Global, regional, and national burden of G6PD deficiency: A three-decade analysis across 204 countries

Abstract Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the most common enzymatic disorders globally, yet its burden remains under-characterized in public health literature. We aimed to evaluate long-term trends in disability, mortality, and prevalence of G6PD deficiency across 204 countries from 1990 to 2021. Methods: We conducted an ecological cross-sectional analysis using data from the Global Burden of Disease (GBD) 2021 study. Estimates of disability-adjusted life years (DALYs), years of life lost (YLLs), and prevalence attributable to G6PD deficiency were extracted for each country from 1990 to 2021. Countries were ranked by aggregate burden in 2021 using the sum of DALYs, YLLs, and prevalence. The top five—India, China, Nigeria, Bangladesh, and Indonesia—were selected for longitudinal analysis. Percent change was calculated between 1990 and 2021. Visualizations included choropleth maps, line plots, and heatmaps created using R (v4.4.2). Results: In 2021, China had the highest G6PD-related DALY burden (53,047.5), though this marked a 12.7% decline since 1990. India's DALYs increased by 75.4% (to 30,527.1), and Nigeria's nearly doubled (+98.9%, to 28,499.0). Bangladesh and Indonesia saw DALY reductions of 29.9% and 8.1%, respectively. Prevalence rose in all five countries, with China reporting 66.1 million cases (+64.4%). YLLs increased sharply in India (+95.3%) and Nigeria (+58.5%), while decreasing in China (−12.2%) and Indonesia (−4.5%). Bangladesh recorded a 54.3% YLL increase. Visualizations highlighted regional heterogeneity, with rising burdens concentrated in South Asia and Sub-Saharan Africa. Conclusions: The global burden of G6PD deficiency remains unevenly distributed. While China and Bangladesh have seen reductions in disability and mortality, India and Nigeria experienced rising burden across all metrics. These findings highlight the need for enhanced screening, prevention, and targeted health system interventions in high-burden regions.