Abstract
Background:
Hernias, particularly inguinal, femoral, and abdominal, present a global health challenge. While the global burden of disease (GBD) study offers insights, systematic analyses of hernias remain limited. This research utilizes the GBD dataset to explore hernia implications, combining current statistics with 2030 projections and frontier analysis.
Methods:
We analyzed data from the 2019 GBD Study, focusing on hernia-related metrics: prevalence, incidence, deaths, and disability-adjusted life years (DALYs) across 204 countries and territories, grouped into 21 GBD regions by the socio-demographic index (SDI). Data analysis encompassed relative change calculations, as well as annual percentage change (APC) and average annual percentage change (AAPC), both of which are based on joinpoint regression analysis. The study additionally employed frontier analysis and utilized the Bayesian age-period-cohort model for predicting trends up to 2030. Analyses utilized R version 4.2.3.
Results:
From 1990 to 2019, the global prevalence of hernia cases surged by 36%, reaching over 32.5 million, even as age-standardized rates declined. A similar pattern was seen in mortality and DALYs, with absolute figures rising but age-standardized rates decreasing. Gender data between 1990 and 2019 showed consistent male dominance in hernia prevalence, even as rates for both genders fell. Regionally, Andean Latin America had the highest prevalence, with Central Sub-Saharan Africa and South Asia noting significant increases and decreases, respectively. Frontier analyses across 204 countries and territories linked higher SDIs with reduced hernia prevalence. Yet, some high SDI countries, like Japan and Lithuania, deviated unexpectedly. Predictions up to 2030 anticipate increasing hernia prevalence, predominantly in males, while age-standardized death rates and age-standardized DALY rates are expected to decline.
Conclusions:
Our analysis reveals a complex interplay between socio-demographic factors and hernia trends, emphasizing the need for targeted healthcare interventions. Despite advancements, vigilance and continuous research are essential for optimal hernia management globally.
Keywords: annual percentage change, average annual percentage change, frontier analysis, inguinal, femoral, abdominal hernias, the bayesian age-period-cohort model, the global burden of disease study
Introduction
Highlights
The 2019 global burden of disease study sheds light on global hernia trends, with cases rising over three decades despite declining age-standardized rates.
Frontier analyses highlight that higher socio-demographic indices generally correlate with reduced hernia prevalence, but high SDI nations, including Japan and Lithuania, presented unexpected deviations.
Predictions until 2030 indicate an increase in hernia prevalence, particularly among males, with a simultaneous expected decrease in hernia-related death rates and disability-adjusted life years.
Hernias, specifically inguinal, femoral, and abdominal types, constitute a significant health concern worldwide1,2. These protrusions of an organ or tissue through the structure that normally contains them not only represent an anatomical dysfunction but can also pose dire clinical implications if not addressed timely3,4. As the global population grows and ages, understanding the comprehensive burden of these conditions becomes of paramount importance.
The global burden of disease (GBD) study offers an invaluable platform for assessing the health impacts of a plethora of diseases and injuries5. By extracting data from such a resource, researchers and policymakers can grasp the prevalence, incidence, mortality rates, and disability-adjusted life years (DALYs) of specific conditions, offering a panoramic view of their global, regional, and national implications6–8. Despite the known impacts of hernias on global health, systematic analyses of their comprehensive burden, especially leveraging GBD data, have been sporadic.
Moreover, the dynamic nature of disease patterns necessitates not just an understanding of the current scenario but also a forward-looking perspective. Projections, especially those extending a decade into the future, allow stakeholders to allocate resources, strategize healthcare priorities, and implement preventive measures with an informed foundation9,10. In the context of hernias, such projections could play a pivotal role in shaping surgical practices, public health campaigns, and patient education drives.
In addition, while mere statistical assessments provide a foundational understanding, it is the supplementary analyses, such as frontier analysis, that present a deeper dive into data intricacies, painting a more nuanced picture of disease implications11. Such analyses benchmark health performances against the best-performing counterparts, offering insights into potential areas of improvement and driving a more effective health response.
Considering these gaps and the immense value such a study can bring to the table, our research aims to systematically elucidate the global, regional, and national burdens of inguinal, femoral, and abdominal hernias. By harnessing the GBD dataset, this study presents a holistic view of the prevalence, incidence, mortality rates, and DALYs of these hernias. Additionally, we venture beyond the present-day data, offering projections up to 2030, complemented by frontier analysis, thereby presenting a comprehensive overview that is both current and future-oriented. Through this rigorous exploration, our work hopes to shed light on the magnitude and nuances of hernia implications worldwide, aspiring to inform healthcare decisions and contribute significantly to the existing body of knowledge.
Methods
Research population and data compilation
Our study utilized data from the 2019 GBD Study, which employed DisMod-MR 2.1 to synthesize varied epidemiological data on non-fatal conditions, including inguinal, femoral, and abdominal hernia. This comprehensive model applies differential equations to enhance the accuracy of the derived insights.
We focused on four principal metrics: prevalence, incidence, mortality, and DALYs associated with hernias. The data, spanning from 1990 to 2019, was sourced from the Global Health Data Exchange (GHDx) and includes annual statistics across age, sex, and location. Our analysis covered 204 countries and territories, grouped into 21 GBD regions based on geographic proximity and further classified into five categories according to the socio-demographic index (SDI).
SDI
The SDI is a composite measure developed by GBD researchers to assess a region’s socio-economic status. It integrates per capita income, educational attainment, and fertility rates into a single indicator that ranges from 0 to 1, reflecting the socio-economic health and progress of a region or country5,12. Higher SDI values correspond to better socio-economic conditions and health outcomes. The SDI categorizes regions into quintiles: low (0–0.454743), low-middle (0.454743–0.607679), middle (0.607679–0.689504), high-middle (0.689504–0.805129), and high (0.805129–1).
