Teng Aiying, Liu Min, Zhang Xuepei, Tang Yunzhi, Yin Xiaolin
Department of Public Health, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250021, China.
Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, China.
BMC Public Health. 2025 Aug 27;25(1):2956. doi: 10.1186/s12889-025-24286-8.
Unsafe sex remains a critical threat to the life and health of females. Following the latest Global Burden of Disease (GBD) 2021 estimates, this study updated the global spatiotemporal trends of disease burden attributable to unsafe sex in females, and firstly conducted forecasts to 2035, to guide the resource allocation and the development of public health strategies.
The number and age-standardized rates (ASRs) of unsafe-sex-related deaths and disability-adjusted life years (DALYs) in females from 1990 to 2021 were retrieved from GBD 2021. The estimated annual percentage change (EAPC) was calculated to quantify the temporal trends in rates. The Autoregressive Integrated Moving Average model was conducted to estimate the future burden.
Globally, the absolute number of female burden due to unsafe sex peaked in the early 2000s and subsequently decreased to 619,130 deaths and 28,782,771 DALYs by 2021. The ASRs showed similar patterns. For age effects, the highest burden was observed among females aged 35-44 years. Besides, there were significant geographic disparities negatively associating with local SDI values, with the low-, low-middle- and middle-SDI regions accounting for nearly 80% of the total. The most severe situation always occurred in Sub-Sahara Africa in spite of downward trends observed with time, while Eastern Europe had a significant increase in the associated burden. Finally, the unsafe-sex-related ASRs was projected to continue declining modestly until 2035.
Despite overall declines, unsafe sex remains a significant health threat to females, particularly in low- to middle-SDI regions and among females of reproductive age. The persistent high burden underscored the need for sustained and targeted public health strategies, including the promotion of safe sexual practices, HPV vaccination, and improved access to healthcare services.
不安全的性行为仍然是对女性生命和健康的重大威胁。根据最新的2021年全球疾病负担（GBD）估计，本研究更新了女性不安全性行为所致疾病负担的全球时空趋势，并首次预测至2035年，以指导资源分配和公共卫生策略的制定。
从GBD 2021中检索1990年至2021年女性不安全性行为相关死亡人数、年龄标准化率（ASRs）以及伤残调整生命年（DALYs）。计算估计年度百分比变化（EAPC）以量化率的时间趋势。采用自回归积分移动平均模型估计未来负担。
在全球范围内，不安全性行为导致的女性负担绝对数在21世纪初达到峰值，随后下降，到2021年降至619,130例死亡和28,782,771个DALYs。ASRs呈现类似模式。就年龄影响而言，35 - 44岁女性负担最高。此外，存在与当地社会人口指数（SDI）值呈负相关的显著地理差异，低、低中、中等SDI地区占总数近80%。尽管随着时间推移呈下降趋势，但最严峻的情况始终出现在撒哈拉以南非洲，而东欧相关负担显著增加。最后，预计到2035年，与不安全性行为相关的ASRs将继续适度下降。
尽管总体呈下降趋势，但不安全的性行为仍然是对女性的重大健康威胁，特别是在低至中等SDI地区以及育龄女性中。持续的高负担凸显了持续和有针对性公共卫生策略的必要性，包括推广安全性行为、人乳头瘤病毒（HPV）疫苗接种以及改善医疗服务可及性。
