Global Patterns and Temporal Trends in Modifiable Risk Factors Among Women of Childbearing Age, 1990–2021: A Systematic Analysis from the Global Burden of Disease Study

Qian Xu,1,2,* Huabin Zhang,1,2,* Bin Chen,3 Zhaomin Xie,2 Queran Lin,4 Yuqing Zhao,1,2 Gaoli She,2 Fei Zhong,2 Jie Li1– 3 1School of Medicine, South China University of Technology, Guangzhou, Guangdong, People’s Republic of China; 2Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China; 3School of Public Health, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China; 4Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, WHO Collaborating Centre for Public Health Education and Training, London, UK*These authors contributed equally to this workCorrespondence: Jie Li, Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China, Tel +86-020-83525975, Email [email protected] Fei Zhong, Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China, Email [email protected]: Women of childbearing age (WCBA, 15– 49 years) are a key population for public health prevention, yet evidence on long-term trends in modifiable risk factors and their attributable burden remains limited. We aimed to assess global patterns and temporal changes in major modifiable risk factors among WCBA.Methods: Using data from the Global Burden of Disease (GBD) 2021, we analysed summary exposure values, deaths, and disability-adjusted life years (DALYs) attributable to 83 modifiable risk factors across metabolic, behavioural, and environmental/occupational domains.Results: In 2021, 1.10 million deaths and 108.0 million DALYs among WCBA were attributable to modifiable risk factors, representing 34.83% of total deaths and 26.52% of total DALYs. The leading Level 3 risk factors for DALYs were unsafe sex (4.89%), iron deficiency (3.36%), high body mass index (BMI) (3.19%), and high fasting plasma glucose (FPG) (2.48%). Between 1990 and 2021, environmental and occupational risk exposures generally declined over time, whereas metabolic risk exposures—particularly high BMI (EAPC 1.83%) and high FPG (EAPC 1.59%)—showed sustained increases across most regions. Risk profiles varied across sociodemographic index (SDI) levels, with reproductive and nutritional risks predominating in lower-SDI settings and metabolic or behavioural risks more prominent in higher-SDI settings.Conclusion: Modifiable risk factors account for a substantial proportion of disease burden among WCBA. The coexistence of rising metabolic risks and persistent reproductive and nutritional challenges calls for targeted strategies—strengthening reproductive health and nutrition programmes in lower-SDI settings, and prioritising obesity prevention and metabolic screening in higher-SDI regions.Keywords: women of childbearing age, modifiable risk factors, global burden of disease, disability-adjusted life years, temporal trends, public health prevention