Data analysis
Our data analysis began with an exploration of the dataset’s structure, calculating counts and rates for key measures such as prevalence, incidence, deaths, and DALYs of hernias on global, regional, and national levels. We then analyzed the metric variations from 1990 to 2019 across different regions. To determine relative changes, we used the formula:
Relative change (%)=[(Value in 2019 - Value in 1990) / Value in 1990]×100%. This was applied to both case numbers and age-standardized rates (ASRs) per 100 000.
We employed a rigorous statistical approach to track hernia trends, using annual percentage change (APC) and average annual percentage change (AAPC)13,14. APC indicates year-to-year variations, while AAPC gives the average trend over specified periods.
Our analysis incorporated joinpoint regression analysis to identify significant changes in data trends over time, distinguishing real shifts in trends from random variability. We also examined the correlation between the SDI and hernia indicators using Pearson correlation, assessing the strength and direction of their linear relationship across various geographies.
Frontier analysis was applied to establish benchmarks for hernia burden, comparing countries and territories against the best-performing counterparts11. This method identifies leading countries and territories, setting standards and targets for others. We computed the ‘effective difference’ for each countries and territories, indicating the gap between the current and potential hernia burden, adjusted for SDI.
We utilized the Bayesian Age-Period-Cohort (BAPC) model to delineate and forecast hernia trends up to 203015,16. This advanced model, incorporating past data and probability distributions, allowed us to estimate future hernia patterns with considerations for age, period, and cohort effects. The work has been reported in line with the strengthening the reporting of cohort, cross-sectional, and case–control studies in surgery (STROCSS) criteria17. Statistical analyses were executed using R version 4.2.3.
Results
Global trends
Between 1990 and 2019, global hernia prevalence saw a 36% absolute rise, with cases increasing from nearly 23.92 million to 32.53 million. Conversely, age-standardized prevalence rates decreased by 16.46%, from 488.3 to 407.9 cases per 100 000 individuals. Incidence rates escalated by 63.67% in absolute terms, though the age-standardized incidence rate remained stable at around 163 per 100000 cases. Mortality rose by 19.77%, yet the age-standardized mortality rate significantly decreased by 40.39%. Global DALYs—reflecting the burden of disease—increased by 9.25% in absolute numbers, while their ASRs fell by 31.12% (Tables 1–4).
Table 1.
Numbers and ASRs per 100 000 cases of prevalence of inguinal, femoral, and abdominal hernia in 1990 and 2019, along with the relative changes and AAPC in ASRs per 100 000 cases from 1990 to 2019, categorized by global, SID, and GBD regions.
| Characteristic | Number in 1990 (95% CI) | Age-standardized rate in 1990 (95% CI) | Number in 2019 (95% CI) | Age-standardized rate in 2019 (95% CI) | Relative change of numbers from 1990 to 2019 (%) | Relative change of age-standardized rate from 1990 to 2019 (%) | AAPC (Age-standardized rate, 95% CI) | P |
|---|---|---|---|---|---|---|---|---|
| Global | 23 919 446 (20 461 308–28 074 520) | 488.3 (418.7–567) | 32 529 665 (27 711 437–37 785 171) | 407.9 (348.1–474.6) | 36 | −16.46 | −0.62 (−0.65 to −0.58) | <0.001 |
| High SDI | 3 142 227 (2 645 437–3 690 081) | 358.1 (302.6–421.1) | 3 600 960 (3 039 153–4 216 717) | 293.4 (251.1–340.2) | 14.6 | −18.05 | −0.68 (−0.75 to −0.6) | <0.001 |
| High-middle SDI | 4 934 554 (4 172 571–5 809 357) | 439.3 (370.7–515.2) | 5 902 972 (4 950 502–6 926 816) | 364.4 (308.4–426.5) | 19.63 | −17.05 | −0.64 (−0.65 to −0.63) | <0.001 |
| Middle SDI | 6 939 172 (5 834 019–8 244 172) | 464.6 (399.1–542.3) | 9 558 680 (8 153 280–11 198 443) | 383.3 (329.7–445.1) | 37.75 | −17.49 | −0.66 (−0.7 to −0.63) | <0.001 |
| Low-middle SDI | 6 160 234 (5 253 685–7 205 553) | 665.8 (574.6–768.3) | 8 351 675 (7 081 571–9 818 130) | 505.1 (431–590.5) | 35.57 | −24.14 | −0.95 (−0.99 to −0.9) | <0.001 |
