Xiaohui Dong, Zhijun Huang, Hui Li, Xiaojie Fu, Xiaoling Liang, Bin Xu
The association between population growth and ageing and rising absolute case volumes suggests demographic shifts as a major driver of the escalating burden of acute abdominal conditions. Pronounced geographic and SDI-related disparities were observed alongside distinct age profiles across the four aetiologies, underscoring the need for context-specific planning of future emergency surgical and preventive care.
BACKGROUND: Acute abdominal conditions--appendicitis, ectopic pregnancy, paralytic ileus and intestinal obstruction, and urolithiasis--are surgical emergencies carrying substantial risks of morbidity, mortality, and long-term disability. An integrated quantification of their collective burden may help identify shared vulnerabilities in global emergency surgical systems.
METHODS: Data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 were used to estimate incidence, prevalence, mortality, years lived with disability, and disability-adjusted life-years (DALYs) for the four conditions from 1990 to 2021 across 204 countries, 21 regions, and five Socio-demographic Index (SDI) quintiles. Temporal trends were quantified using the estimated annual percentage change, and Autoregressive Integrated Moving Average models projected key indicators to 2030. All analyses complied with GATHER guidelines.
RESULTS: In 2021, the combined age-standardised incidence rate was stable at 1,200 (95% UI 1,150-1,250) per 100,000 (EAPC -0.05%, 95% CI -0.10 to 0.00), while absolute cases rose by 85%, from 50 million in 1990 to 92 million in 2021. Age-standardised DALY rate declined (EAPC -1.2%, 95% CI -1.4 to -1.0) and global deaths fell by 20% (18-22%). Highest incidence rates occurred in Eastern Europe and Central Asia; the heaviest DALY burdens were in sub-Saharan Africa and South Asia. A bimodal age pattern was observed, peaking at 15-49 years (ectopic pregnancy, appendicitis) and ≥70 years (paralytic ileus and intestinal obstruction). Projections to 2030 indicate continued DALY declines for appendicitis, ectopic pregnancy, and paralytic ileus, whereas urolithiasis DALYs may oscillate or rise, particularly in middle- and high-SDI settings.
CONCLUSION: The association between population growth and ageing and rising absolute case volumes suggests demographic shifts as a major driver of the escalating burden of acute abdominal conditions. Pronounced geographic and SDI-related disparities were observed alongside distinct age profiles across the four aetiologies, underscoring the need for context-specific planning of future emergency surgical and preventive care.