Trends and Projections of the Burden of Uterine Prolapse in China and G20 Countries: A Comparative Study Based on Global Burden of Disease 2023

Summary

This study compared the historical and future disease burden of uterine prolapse between China and G20 countries using Global Burden of Disease (GBD) 2023 data. Although China showed lower age standardized burden than the G20 overall, absolute case numbers are expected to increase because of population aging. These findings highlight the need for targeted, age-specific prevention and management strategies.

Abstract

This observational longitudinal study utilized the Global Burden of Disease (GBD) 2023 database to comprehensively analyze and project the burden of uterine prolapse (UP) in China and G20 countries from 1990 to 2050. Incidence, deaths, prevalence, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were assessed, including their age-standardized rates (ASRs). Trends from 1990 to 2023 were analyzed using Joinpoint regression (calculating the average annual percentage change, AAPC), along with their respective 95% confidence intervals (CI), and decomposition analysis. The future burden to 2050 was projected using autoregressive integrated moving average (ARIMA) and Bayesian age-period-cohort (BAPC) models. From 1990 to 2023, the ASRs for incidence, prevalence, DALYs, and YLDs of UP in China showed a declining trend, with AAPCs of −0.47 (95% CI −0.51 to −0.44), −0.52 (95% CI −0.56 to −0.47), −0.50(95% CI −0.54 to −0.46), and −0.52 (95% CI −0.55 to −0.48), respectively. A transient increase was observed between 2010 and 2015. The ASR for deaths remained near zero, while the ASR for YLLs increased (AAPC = 2.12, 95% CI 1.32–2.93). The G20 countries showed similar declining trends for non-fatal burdens, with reductions more pronounced than in China. Projections indicate that from 2023 to 2050, the ASRs for incidence, prevalence, DALYs, and YLDs will continue to decline in both China and G20 countries, with a faster decrease anticipated in China. Consequently, the age-standardized burden among Chinese women is expected to remain lower than the G20 average. In conclusion, while China's age-standardized UP burden is historically and prospectively lower than the G20 aggregate, rising absolute numbers due to population aging indicate a substantial future healthcare burden. This underscores the need for China to develop targeted, age-group-specific prevention and control strategies.

Introduction

Uterine prolapse (UP), also known as pelvic organ prolapse (POP), is a prevalent pelvic floor disorder among women. It is characterized by the displacement of the uterus from its normal anatomical position into or outside the vagina^1,2. This condition is often associated with symptoms such as lower abdominal pressure, urinary and defecatory dysfunction, and sexual discomfort, which compromise patients' quality of life and social functioning³. The anatomical changes associated with UP include alterations in the axial positions of the uterus and vagina. Previous research has demonstra....

Protocol

Ethical Approval and Consent to Participate

This study was an analysis of existing, publicly available, and de-identified summary data from the Global Burden of Disease Study 2023 (GBD 2023). As the research did not involve direct interaction with human or animal subjects, the collection of new primary data, or access to any individually identifiable information, it was deemed exempt from the requirement for formal approval by an institutional review board (IRB) or ethics committee. The study was conducted in accordance with the principles outlined in the Declaration of Helsinki. The use of GBD data complies with its terms of....

Results

Overall trends of uterine prolapse DALYs, Deaths, Incidence, Prevalence, YLDs, YLLs in China and G20 Countries

Overall, the number of uterine prolapse cases in China increased from 1051,197.19 in 1990 (95% UI: 871,473.64–1254,781.07) to 2218,831.76 in 2023 (95% UI: 1829,927.18–2655,003.13), representing a growth of 111.08%. During the same period, the cumulative amount of prevalence in China increased by 126.06% year-on-year. In 2023, a total of 19,054,548.16 women were affect.......

Discussion

This study conducted a comprehensive analysis of the changes in the disease burden of uterine prolapse in China and the G20 countries from 1990 to 2023, employing age stratification and decomposition analysis. To predict and analyze future disease burden, the ARIMA time series model and the Bayesian age-period-cohort (BAPC) model were utilized to predict and analyze the future disease burden. The findings revealed both similarities and notable differences. The disease burden (such as the numbers of prevalence and DALYs) .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
ARIMA model	R (forecast package)	–	Time series forecasting of disease burden
BAPC model	R (BAPC package)	Version 0.0.36 (relies on INLA (v24.11.25).)	Bayesian age-period-cohort prediction
GBD 2023 data	Global Health Data Exchange	–	Source of uterine prolapse burden data
Joinpoint Regression Program	National Cancer Institute	Version 5.1.0.0	Trend analysis using APC and AAPC
R software	R Foundation for Statistical Computing	Version 4.4.1	Statistical analysis and visualization