| Low SDI | 2 728 420 (2 329 612–3 194 106) | 672.8 (587.9–764.7) | 5 091 908 (4 315 053–6 044 715) | 578.7 (498–663.8) | 86.62 | −13.99 | −0.52 (−0.57 to −0.47) | <0.001 |
| Andean Latin America | 453 529 (398 095–518 618) | 1185.1 (1049.4–1346.4) | 583 152 (496 486–678 800) | 938.4 (801.5–1089.9) | 28.58 | −20.81 | −0.81 (−0.84 to −0.77) | <0.001 |
| Australasia | 64 616 (53 412–76 318) | 295 (244.6–348.3) | 100 381 (82 967–118 445) | 261.5 (218.4–306) | 55.35 | −11.38 | −0.41 (−0.44 to −0.38) | <0.001 |
| Caribbean | 280 181 (239 562–328 522) | 831.7 (714.7–965) | 419 263 (354 560–491 797) | 874.5 (738.5–1028.1) | 49.64 | 5.14 | 0.17 (0.16–0.18) | <0.001 |
| Central Asia | 309 560 (260 994–364 273) | 476.9 (408.3–555) | 463 646 (385 216–551 502) | 498.9 (417–591) | 49.78 | 4.59 | 0.17 (0.07–0.26) | 0.001 |
| Central Europe | 693 592 (606 294–788 301) | 517.2 (451.8–588.7) | 545 938 (467 726–625 784) | 405.4 (352.5–461) | −21.29 | −21.61 | −0.85 (−1.15 to −0.55) | <0.001 |
| Central Latin America | 1 281 932 (1 093 957–1 494 828) | 996 (867.2–1135.2) | 1 889 111 (1 621 570–2 174 235) | 765.1 (662.8–878.5) | 47.36 | −23.18 | −0.9 (−0.94 to −0.86) | <0.001 |
| Central Sub-Saharan Africa | 254 581 (205 356–308 167) | 556.4 (474.6–640.9) | 718 512 (583 986–872 810) | 695.6 (581.6–817.2) | 182.23 | 25.03 | 0.77 (0.73–0.81) | <0.001 |
| East Asia | 3 142 155 (2 499 570–3 947 212) | 283.4 (226.3–351.4) | 3 873 669 (3 133 338–4 687 953) | 251.4 (205.1–305) | 23.28 | −11.31 | −0.42 (−0.49 to −0.35) | <0.001 |
| Eastern Europe | 1 518 575 (1 256 878–1 826 714) | 632 (521.6–763.4) | 1 345 298 (1 102 505–1 634 799) | 574.6 (471.4–703.9) | −11.41 | −9.08 | −0.3 (−0.37 to −0.24) | <0.001 |
| Eastern Sub-Saharan Africa | 595 777 (485 270–724 308) | 407.3 (350.2–469.2) | 1 313 507 (1 111 629–1 553 530) | 448.9 (384.9–516.9) | 120.47 | 10.21 | 0.33 (0.32–0.35) | <0.001 |
| High-income Asia Pacific | 993 486 (824 428–1 189 803) | 592.6 (489.9–711.8) | 1 073 424 (897 793–1 273 465) | 564.7 (475.9–664.3) | 8.05 | −4.7 | −0.14 (−0.22 to −0.06) | <0.001 |
| High-income North America | 704 290 (574 835–861 433) | 226.2 (183.6–277.5) | 813 579 (683 420–956 710) | 175.6 (148.3–205.2) | 15.52 | −22.4 | −0.88 (−0.93 to −0.83) | <0.001 |
| North Africa and Middle East | 688 382 (551 451–855 343) | 211.9 (174.3–253.5) | 1 313 585 (1 083 333–1 576 363) | 229 (188.8–273.3) | 90.82 | 8.08 | 0.27 (0.25–0.29) | <0.001 |
| Oceania | 14 374 (11 465–17 655) | 269.7 (226.1–316.8) | 36 251 (29 698–44 004) | 314.9 (264.2–370.9) | 152.19 | 16.77 | 0.54 (0.51–0.57) | <0.001 |
| South Asia | 7 005 337 (5 972 845–8 259 742) | 803.1 (692.9–931.9) | 8 852 278 (7 385 004–10 642 285) | 518.9 (437.6–619) | 26.36 | −35.38 | −1.5 (−1.57 to −1.44) | <0.001 |
| Southeast Asia | 1 769 281 (1 524 711–2 050 630) | 491.5 (429.8–560) | 2 590 594 (2 249 989–2 958 284) | 387.1 (339.1–436.6) | 46.42 | −21.25 | −0.86 (−0.99 to −0.74) | <0.001 |
| Southern Latin America | 215 950 (183 752–249 716) | 444.3 (377.1–512.9) | 345 416 (289 543–403 214) | 480.2 (405–559.3) | 59.95 | 8.07 | 0.27 (0.22–0.32) | <0.001 |
| Southern Sub-Saharan Africa | 392 542 (317 545–481 696) | 784.5 (660.6–929.2) | 532 448 (439 820–642 286) | 694.2 (579.1–827.4) | 35.64 | −11.5 | −0.42 (−0.45 to −0.39) | <0.001 |
| Tropical Latin America | 920 589 (785 603–1 071 401) | 765 (658.8–884.4) | 1 592 874 (1 360 179–1 868 475) | 664.3 (570.5–771.1) | 73.03 | −13.17 | −0.48 (−0.53 to −0.42) | <0.001 |
| Western Europe | 1 689 012 (1 425 184–1 984 763) | 365.1 (309.6–428.1) | 1 968 129 (1 636 608–2 333 383) | 335.9 (283.6–396.4) | 16.53 | −7.99 | −0.27 (−0.33 to −0.2) | <0.001 |
| Western Sub-Saharan Africa | 931 705 (780 764–1 116 126) | 581.4 (500.2–674.3) | 2 158 609 (1 826 179–2 575 741) | 602.2 (520.4–693.2) | 131.68 | 3.58 | 0.12 (0.07–0.16) | <0.001 |
Table 4.
Numbers and ASRs per 100 000 cases of DALYs of inguinal, femoral, and abdominal hernia in 1990 and 2019, along with the relative changes and AAPC in ASRs per 100 000 cases from 1990 to 2019, categorized by global, SID and GBD regions.
