Global pattern, trend and cross-country inequalities of inguinal, femoral, and abdominal hernia among individuals aged 60 and above from 1990 to 2021 and projections until 2040: a population-based study.

BACKGROUND

Inguinal, femoral, and abdominal hernias are significant health concerns among older adults, leading to substantial morbidity worldwide. Comprehensive data on the global and regional burden of these hernias, particularly in relation to demographic and socioeconomic factors, remain limited. This study aims to analyze hernia prevalence, incidence, deaths, and DALYs among individuals aged 60 and above, providing crucial insights for public health planning and resource allocation.

METHODS

Our study utilized data from the Global Burden of Disease (GBD) 2021 study, which assessed the health impacts of 371 diseases across 204 countries and territories. We extracted data on prevalence, incidence, mortality, and disability-adjusted life years (DALYs) associated with inguinal, femoral, and abdominal hernias, standardized to per 100,000 population. Descriptive analyses were conducted to examine global, regional, and national trends from 1990 to 2021, using joinpoint regression to calculate annual and average annual percent changes. Spearman or pearson correlation analyses explored relationships between sociodemographic index and hernia metrics, while frontier and cross-country inequality analyses assessed disparities. Projections through 2040 were made using the Bayesian age-period-cohort model. All analyses were performed using R version 4.3.3.

RESULTS

From 1990 to 2021, the global burden of inguinal, femoral, and abdominal hernias in individuals aged 60 and above increased significantly, with prevalence rising from 2.52 million to 3.62 million cases, incidence from 0.94 million to 1.48 million cases, deaths from 0.02 million to 0.04 million, and DALYs from 0.58 million to 0.81 million. Despite these increases, age-standardized rates (ASRs) for all metrics declined. Males consistently had higher ASRs than females, with the burden of DALYs and deaths peaking in older age groups. Significant regional and national disparities were observed, with declines seen in regions such as Central Europe and countries like Poland, and increasing trends in areas including Georgia, Mozambique, and American Samoa. Higher SDI countries generally had lower ASRs for prevalence, deaths, and DALYs but higher incidence rates. Projections for 2022 to 2040 indicate rising case numbers, although ASRs for deaths and DALYs are expected to decline. Inequalities in hernia burden have grown, disproportionately affecting lower socio-economic groups.

CONCLUSIONS

Despite declining ASRs, the global burden of inguinal, femoral, and abdominal hernias in older adults has increased, with significant regional and national disparities. Males and lower socio-economic groups are disproportionately affected, underscoring the need for targeted public health interventions. Effective public health interventions are needed, especially in lower SDI countries, to address these inequalities and improve outcomes for socio-economically disadvantaged populations. As the global population ages, targeted strategies are essential to reduce the impact of hernias on public health.