Systematic analysis of global trends in otitis media burden across Socio-Demographic Index levels, 1990–2021: findings from the global burden of disease study 2021

Background Otitis media (OM) represents a major global health burden, particularly in children. While its association with socioeconomic development is recognized, the complex temporal dynamics across developmental stages remain unclear. This study analyzes the multidimensional relationship between the Socio-Demographic Index (SDI) and OM burden to inform targeted health strategies. Methods Using Global Burden of Disease (GBD) Study 2021 data from 204 countries, we assessed OM prevalence, incidence, and years lived with disability (YLDs). We employed Spearman's correlation, Age-Period-Cohort (APC) modeling stratified by SDI, and Frontier analysis to evaluate disease burden patterns and control efficiency. Results From 1990–2021, Age-standardized rate (ASR) of prevalence and YLDs decreased by 11.18 and 11.64% respectively, while incidence paradoxically increased by 3.75%. Strong negative correlations existed between SDI and disease burden (ρ = −0.928 for prevalence), except for incidence in High-SDI regions showing positive correlation with development. APC analysis revealed universal early childhood burden peaks that decreased with increasing SDI. Low-SDI regions showed minimal improvement (7.41% prevalence reduction) despite highest burden potential. Recent birth cohorts demonstrated declining prevalence but rising incidence. Frontier analysis identified unexpected efficiency patterns: some low-income countries achieved optimal incidence control while certain high-income nations showed significant gaps. Conclusion Global OM epidemiology shows divergent trends: decreasing prevalence alongside rising incidence, with pronounced disparities across SDI levels. High-SDI regions face emerging incidence challenges while Low-SDI regions show the slowest improvement despite highest burden. The 0–5 age group demonstrates concerning upward trends across multiple SDI levels, not just in resource-limited settings. These findings support SDI and age-stratified intervention strategies, prioritizing early childhood programs universally, with resource intensity calibrated to regional burden.