| Characteristic | Number in 1990 (95% CI) | Age-standardized rate in 1990 (95% CI) | Number in 2019 (95% CI) | Age-standardized rate in 2019 (95% CI) | Relative change of numbers from 1990 to 2019 (%) | Relative change of age-standardized rate from 1990 to 2019 (%) | AAPC (Age-standardized rate, 95% CI) | P |
|---|---|---|---|---|---|---|---|---|
| Global | 3 069 930 (2 355 864–3 897 903) | 62.1 (48.5–77.5) | 3 354 016 (2 610 569–4 247 142) | 42.7 (33.4–54) | 9.25 | −31.12 | −1.27 (−1.33 to −1.22) | <0.001 |
| High SDI | 323 992 (252 196–409 587) | 36 (27.6 46.1) | 341 845 (261 098–432 826) | 25.9 (19.3–33.6) | 5.51 | −27.98 | −1.12 (−1.2 to −1.04) | <0.001 |
| High-middle SDI | 540 943 (419 212–686 026) | 50 (39.2–62.8) | 533 108 (396 999–691 159) | 32.6 (24.2–42.6) | −1.45 | −34.78 | −1.45 (−1.51 to −1.38) | <0.001 |
| Middle SDI | 888 722 (649 058–1 189 036) | 59.2 (45.4–74.7) | 945 356 (729 102–1 207 538) | 39.2 (30.4–50.1) | 6.37 | −33.76 | −1.42 (−1.48 to −1.37) | <0.001 |
| Low-middle SDI | 833 624 (631 589–1 059 974) | 88.5 (68.9–108.7) | 875 136 (679 692–1 122 028) | 55.6 (43.9–70.3) | 4.98 | −37.17 | −1.58 (−1.65 to −1.51) | <0.001 |
| Low SDI | 480 230 (334 892–615 767) | 106.9 (81.5–130.4) | 655 949 (499 451–832 433) | 77.4 (59–99.7) | 36.59 | −27.61 | −1.11 (−1.15 to −1.08) | <0.001 |
| Andean Latin America | 79 977 (54 472–111 673) | 182.2 (130.1–243.4) | 52 197 (38 838–70 120) | 84.5 (63.1–113.3) | −34.74 | −53.6 | −2.65 (−2.86 to −2.45) | <0.001 |
| Australasia | 6316 (4864–8097) | 29.1 (22.4–37.1) | 9583 (7277–12 328) | 23.6 (17.6–30.7) | 51.72 | −18.86 | −0.71 (−0.77 to −0.65) | <0.001 |
| Caribbean | 45 153 (27 949–67 982) | 124.8 (80.8–181.1) | 44 267 (31 469–60 163) | 94.9 (66.5–130.1) | −1.96 | −23.97 | −0.95 (−1.03 to −0.87) | <0.001 |
| Central Asia | 39 180 (31 405–48 460) | 57.5 (46–71.8) | 39 478 (28 590–53 646) | 43.9 (32.2–59) | 0.76 | −23.54 | −0.9 (−0.98 to −0.83) | <0.001 |
| Central Europe | 90 762 (74 782–108 155) | 70.6 (57.9–84.3) | 52 616 (40 955–67 152) | 36 (26.9–46.7) | −42.03 | −49.03 | −2.28 (−2.48 to −2.07) | <0.001 |
| Central Latin America | 145 520 (112 959–184 134) | 111.9 (89.1–138.7) | 185 912 (144 104–237 198) | 76.7 (59.6–97.5) | 27.76 | −31.48 | −1.3 (−1.37 to −1.24) | <0.001 |
| Central Sub-Saharan Africa | 59 618 (34 174–87 662) | 100.5 (65.3–131.5) | 89 254 (62 543–132 401) | 87.3 (62.8–127.1) | 49.71 | −13.2 | −0.48 (−0.54 to −0.43) | <0.001 |
| East Asia | 382 757 (248 176–547 112) | 34.5 (22.9–48.4) | 300 521 (207 472–407 260) | 20.1 (14–28) | −21.49 | −41.81 | −1.84 (−1.98 to −1.71) | <0.001 |
| Eastern Europe | 140 391 (103 800–182 532) | 59.5 (44.2–77.1) | 121 328 (89 360–159 944) | 49.3 (35.4–66.3) | −13.58 | −17.14 | −0.63 (−0.79 to −0.47) | <0.001 |
| Eastern Sub-Saharan Africa | 154 163 (85 907–212 558) | 85.3 (56.6–111.3) | 204 924 (150 651–290 015) | 72 (52.2–111.6) | 32.93 | −15.59 | −0.59 (−0.65 to −0.52) | <0.001 |
| High-income Asia Pacific | 81 628 (57 839–111 537) | 48.8 (34.7–67.5) | 83 668 (58 698–112 642) | 41.6 (28.4–58.4) | 2.5 | −14.86 | −0.54 (−0.61 to −0.48) | <0.001 |
| High-income North America | 76 260 (59 947–96 080) | 24.4 (18.9–30.9) | 92 204 (74 022–113 485) | 19.5 (15.4–24.2) | 20.91 | −20.17 | −0.78 (−0.86 to −0.71) | <0.001 |
| North Africa and Middle East | 78 034 (49 888–113 022) | 23.5 (16.1–32.1) | 111 488 (80 063–150 494) | 20.4 (14.9–27.1) | 42.87 | −12.94 | −0.47 (−0.54 to −0.41) | <0.001 |
| Oceania | 2217 (1503–3243) | 40.2 (28–54.4) | 4515 (3129–6640) | 39.3 (28.6–53.2) | 103.63 | −2.07 | −0.08 (−0.14 to −0.01) | 0.017 |
| South Asia | 850 620 (660 191–1 052 866) | 104.5 (81.9–127.5) | 919 587 (700 868–1 191 111) | 57.4 (44.4–73.3) | 8.11 | −45.12 | −2.04 (−2.21 to −1.88) | <0.001 |
| Southeast Asia | 345 232 (217 572–570 679) | 87.3 (62.2–120.8) | 348 090 (279 868–421 610) | 56.1 (45.7–67.3) | 0.83 | −35.74 | −1.53 (−1.64 to −1.42) | <0.001 |
| Southern Latin America | 26 111 (21 065–32 429) | 54.3 (43.8–67.2) | 32 935 (25 229–42 278) | 44.7 (33.9–58) | 26.14 | −17.56 | −0.65 (−0.82 to −0.48) | <0.001 |
| Southern Sub-Saharan Africa | 36 686 (26 562–49 306) | 78.1 (58.6–101.6) | 51 209 (37 842–68 707) | 70.4 (52.8–93) | 39.59 | −9.79 | −0.36 (−0.43 to −0.29) | <0.001 |
| Tropical Latin America | 102 893 (79 705–129 993) | 85.2 (67.3–106) | 159 147 (123 400–203 160) | 67.5 (52.7–85.8) | 54.67 | −20.78 | −0.8 (−0.94 to −0.65) | <0.001 |
| Western Europe | 193 431 (154 898–240 239) | 39.6 (31.1–49.7) | 193 550 (148 284–247 107) | 29.3 (21.6–38.5) | 0.06 | −26.13 | −1.03 (−1.12 to −0.94) | <0.001 |
| Western Sub-Saharan Africa | 132 981 (86 983–172 353) | 78.8 (56.8–103.4) | 257 542 (190 011–332 759) | 74.3 (55.7–97.6) | 93.67 | −5.69 | −0.2 (−0.23 to −0.17) | <0.001 |
An in-depth analysis using APC and AAPC revealed varied trends. Prevalence rates from 2005–2010 experienced the sharpest decline with an APC of −1.50%. Incidence rates showed minor variations but an overall AAPC close to 0%, indicating stability. Death rates saw a marked decline during 1996–2004, with an APC of −2.75%. DALY rates also dropped significantly between 1997 and 2001, with an APC of −2.02% (Fig. 1).
