Luo Yu, Zheng Rubin, Chen Jiaxi, Deng Miao, Zhang Ziyang, Tan Zhouke, Bai Zhixun
Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563006, China.
Department of Nephrology, People's Hospital of Qianxinan Prefecture, Xingyi, 562400, Guizhou, China.
Trop Med Health. 2025 May 12;53(1):68. doi: 10.1186/s41182-025-00750-4.
Congenital musculoskeletal and limb (CML) anomalies are uncommon, multifactorial conditions whose global incidence trends remain underexplored. This study delineates the epidemiology and temporal evolution of CML anomalies from 1990 to 2021.
We extracted data from the 2021 global burden of disease (GBD) Study, stratifying by sex, region, country and socio-demographic index (SDI). We calculated age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and estimated annual percentage change (EAPC). Decomposition analysis quantified the contributions of population growth, aging, and epidemiological change. Projections to 2031 were made using an autoregressive integrated moving average (ARIMA) model. Health inequities were assessed via the slope index of inequality (SII) and concentration index (CI).
Global epidemiological patterns of CML anomalies exhibited significant disparities between 1990 and 2021. Brunei Darussalam demonstrated the highest ASIR, while Afghanistan and the United Mexican States recorded the highest ASMR and ASPR, respectively. Absolute case and death burdens predominantly clustered in populous nations, with India and China reporting the highest absolute numbers. ARIMA modeling projected a 0.85% increase in incident cases (from 2,437,890.12 to 2,458,596.45), a 25.46% decrease in mortality (from 13,599.83 to 10,137.02), and a 3.55% increase in prevalence (from 18,549,408.27 to 19,207,414.19) by 2031. Decomposition analyses revealed that population growth was the primary driver of increased cases in middle SDI regions, whereas epidemiological transitions and aging were the main contributors to mortality reductions. In lower-middle SDI regions, concurrent demographic expansion and epidemiological changes amplified case burdens. Health inequality significantly increased, with the incidence CI rising from 0.28 to 0.35 and the mortality CI from 0.34 to 0.42 between 1990 and 2021. Significant correlations were observed between EAPC and baseline ASIR/ASMR, with declining trends in mortality and rising prevalence driven by population growth and epidemiological transitions.
From 1990 to 2021, CML anomalies' incidence and mortality exhibited divergent trends across SDI strata, with less favorable outcomes in lower-SDI countries. Tailored interventions are essential to mitigate the growing burden in these settings.
先天性肌肉骨骼和肢体（CML）异常是罕见的多因素疾病，其全球发病率趋势仍未得到充分研究。本研究描述了1990年至2021年CML异常的流行病学和时间演变情况。
我们从2021年全球疾病负担（GBD）研究中提取数据，按性别、地区、国家和社会人口指数（SDI）进行分层。我们计算了年龄标准化发病率（ASIR）、年龄标准化死亡率（ASMR）、年龄标准化患病率（ASPR）以及估计年变化百分比（EAPC）。分解分析量化了人口增长、老龄化和流行病学变化的贡献。使用自回归积分移动平均（ARIMA）模型对2031年进行了预测。通过不平等斜率指数（SII）和集中指数（CI）评估健康不平等情况。
1990年至2021年期间，CML异常的全球流行病学模式存在显著差异。文莱达鲁萨兰国的ASIR最高，而阿富汗和墨西哥合众国分别记录了最高的ASMR和ASPR。绝对病例和死亡负担主要集中在人口众多的国家，印度和中国报告的绝对数字最高。ARIMA模型预测，到2031年，发病病例将增加0.85%（从2437890.12例增至2458596.45例），死亡率将下降25.46%（从13599.83例降至10137.02例），患病率将增加3.55%（从18549408.27例增至19207414.19例）。分解分析表明，人口增长是中等SDI地区病例增加的主要驱动因素，而流行病学转变和老龄化是死亡率下降的主要原因。在中低收入SDI地区，人口增长和流行病学变化同时加剧了病例负担。健康不平等显著增加，1990年至2021年期间，发病率CI从0.28升至0.35，死亡率CI从0.34升至0.42。EAPC与基线ASIR/ASMR之间存在显著相关性，死亡率下降趋势和患病率上升趋势是由人口增长和流行病学转变驱动的。
1990年至2021年期间，CML异常的发病率和死亡率在不同SDI阶层呈现出不同趋势，低收入SDI国家的结果较差。量身定制的干预措施对于减轻这些地区日益加重的负担至关重要。
