Frontier and Inequality Analyses of the Global Burden of Ectopic Pregnancy: Insights from the GBD 2021

Xiaowei Cao, Zhuying Yu, Shengsheng Wu Department of Gynecology, Meizhou People’s Hospital, Meizhou, Guangdong Province, 514031, People’s Republic of ChinaCorrespondence: Shengsheng Wu, Email [email protected]: Ectopic pregnancy (EP) is a significant global health concern and is associated with maternal mortality and compromised future fertility. This research aims to refine the assessment of EP’s global impact and its associated inequalities.Methods: EP’s incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were analyzed using the data from the Global Burden of Disease study from 1990 to 2021. Decomposition analysis was performed to examine the roles of ageing, population growth, and epidemiological changes. Novel frontier and health inequality analyses (Slope Index of Inequality, Concentration Index) were conducted to evaluate socio-demographic disparities.Results: From 1990 to 2021, the global age-standardized incidence rate (ASIR) decreased from 305.9 to 212.87 per 100,000. However, absolute DALYs increased from 288,083 to 396,856, with the highest burden shifting to the 20– 24 age group. Health inequality analysis revealed a significant but narrowing absolute disparity (SII: − 56.68 to − 36.56), while frontier analysis identified sub-Saharan African nations with the largest unmet potential for health improvement. Decomposition showed that population growth and epidemiological changes were primary drivers of rising DALYs.Conclusion: Declining EP incidence masks increasing absolute burden and persistent severe inequities. Our findings underscore an urgent public health imperative: to implement equity-focused interventions that enhance early diagnosis, safe management, and the preservation of fertility, particularly in low-resource settings.Plain Language Summary: EP has posed a considerable health challenge, especially in areas defined by low- and middle-income status. This study analyzes the GBD data from 1990 to 2021 to provide updated estimates related to the incidence, prevalence, mortality, and DALYs associated with EP. Our comprehensive examination indicated a reduction in the occurrence of EP; however, there is an accompanying increase in the overall mortality and years lived with disability, underscoring persistent challenges in this domain. This work reveals significant health disparities across different regions globally and highlights the necessity for enhancing reproductive health services and implementing targeted interventions to improve outcomes for women impacted by EP worldwide.Keywords: disability-adjusted life years, ectopic pregnancy, global burden of disease, health inequality