Figure 1.
The APC and AAPC of ASR for prevalence (A), incidence (B), deaths (C) and DALYs (D) in inguinal, femoral, and abdominal hernias at the global level based on the joinpoint regression analysis model.
Global trends by sex
A discernible decline in ASRs is observed over this three-decade period for both sex. While both males and females exhibited similar declining patterns, males consistently registered higher rates in all categories. On the other hand, when focusing on absolute numbers, a significant uptick is observed over time, especially noticeable in prevalence and incidence (Figs 2–3).
Figure 2.
The trends in ASR of prevalence (A), incidence (B), deaths (C), and DALYs (D) for inguinal, femoral, and abdominal hernias among different sexes, female and male, from 1990 to 2019.
Figure 3.
The trends in numbers of prevalence (A), incidence (B), deaths (C), and DALYs (D) for inguinal, femoral, and abdominal hernias among different sexes, female and male, from 1990 to 2019.
From 1990 to 2019, sex-specific analysis of hernia prevalence showed a marked decline in ASRs, with males and females experiencing the greatest reductions between 2005 and 2010 (APC: −1.69%) and 1990–2000 (APC: −0.93%), respectively. However, recent trends indicate a concerning reversal, with rising ASRs in both genders. Incidence rates also decreased, most notably for males between 2005 and 2009 (APC: −0.77%) and for females during 2017–2019 (APC: −1.91%). Across both prevalence and incidence, the data revealed that males had a higher ASR than females. Male prevalence declined faster (AAPC: −0.69%) compared to females (−0.44%). For incidence, male rates slightly decreased (AAPC: −0.06%), while female rates increased (AAPC: 0.35%) ( Fig. 4).
Figure 4.
The APC and AAPC of ASR for prevalence (A) and incidence (B) by gender (both, female and male) in inguinal, femoral, and abdominal hernias at the global level based on the joinpoint regression analysis model.
Across sexes, there were discernible trends in ASRs for deaths and DALYs. For deaths, males showed the most significant decrease between 1997 and 2005 (APC: −2.94%), while females had a consistent decline with the sharpest fall between 1994 and 2001 (APC: −2.63%), resulting in an overall AAPC of −1.77%. DALY trends mirrored this positive trajectory, with both sexes experiencing substantial reductions; males between 1997 and 2000 and females from 1995 to 2002, each with an APC of −2.07%. The overall downward trend in DALYs was captured by an AAPC of −1.27%. (Fig. 5).
Figure 5.
The APC and AAPC of ASR for deaths (A) and DALYs (B) by gender (both, female and male) in inguinal, femoral, and abdominal hernias at the global level based on the joinpoint regression analysis model.
Global trends by age group
Prevalence rates escalate in older age groups, with a notable spike between 65 and 69 years, and males consistently outpacing females. Incidence rates similarly rise with age, peaking in the 65–69 years bracket, where males again register higher rates than females. Death rates surge most significantly for both sexes at 95+ years, with males showing a slightly elevated rate. As for DALYs, the trend mirrors age progression, reaching its zenith in the 95+ years group. Throughout these metrics, males consistently record higher rates than females across all age categories (Fig. 6).
Figure 6.
The trends in prevalence (A), incidence (B), deaths (C), and DALYs (D) for inguinal, femoral, and abdominal hernias across different genders, female and male, by age groups ranging from under 5 years to 95+ years.
Regional trends
From 1990 to 2019, there were significant variations in the prevalence of inguinal, femoral, and abdominal hernias across 21 regions. The highest ASR in 2019 was observed in Andean Latin America at 938.4 (95% CI: 801.5–1089.9) per 100000 cases, while high-income North America recorded the lowest at 175.6 (95% CI: 148.3–205.2) per 100000 cases. South Asia displayed a substantial decline in its ASR, marking a relative change of −35.38% and an AAPC of −1.5% (95%CI: −1.57% to −1.44%). On the contrary, Central Sub-Saharan Africa showed an uptick in hernia cases, as evidenced by a 25.03% relative change in its ASR coupled with an AAPC of 0.77% (95% CI: 0.73%–0.81%). For incidences, Tropical Latin America reported the highest ASR in 2019 at 303.1 (95% CI: 248.1–364.8) per 100000 cases, while the North Africa and Middle East region indicated the lowest at 76.7 (95% CI: 62.8–91.3) per 100000 cases (Tables 1–2).
Table 2.
Numbers and ASRs per 100 000 cases of incidence of inguinal, femoral, and abdominal hernia in 1990 and 2019, along with the relative changes and AAPC in ASRs per 100 000 cases from 1990 to 2019, categorized by global, SID and GBD regions.
