Global Trends in Endometriosis Burden, 1990–2021: A Sociodemographic Analysis Using GBD 2021 Data and Projections to 2036

Fei Liu,1,2,* Suzhen Yuan,1,2,* Qing Yan,1,2 Shuhao Yang,1,2 Wei Yan,1,2 Tao Xiang,1,2 Zhangying Wu,3 Guirong Li,3 Wu Ren,1,2 Wenwen Wang1,2 1Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Key Laboratory of Cancer Invasion and Metastasis (Ministry of Education), Hubei Key Laboratory of Tumor Invasion and Metastasis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 3Gynecology Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wu Ren, Email [email protected] Wenwen Wang, Email [email protected]: Endometriosis is a chronic inflammatory disorder that significantly compromises women’s health, typically manifesting as pelvic pain and/or infertility. This condition imposes a substantial burden on global healthcare systems.Methods: This socioeconomic-demographic analysis utilized Global Burden of Disease (GBD) 2021 data encompassing worldwide endometriosis burden metrics from 1990– 2021. Four principal indicators: Age-Standardized Prevalence Rate (ASPR), Age-Standardized Incidence Rate (ASIR), Estimated Annual Percent Change (EAPC) and Disability-Adjusted Life-Years (DALY) were interpreted, stratified by geographic region, Socio-demographic Index (SDI) and age distribution. The slope index of inequality (SII) and concentration index (CIX) were also calculated to quantify health inequalities. Advanced analytical approaches were also implemented including frontier analysis decomposition analysis and Bayesian age-period-cohort (BAPC) model.Results: Based on the GBD 2021 data, this study systematically analyzed the global burden of endometriosis and its trends from 1990 to 2021. The results show that while the age-standardized prevalence and incidence rates have steadily declined (with estimated annual percentage changes of − 1.02% and − 1.00%, respectively), the total number of cases and DALY continued to rise due to population growth and aging. The burden of endometriosis was unevenly distributed geographically, with significantly higher burdens in low SDI regions. East Asia, South Asia, and Southeast Asia exhibited the highest age-standardized rates, while Eastern Europe was the only region showing a positive EAPC. Health inequality analysis revealed that although absolute disparities have narrowed, relative inequality has intensified in middle- and high SDI regions. Furthermore, the high incidence among adolescents (15– 19 years) highlights this group as a key target for endometriosis prevention and control.Conclusion: Through stratified analysis and long-term projection, this study reveals that although the age-standardized burden of endometriosis is declining globally, the absolute burden continues to grow due to demographic dynamics, with significant geographic and age-related disparities. Projections to 2036 indicate a further decline in the standardized burden, yet gaps persist across regions with different SDI levels, and relative inequality remains pronounced, particularly in middle- and high SDI regions. The findings underscore the need to prioritize adolescent populations and develop tailored prevention and management strategies for high-burden and vulnerable groups, alongside advancing diagnostic and therapeutic technologies, to achieve equitable reduction in the global burden of endometriosis.Keywords: endometriosis, global burden of disease, sociodemographic analysis, epidemiology, projection