是在资源有限的环境中。未来预测表明，尽管年龄标准化发病率相对稳定，但绝对负担仍在增加，这凸显了迫切需要加强预防措施、改善治疗方法并战略性地分配卫生人力资，以应对这一日益严峻的公共卫生挑战。