| Characteristic | Number in 1990 (95% CI) | Age-standardized rate in 1990 (95% CI) | Number in 2019 (95% CI) | Age-standardized rate in 2019 (95% CI) | Relative change of numbers from 1990 to 2019 (%) | Relative change of age-standardized rate from 1990 to 2019 (%) | AAPC (Age-standardized Rate, 95% CI) | P |
|---|---|---|---|---|---|---|---|---|
| Global | 7 955 575 (6 614 299–9 409 892) | 163 (134.6–192.6) | 13 020 725 (10 682 088–15 490 165) | 163 (134.1–192.9) | 63.67 | −0.04 | 0 (−0.13 to 0.14) | 0.977 |
| High SDI | 1 392 676 (1 133 442–1 650 067) | 157.9 (128.6–187.3) | 1 822 358 (1 457 593–2 172 805) | 147.7 (121.8–174.5) | 30.85 | −6.49 | −0.21 (−0.27 to −0.15) | <0.001 |
| High-middle SDI | 1 986 702 (1 629 422–2 376 191) | 176.8 (144.4–211.2) | 3 006 397 (2 413 527–3 629 183) | 183.7 (150.2–219.5) | 51.33 | 3.89 | 0.14 (0.09–0.18) | <0.001 |
| Middle SDI | 2 178 945 (1 822 444–2 577 017) | 145.8 (120.6–172.1) | 3 985 238 (3 255 768–4 738 506) | 159.6 (131.6–188) | 82.9 | 9.48 | 0.32 (0.23–0.4) | <0.001 |
| Low-middle SDI | 1 704 877 (1 410 050–2 025 972) | 181 (149.9–214.6) | 2 761 206 (2 278 502–3 332 150) | 167 (137.4–200.2) | 61.96 | −7.72 | −0.27 (−0.34 to −0.19) | <0.001 |
| Low SDI | 688 096 (574 311–811 241) | 161.5 (135.1–188.5) | 1 437 755 (1 197 110–1 710 868) | 159 (132.3–187.3) | 108.95 | −1.57 | −0.06 (−0.09 to −0.03) | <0.001 |
| Andean Latin America | 96 148 (84 786–108 478) | 252.8 (223.5–283.8) | 180 437 (153 547–208 602) | 289.8 (247.4–333.1) | 87.67 | 14.6 | 0.46 (0.43–0.49) | <0.001 |
| Australasia | 27 368 (22 485–32 298) | 125.6 (103.1–147.5) | 46 344 (38 252–54 952) | 122.5 (101.6–144.7) | 69.33 | −2.43 | −0.08 (−0.09 to −0.07) | <0.001 |
| Caribbean | 76 339 (64 833–88 772) | 226.9 (193.8–262.2) | 127 187 (107 186–147 942) | 265.4 (224.4–308.2) | 66.61 | 16.97 | 0.54 (0.51–0.58) | <0.001 |
| Central Asia | 88 992 (75 215–104 248) | 134.5 (115.2–156.4) | 151 180 (125 736–179 072) | 160.9 (134.6–190.1) | 69.88 | 19.6 | 0.62 (0.56–0.69) | <0.001 |
| Central Europe | 254 331 (217 491–292 936) | 190.2 (163.3–218.4) | 241 151 (203 365–278 739) | 184.6 (157.7–212.9) | −5.18 | −2.94 | −0.08 (−0.13 to −0.04) | 0.001 |
| Central Latin America | 422 740 (360 231–494 775) | 325.3 (274.6–378.1) | 724 490 (607 888–852 476) | 293.5 (246.8–342.3) | 71.38 | −9.79 | −0.35 (−0.39 to −0.31) | <0.001 |
| Central Sub-Saharan Africa | 58 031 (47 494–70 061) | 117.8 (101.1–135) | 181 664 (147 366–218 099) | 171.6 (143.2–201.9) | 213.04 | 45.7 | 1.31 (1.23–1.38) | <0.001 |
| East Asia | 1 047 642 (838 418–1 266 811) | 95.4 (75.7–115.5) | 1 994 954 (1 544 280–2 476 277) | 124 (99.8–148.3) | 90.42 | 30.02 | 0.9 (0.8–1) | <0.001 |
| Eastern Europe | 663 359 (533 265–812 168) | 277.1 (223.9–335) | 681 018 (537 112–833 012) | 291.7 (234.3–353.5) | 2.66 | 5.27 | 0.19 (0.14–0.24) | <0.001 |
| Eastern Sub-Saharan Africa | 142 542 (116 384–171 872) | 92.7 (77.3–107.9) | 372 703 (310 883–439 717) | 125.9 (105.1–146.8) | 161.47 | 35.76 | 1.06 (1.04–1.08) | <0.001 |
| High-income Asia Pacific | 439 031 (349 623–528 748) | 258.2 (210.1–307.7) | 577 596 (454 326–704 255) | 276 (226.9–323.9) | 31.56 | 6.88 | 0.23 (0.2–0.27) | <0.001 |
| High-income North America | 369 887 (289 443–448 830) | 120.6 (94.8–146) | 450 234 (358 359–545 737) | 100.8 (82.6–119.7) | 21.72 | −16.42 | −0.6 (−0.66 to −0.54) | <0.001 |
| North Africa and Middle East | 188 015 (151 000–231 029) | 56.2 (45.9–67.2) | 439 992 (357 717–529 226) | 76.7 (62.8–91.3) | 134.02 | 36.44 | 1.08 (1.05–1.11) | <0.001 |
| Oceania | 3496 (2839–4253) | 64.9 (54.5–75.1) | 9807 (8075–11 820) | 83.5 (70.5–97.2) | 180.54 | 28.68 | 0.87 (0.85–0.89) | <0.001 |
| South Asia | 2 038 388 (1 654 311–2 439 958) | 228.1 (185.9–273.6) | 3 095 824 (2 484 942–3 804 158) | 181.5 (146.2–220.9) | 51.88 | −20.43 | −0.79 (−0.88 to −0.7) | <0.001 |
| Southeast Asia | 538 745 (447 263–632 431) | 149.3 (123.4–175.8) | 1 063 925 (881 744–1 256 251) | 157 (130.7–184.1) | 97.48 | 5.17 | 0.14 (0–0.28) | 0.053 |
| Southern Latin America | 58 894 (50 220–67 828) | 121.6 (103.8–139.9) | 116 045 (97 667–134 879) | 162.3 (137.3–188.5) | 97.04 | 33.51 | 1 (0.93–1.06) | <0.001 |
| Southern Sub-Saharan Africa | 116 836 (95 078–142 314) | 231.3 (191.2–276.8) | 178 408 (146 141–216 078) | 231.6 (190.3–279.3) | 52.7 | 0.1 | 0 (−0.04 to 0.03) | 0.892 |
| Tropical Latin America | 357 729 (291 848–429 521) | 294.1 (236.3–359.1) | 725 963 (587 397–879 747) | 303.1 (248.1–364.8) | 102.94 | 3.09 | 0.11 (0.03–0.19) | 0.009 |
| Western Europe | 693 248 (572 943–816 761) | 150.9 (124.7–177.6) | 958 832 (765 583–1 150 292) | 166.4 (136.1–197) | 38.31 | 10.28 | 0.39 (0.16–0.61) | 0.001 |
| Western Sub-Saharan Africa | 273 812 (227 722–327 429) | 163 (136.6–192) | 702 970 (588 182–831 665) | 189.4 (160–221.1) | 156.73 | 16.21 | 0.51 (0.49–0.53) | <0.001 |
In terms of mortality, Central Europe underwent a significant reduction in ASR by 70.76% over the three decades, with an AAPC of −4.17% (95% CI: – 4.32% to − 4.02%). Conversely, Tropical Latin America saw a pronounced surge in numbers by 123.84%, even though its ASR decreased by −14.81%. Regions like East Asia, Andean Latin America, and Central Asia experienced notable decreases in both numbers and ASRs. Furthermore, the impact of hernia-related DALYs showcased varied trends; for instance, Oceania exhibited the most substantial relative change in numbers at 103.63% but had a slight reduction in ASR by −2.07% with an AAPC of −0.08% (95% CI: −0.14% to −0.01%). In stark contrast, Central Europe and Andean Latin America showed declining trends in their numbers by −42.03% and −34.74%, respectively, with AAPC values of −2.28% (95% CI: −2.48% to −2.07%) and −2.65% (95% CI: −2.86% to −2.45%) (Tables 3–4).
