S3200 Temporal Trends in the Incidence of Peptic Ulcer Disease in the Middle East and North Africa Over the Past 3 Decades

Introduction: Peptic ulcer disease (PUD) is among the most prevalent gastrointestinal disorders worldwide and imposes a significant burden due to associated morbidity and diminished quality of life. Accordingly, evaluating the temporal trends in the incidence and disability-adjusted life year (DALY) of PUD in the Middle East and North Africa (MENA) region is of paramount significance as it enables risk stratification and introduction of health policy measures. Methods: Temporal trends in the age-standardized incidence rate (ASIR) and the age-standardized DALY rate (ASDR) of PUD in the MENA region for the period 1990-2019 were evaluated by retrieving data from the Global Burden of Disease database. The Annual Percent Change (APC) and the Average Annual Percent Change (AAPC) were calculated using Joinpoint analysis. Stratification on a national level was performed to evaluate for any differences between nations. Results: Over the span of 3 decades, an estimated total of 3,599,432 PUD cases with relatively equal distribution between men and women were reported in the MENA region. A statistically significant decline in PUD ASIR was observed in the MENA region with an AAPC of -1.13 (95% CI -1.54 to -1.17; P < 0.001). Stratification at a national level revealed a statistically significant decline in the ASIR across all nations except Qatar which experienced a statistically significant increase in the ASIR (AAPC 0.18; 95% CI 0.15 to 0.20; P < 0.001). The highest decline in the ASIR was noted in Iran (AAPC -2.08; 95% CI -2.10 to -2.06; P < 0.001), followed by Jordan (AAPC -1.71; 95% CI -1.72 to -1.69; P < 0.001) and Algeria (AAPC -1.49; 95% CI -1.50 to -1.48; P < 0.001). In regard to the ASDR, a statistically significant decline was observed in the MENA region with an AAPC of -3.83 (95%CI -3.96 to -3.80, P < 0.001). Stratification on a national level revealed a statistically significant decline in the ASDR across all nations with the highest decline noted in Qatar (AAPC -8.29; 95% CI 8.61 to -8.00; P < 0.001), followed by Jordan (AAPC -4.92; 95% CI -5.00 to -4.84; P < 0.001) and Egypt (AAPC -4.89; 95% CI -5.03 to -4.72; P < 0.001). Conclusion: Over the period 1990-2019, a statistically significant decline in PUD ASIR and ASDR was observed across all nations except Qatar which experienced a statistically significant increase in the incidence. These findings prompt recognition to identify the factors leading to the witnessed trends.