Evolution of the global burden of vascular intestinal diseases in middle-aged and elderly population: Trend analysis from 1990 to 2021 and projections to 2040

Vascular intestinal diseases (VID), including mesenteric ischemia and ischemic colitis, are increasingly important public health issues, particularly among aging populations. However, their long-term epidemiological trends and future global burden remain underexplored. This observational cross-sectional study aimed to assess global VID trends from 1990 to 2021 and project future burden through 2040 using data from the Global Burden of Disease 2021 (GBD 2021) database. We extracted VID-related incidence, prevalence, and disability-adjusted life years (DALYs) data for individuals aged ≥45 years from GBD 2021. Age-standardized rates (ASRs) and estimated annual percentage change were used to quantify trends. Joinpoint regression, age-period-cohort analysis, decomposition analysis, and health inequality indices were applied to evaluate patterns and contributing factors. The Bayesian age-period-cohort model was used to project VID burden to 2040. From 1990 to 2021, global ASRs for VID showed a consistent decline: -0.49%/yr for incidence, -0.51% for prevalence, and -1.48% for DALYs. Despite this, the absolute number of VID cases and DALYs increased, driven primarily by population growth and aging. Age-period-cohort analysis revealed that VID risk rose with age but declined across successive birth cohorts. Decomposition analysis identified demographic changes as the main drivers of the increased burden. Health inequality metrics showed a narrowing of global disparities over time. Projections indicate continued increases in total VID cases by 2040, although ASRs are expected to decline further. The global burden of VID in middle-aged and elderly populations reflects both progress in disease control and emerging demographic challenges. While individual risk is decreasing, population aging continues to drive up the absolute burden. Efforts should prioritize early intervention, equitable healthcare access, and targeted public health strategies, particularly in low- and middle-sociodemographic index regions.