Table 3.
Numbers and ASRs per 100 000 cases of deaths of inguinal, femoral, and abdominal hernia in 1990 and 2019, along with the relative changes and AAPC in ASRs per 100 000 cases from 1990 to 2019, categorized by global, SID and GBD regions.
| Characteristic | Number in 1990 (95% CI) | Age-standardized rate in 1990 (95% CI) | Number in 2019 (95% CI) | Age-standardized rate in 2019 (95% CI) | Relative change of numbers from 1990 to 2019 (%) | Relative change of age-standardized rate from 1990 to 2019 (%) | AAPC (Age-standardized rate, 95% CI) | P |
|---|---|---|---|---|---|---|---|---|
| Global | 40 141 (32 804–45 418) | 1.1 (0.9–1.2) | 48 077 (41 654–54 021) | 0.6 (0.5–0.7) | 19.77 | −40.39 | −1.77 (−1.85 to −1.68) | <0.001 |
| High SDI | 6725 (5639–7128) | 0.7 (0.5–0.7) | 7653 (6391–8854) | 0.3 (0.3–0.4) | 13.79 | −47.03 | −2.18 (−2.33 to −2.02) | <0.001 |
| High-middle SDI | 7510 (6798–8286) | 0.8 (0.7–0.9) | 7674 (6786–9703) | 0.4 (0.4–0.5) | 2.18 | −51.15 | −2.43 (−2.53 to −2.32) | <0.001 |
| Middle SDI | 9596 (7328–11 795) | 1 (0.8–1.2) | 12 698 (10 730–14 646) | 0.6 (0.5–0.7) | 32.32 | −37.7 | −1.62 (−1.71 to −1.54) | <0.001 |
| Low-middle SDI | 10 023 (7577–11 935) | 1.7 (1.2–2.2) | 11 615 (9415–13 691) | 1 (0.8–1.2) | 15.87 | −41.93 | −1.78 (−1.98 to −1.58) | <0.001 |
| Low SDI | 6255 (4167–7720) | 2.4 (1.5–3.5) | 8402 (6051–11 832) | 1.7 (1.2–2.5) | 34.32 | −28.02 | −1.11 (−1.18 to −1.04) | <0.001 |
| Andean Latin America | 700 (414–1059) | 1.9 (1.3–2.7) | 393 (296–520) | 0.7 (0.5–0.9) | −43.78 | −63.52 | −3.45 (−3.82 to −3.08) | <0.001 |
| Australasia | 114 (102–129) | 0.5 (0.5–0.6) | 237 (193–276) | 0.4 (0.3–0.5) | 107.25 | −20.26 | −0.75 (−0.99 to −0.5) | <0.001 |
| Caribbean | 468 (266–722) | 1.5 (1–2.1) | 473 (328–638) | 1 (0.7–1.3) | 1.16 | −35.42 | −1.49 (−1.71 to −1.28) | <0.001 |
| Central Asia | 375 (332–426) | 0.7 (0.6–0.8) | 251 (222–297) | 0.4 (0.4–0.5) | −33.23 | −40.9 | −1.81 (−2.01 to −1.6) | <0.001 |
| Central Europe | 2034 (1541–2154) | 1.6 (1.2–1.7) | 1028 (870–1428) | 0.5 (0.4–0.6) | −49.48 | −70.76 | −4.17 (−4.32 to −4.02) | <0.001 |
| Central Latin America | 1611 (1437–1817) | 1.9 (1.6–2) | 2783 (2349–3242) | 1.2 (1–1.4) | 72.79 | −34.83 | −1.43 (−1.67 to −1.2) | <0.001 |
| Central Sub-Saharan Africa | 688 (306–1017) | 2.2 (1.1–3.9) | 902 (530–1665) | 1.7 (1–3.1) | 31 | −23.43 | −0.9 (−0.97 to −0.84) | <0.001 |
| East Asia | 2987 (1520–4576) | 0.4 (0.2–0.5) | 1786 (1430–2264) | 0.1 (0.1–0.1) | −40.2 | −68.52 | −3.98 (−4.11 to −3.85) | <0.001 |
| Eastern Europe | 1630 (1495–2030) | 0.7 (0.6–0.8) | 1650 (1424–2260) | 0.5 (0.4–0.7) | 1.22 | −27.7 | −1 (−1.6 to −0.4) | 0.001 |
| Eastern Sub-Saharan Africa | 2093 (1027–2771) | 2.2 (1.3–3.9) | 2993 (1970–5623) | 1.9 (1.2–3.8) | 43 | −12.24 | −0.45 (−0.52 to −0.38) | <0.001 |
| High-income Asia Pacific | 701 (568–754) | 0.4 (0.3–0.5) | 1078 (786–1376) | 0.2 (0.1–0.2) | 53.66 | −59.78 | −3.12 (−3.26 to −2.99) | <0.001 |
| High-income North America | 1560 (1391–1654) | 0.4 (0.4–0.5) | 2419 (2058–2674) | 0.4 (0.3–0.4) | 55.06 | −15.89 | −0.59 (−0.71 to −0.47) | <0.001 |
| North Africa and Middle East | 633 (311–1076) | 0.3 (0.2–0.5) | 853 (664–1210) | 0.2 (0.2–0.4) | 34.75 | −28.74 | −1.16 (−1.38 to −0.94) | <0.001 |
| Oceania | 26 (14–40) | 0.8 (0.5–1.3) | 47 (29–78) | 0.7 (0.4–1.1) | 83.33 | −16.06 | −0.61 (−0.77 to −0.44) | <0.001 |
| South Asia | 10 912 (7 338–12 923) | 2.3 (1.5–3) | 12 747 (9850–16 331) | 1.1 (0.9–1.4) | 16.81 | −52.37 | −2.49 (−2.71 to −2.26) | <0.001 |
| Southeast Asia | 4971 (3207–6849) | 1.9 (1.3–2.4) | 6846 (5162–8109) | 1.3 (1–1.6) | 37.72 | −28.05 | −1.12 (−1.19 to −1.06) | <0.001 |
| Southern Latin America | 392 (350–423) | 0.9 (0.8–1) | 557 (483–627) | 0.7 (0.6–0.7) | 42.23 | −27.62 | −1.13 (−1.39 to −0.87) | <0.001 |
