Global Burden of Polycystic Ovary Syndrome: A Systematic Analysis of Pre- and Post-Pandemic Trends from the 2021 Global Burden of Disease Study (1990–2021)

Yingwu Guo,1,* Yingrong Du,1,* Lingfang Zhang,1,* Huihui Xu,2,* Jun Liu,1 Shenghao Li,1 Zhaoyuan Xu,1 Junfang Yan,1 Jie Chen,3 Huawei Wang2 1Department of Infectious Diseases, Kunming Third People’s Hospital, Kunming, Yunnan, 650041, People’s Republic of China; 2Reproduction and Genetics Department, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, People’s Republic of China; 3Clinical Pharmacy Center, Kunming Third People’s Hospital, Kunming, Yunnan, 650041, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huawei Wang, Reproduction and Genetics Department, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650032, People’s Republic of China, Tel +86871-6532 4888, Fax +86871-6532 4888-2151, Email [email protected] Jie Chen, Clinical Pharmacy Center, The Third People’s Hospital of Kunming, Kunming, Yunnan, 650041, People’s Republic of China, Tel +86 138-8815-6527, Email [email protected]: The study systematically examines the long-term trends in the global burden of Polycystic ovary syndrome (PCOS) across 204 countries and territories, with a specific focus on comparing pre-pandemic (1990– 2019) and post-pandemic (2019– 2021) periods.Methods: Using data from the Global Burden of Disease (GBD) 2021 for women aged 15– 54, we estimated incidence, prevalence, and years lived with disability (YLDs). Age-standardized rates (ASIR, ASPR, ASYR) and estimated annual percentage change (EAPC) were calculated. Joinpoint, Age-Period-Cohort, and Bayesian models were used to analyze trends from 1990– 2021 and project burden to 2050. Mendelian randomization (MR) assessed whether anxiety and guilt contribute to PCOS risk.Results: All burden measures increased globally from 1990 to 2021. Post-2019, the rate of increase (EAPC) accelerated significantly compared to the pre-pandemic period. High-SDI regions showed the lowest pre-pandemic growth but the largest increases during the pandemic. Health inequalities modestly improved by 2021. Projections indicate continued growth, with ASIR, ASPR, and ASYR reaching 73.66, 2104.41, and 18.37 per 100,000 by 2050, respectively. MR supports anxiety and guilt as likely risk factors.Conclusion: The post-pandemic rise in PCOS burden underscores systemic vulnerabilities in women’s endocrine healthcare during health emergencies and signals a growing global health challenge.Plain Language Summary: What your research question was: The core objective of this study was to systematically assess the global disease burden, its distribution, and risk factors for Polycystic Ovary Syndrome (PCOS) from 1990 to 2021, particularly in the context of the COVID-19 pandemic.What you found: The study found a significant and continuous increase in the global burden of PCOS, with an accelerated rise post-pandemic, notable geographic and age disparities in its distribution, and revealed for the first time through genetic methods that psychological factors like anxiety are causal risk factors for PCOS.Why it is important: This research is critically important as it provides comprehensive epidemiological evidence for the global prevention and management of PCOS, highlights its escalating burden, and offers a crucial foundation for developing targeted public health interventions for high-risk regions and populations.Keywords: polycystic ovary syndrome, COVID-19 pandemic, global burden of disease 2021, joinpoint regression model, Bayesian age-period-cohort model, two-sample mendelian randomization