Xu Shuangfei, Zhang Yi, Ye Peng, Huang Qin, Wang Yinan, Zhang Yan, Yang Chaogang, Ding Jinli
Reproductive Medical Center, Renmin Hospital of Wuhan University and Hubei Clinic Research center for Assisted Reproductive Technology and Embryonic Development, Wuhan, China.
Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, China.
Int J Surg. 2025 Jun 20. doi: 10.1097/JS9.0000000000002647.
Endometriosis is a major contributor to infertility and pelvic pain, which brings a significant burden on family and society. Although the data of endometriosis in Global Burden of Disease (GBD) 2019 was reviewed, no updated analysis has been conducted using GBD 2021, and the disease burden across different age groups has not been analyzed. The aim of this cross-sectional analysis was to provide an up-to-date assessment of the prevalence, incidence, and disability-adjusted life-years (DALYs) of endometriosis from 1990 to 2021 at the global, national, and regional levels.
We obtained data on the prevalence, incidence, and DALYs of endometriosis from GBD 2021. These data were analyzed to provide an overview of the epidemiological trends and disease burden of endometriosis in 204 countries and regions worldwide from 1990 to 2021, and we projected trends through 2040. Health inequality analysis, joinpoint regression analysis, and decomposition analysis were applied to data assessment.
In 2021, the global burden of endometriosis remained substantial, with a total of 22.28 million cases (95% UI: 13.67, 33.69), corresponding to an age-standardized prevalence rate (ASPR) of 1023.8 per 100 000 (95% UI: 627.36, 1549.77). The age-standardized incidence rates (ASIR) was 162.71 (95% UI: 85.21, 265.35) per 100 000, while the age-standardized DALY rate (ASDR) was 94.25 (95% UI: 50.82, 157.73) per 100 000. Regionally, areas with low sociodemographic index (SDI) experienced the highest ASPR, ASIR, and ASDR, while high SDI regions exhibited the lowest rates. Geospatially, Oceania and Eastern Europe displayed the highest ASPR, ASIR, and ASDR. Among countries, Niger had both the highest ASPR and ASDR, and Solomon Islands had the highest ASIR. Women aged 25-29 years emerged as the most affected group, suggesting that this cohort should be a key focus for interventions. By 2040, the global ASPR of endometriosis is projected decline to 887.89 per 100 000 (95% CI: 530.79, 1245), representing a decrease of 13.28% from 2021. Decomposition analysis showed population growth was the major contributing factor, followed by epidemiologic change.
While the burden of endometriosis has decreased globally from 1990 to 2021, significant disparities remain, especially in low SDI regions. It is necessary to develop better policies and preventive measures to effectively address the range of problems associated with endometriosis.
子宫内膜异位症是导致不孕和盆腔疼痛的主要原因，给家庭和社会带来了沉重负担。尽管对《2019年全球疾病负担》（GBD）中子宫内膜异位症的数据进行了审查，但尚未使用GBD 2021进行更新分析，且未对不同年龄组的疾病负担进行分析。本横断面分析的目的是在全球、国家和区域层面提供1990年至2021年子宫内膜异位症患病率、发病率和伤残调整生命年（DALY）的最新评估。
我们从GBD 2021中获取了子宫内膜异位症的患病率、发病率和DALY数据。对这些数据进行分析，以概述1990年至2021年全球204个国家和地区子宫内膜异位症的流行病学趋势和疾病负担，并预测至2040年的趋势。健康不平等分析、连接点回归分析和分解分析应用于数据评估。
2021年，全球子宫内膜异位症负担仍然很重，共有2228万例（95%不确定区间：1367万，3369万），年龄标准化患病率（ASPR）为每10万人1023.8例（95%不确定区间：627.36，1549.77）。年龄标准化发病率（ASIR）为每10万人162.71例（95%不确定区间：85.21，265.35），而年龄标准化DALY率（ASDR）为每10万人94.25例（95%不确定区间：50.82，157.73）。在区域层面，社会人口指数（SDI）较低的地区ASPR、ASIR和ASDR最高，而高SDI地区的这些比率最低。在地理空间上，大洋洲和东欧的ASPR最为高、ASIR和ASDR。在各国中，尼日尔的ASPR和ASDR最高而所罗门群岛的ASIR最高。25 - 29岁的女性是受影响最严重的群体，这表明该年龄段人群应成为干预的重点。到2040年，预计全球子宫内膜异位症的ASPR将降至每10万人887.89例（95%置信区间：530.79，1245），比2021年下降13.28%。分解分析表明，人口增长是主要影响因素，其次是流行病学变化。
虽然1990年至2021年全球范围内子宫内膜异位症的负担有所下降，但仍存在显著差异，尤其是在低SDI地区。有必要制定更好的政策和预防措施，以有效解决与子宫内膜异位症相关的一系列问题。
