Global temporal trends and projections of gastroesophageal reflux disease prevalence: Age-period-cohort analysis 2021

BACKGROUND: Gastroesophageal reflux disease (GERD) represents a major global health challenge with varied regional epidemiological patterns. This study aimed to comprehensively analyze temporal trends, health inequalities, and driving factors of GERD. METHODS: Using Global Burden of Disease 2021 data, we extracted GERD prevalence across 204 territories. Age-standardized prevalence rate (ASPR) was calculated and analyzed using age-period-cohort framework. An autoregressive integrated moving average model was employed to project future trends to 2036. Health inequalities were assessed using slope index and concentration index. RESULTS: Global GERD prevalence surged from 450,765,455 cases in 1990-825,603,654 in 2021, with an annual percentage change of 0.04% in ASPR. Significant regional disparities were observed across Socio-demographic Index (SDI) quintiles: middle SDI regions exhibited the steepest ASPR increase (0.22% annually), contrasting with declining trends in high-middle (-0.26%) and high SDI regions (-0.18%). Latin American countries demonstrated the highest burden, with Paraguay, Brazil, and El Salvador leading globally. The United States and China revealed notable post-2010 prevalence rebounds. Notably, populations aged 25-34 years showed the most rapid prevalence growth (>0.3% annually), challenging traditional age-risk paradigms. The slope index increased from -1978.5 to -2053.4, signifying worsening absolute health disparities, with low SDI nations bearing a disproportionate GERD burden. CONCLUSIONS: The increasing prevalence of GERD has resulted in major health burdens over the past three decades. Future strategies should prioritize targeted interventions for high-risk populations and modifiable risk factors, enhanced healthcare accessibility, and integration of GERD management within non-communicable disease frameworks to address this emerging public health challenge.