Burden of polycystic ovary syndrome in low-and middle-income countries, 1990–2023: results from the global burden of disease study 2023

Polycystic ovary syndrome (PCOS) is prevalent in low- and middle-income countries (LMICs), yet comprehensive assessments of its disease burden are lacking. This study aimed to evaluate the disease burden of PCOS in LMICs from 1990 to 2023. Using Global Burden of Disease (GBD) 2023 estimates, we analyzed PCOS prevalence, incidence, and disability-adjusted life-years (DALYs) among individuals aged 10–54 years across 131 countries, stratified by Gross National Income (GNI) into low-income (LCs), lower-middle-income (LMCs), and upper-middle-income (UMCs) groups. Temporal trends were assessed using relative percentage change and the estimated annual percentage change (EAPC). Pearson correlation analyses evaluated the associations between GNI per capita and PCOS burden. Cross-country inequality and decomposition analyses were performed, and future burden was projected to 2050. All estimates are presented with 95% uncertainty intervals (UI). PCOS cases in LMICs accounted for 71.33% of the global total. PCOS-related DALYs showed a positive correlation with economic income levels, as measured by GNI per capita ( R = 0.328, 95% CI 0.16–0.477, p < 0.001). Within LMICs, upper-middle-income countries experienced the highest contribution from epidemiological changes (82.46%), with population aging partially offsetting the overall increase in disease burden. In contrast, low-income countries, largely concentrated in Africa, experienced a sharp increase in PCOS incidence primarily driven by population growth. Although the peak age of onset (10–19 years) was uniform across LMICs, the decline in incidence began after age 25 in low-income countries but only after age 50 in both lower-middle-income and upper-middle-income countries. Projections to 2050 indicate an overall declining trend in PCOS burden for LMICs as a whole, yet lower-middle-income countries alone are projected to exhibit a contrasting upward trend. From 1990 to 2023, the prevalence, incidence, and DALYs of PCOS in LMICs increased significantly. Socioeconomic factors showed significant associations with PCOS epidemiology, though substantial variance remains unexplained.