Persistent health inequality in the global burden of digestive diseases attributable to risk factors: a systematic analysis for the Global Burden of Disease Study 2021

Background: Digestive diseases are a major cause of health burden globally. Understanding the relative contribution of various risk factors to this burden is essential for developing effective reduction strategies. However, there is a gap in knowledge regarding the global burden of digestive diseases attributable to risk factors. Objective: This study aimed to assess the global burden of digestive diseases attributable to risk factors from 1990 to 2021. Design: We analysed data from the Global Burden of Diseases 2021, covering 12 digestive diseases and 10 risk factors across 204 countries and territories. Age-standardised rates of disability-adjusted life-years (DALYs) were estimated. The estimated annual percentage change determined annual percent change. Results: In 2021, there were 3.30 million deaths and 116.73 million DALYs from digestive diseases globally, accounting for 43.3% and 45.9% of all digestive disease deaths and DALYs, respectively. Males accounted for 74.42 million digestive disease DALYs attributable to risk factors, representing 49.1% of total DALYs in males, whereas females accounted for 42.31 million DALYs, representing 41.1%. Unsafe water, sanitation, and handwashing was the leading risk factor in both males and females (26.95 million and 17.8% in males; 24.67 million and 24.0% in females). The age-standardised DALY rates of digestive diseases attributable to environmental and occupational risks and behavioural risks decreased, while that attributable to metabolic risks increased. Conclusion: The risk factors highly associated with economic and social development caused a substantial digestive disease burden. The highest burdens of environmental and occupational and behavioural risks were concentrated in countries in sub-Saharan Africa. More global cooperation is needed in the field of digestive diseases to promote health equity and achieve the Sustainable Development Goals.