Trends in the burden and quality of care for upper gastrointestinal diseases from 1990 to 2021: An analysis of the global burden of disease study 2021

Background: Upper gastrointestinal (GI) diseases, primarily gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis and duodenitis (GD), are highly prevalent, chronic, and recurrent conditions worldwide, imposing a substantial burden on population health and quality of life. However, long-term trends in their quality of care and the disease-specific burden remain poorly characterized. This study aimed to analyze global trends in the disease burden and quality of care for upper-GI diseases, from 1990 to 2021. Methods: Based on data from the Global Burden of Disease Study 2021, we analyzed the global temporal trends in the incidence, prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost, years lived with disability, and their age-standardized rates of upper-GI diseases and the three main subtypes (GERD, PUD and GD), from 1990 to 2021. We further assessed trends in the Quality-of-Care Index (QCI) and examined variations across regions, sexes, and age groups. Additionally, we conducted cross-national inequality analyses. Results: From 1990 to 2021, global case numbers of upper-GI diseases increased by 77.185% for incidence and 81.033% for prevalence, with modest rises in age-standardized incidence rate (ASIR; +1.794%) and prevalence rate (+2.130%). Age-standardized mortality rate and DALYs rate (ASDR) declined by 59.778% and 43.041%, respectively. The global QCI continued to rise, reaching 92.403 in 2021 with an estimated annual percentage change (EAPC) of 0.269 (95% CI: 0.262–0.276). Regions with lower sociodemographic indices (SDI) showed poorer care quality but greater improvement (EAPC =0.561). Females consistently maintained higher QCI scores than males, though this sex gap gradually narrowed. QCI declined with advancing age in elderly populations. Cross-national inequality analysis revealed that in 2021, the global slope index of inequality and concentration index for QCI were 9.612 (95% CI: 7.515–11.708) and 0.010 (95% CI: 0.005–0.014), respectively, showing reductions compared to 1990. Analysis of the component diseases revealed marked heterogeneity: the ASIR and ASDR for GERD showed an upward trend, whereas the corresponding indicators for PUD and GD declined substantially. Conclusion: During 1990–2021, despite the global trends of improvements in disease burden and the quality of care for upper-GI diseases, heterogeneity among diseases and inequalities in healthcare quality remain. Future efforts should prioritize international collaboration, particularly through targeted health system support for low-SDI countries, and adopt disease-specific, differentiated interventions aligned with each condition’s epidemiological profile, to advance global health equity goals.