| Southern Sub-Saharan Africa | 266 (212–325) | 0.9 (0.7–1.2) | 503 (374–602) | 1 (0.7–1.2) | 89.05 | 3.31 | 0.14 (−0.12 to 0.4) | 0.286 |
| Tropical Latin America | 1144 (1023–1309) | 1.3 (1.2–1.5) | 2561 (2260–2833) | 1.1 (1–1.2) | 123.84 | −14.81 | −0.54 (−0.76 to −0.31) | <0.001 |
| Western Europe | 5310 (4515–5636) | 0.9 (0.8–1) | 5244 (4434–6499) | 0.5 (0.4–0.6) | −1.24 | −49.81 | −2.35 (−2.43 to −2.26) | <0.001 |
| Western Sub-Saharan Africa | 1525 (820–2280) | 1.5 (0.9–2.5) | 2727 (1869–4316) | 1.4 (1–2.3) | 78.78 | −6.53 | −0.23 (−0.32 to −0.13) | <0.001 |
National trends
From 1990 to 2019, the relative change in numbers of inguinal, femoral, and abdominal hernias saw marked variations across 204 countries and territories. In terms of prevalence, 191 countries experienced significant growth, with Qatar’s spike at 608.78% being the most notable. Contrastingly, 13 countries, including Bulgaria at −51.57% and Poland at −44.3%, saw a decline. Regarding incidence, a majority, 196 out of 204, witnessed an increase, with Qatar’s surge of 846.22% at the forefront. However, Bulgaria displayed the most substantial decline at −48.91%. Mortality rates were diverse, with the United Arab Emirates recording the highest increase at 418.02%, while Mongolia showed the most significant decrease at −86.98%. For DALYs, Qatar reported the steepest rise at 510.2%, whereas Albania marked the highest drop at −70.16%. (Tables S1–S4, Supplemental Digital Content 1, http://links.lww.com/JS9/B752, Figures S1–S4, Supplemental Digital Content 2, http://links.lww.com/JS9/B753).
When considering ASRs, Bulgaria, Mongolia, and Poland consistently showcased significant declines across the different parameters. Specifically, Mongolia stood out with a decline of −88.94% in mortality and −73.98% in DALY. In contrast, countries like Georgia, with a 57.43% rise in prevalence, and Burundi, with an 88.03% increase in incidence, led the upward trends. The AAPC provided deeper insights: Georgia and Burundi emerged with positive values, especially Georgia with an AAPC of 1.6% (95% CI: 1.5%–1.7%) for prevalence, and Burundi’s 2.21% (95% CI: 2.13%−2.28%) for incidence. In contrast, Mongolia and Bulgaria displayed the most marked negative trends, particularly Mongolia’s −7.32% (95% CI: −7.72% to −6.93%) in mortality rates. (Tables S1–S4, Supplemental Digital Content 1, http://links.lww.com/JS9/B752, Figures S5–S12, Supplemental Digital Content 2, http://links.lww.com/JS9/B753).
Correlations of ASR with SDI
Investigating hernia metrics across 21 regions, a nuanced correlation with the SDI emerged. Prevalence and incidence ASRs displayed negligible associations with SDI, being slightly negative (R=−0.303, P=0.182) and marginally positive (R=0.122, P=0.599), respectively, neither reaching statistical significance. Conversely, a strong negative correlation was observed between mortality ASR and SDI (R=−0.763, P<0.001). This trend continued with DALYs ASR, which also negatively correlated with SDI (R=−0.599, P=0.004). Similarly, a broader analysis across 204 countries and territories confirmed these patterns: prevalence ASR negatively correlated with SDI (R=−0.341, P<0.001), and while incidence ASR’s positive correlation was not statistically significant (R=0.063, P=0.12), mortality and DALYs ASRs strongly negatively correlated (R=−0.664 and R=−0.6, respectively, P<0.001) (Figs 7–8).
Figure 7.
Pearson correlation analysis between the SDI and ASR of prevalence (A), incidence (B), deaths (C), and DALYs (D) for inguinal, femoral, and abdominal hernias across 21 regional levels in 2019 (The cases of prevalence, incidence, deaths, and DALYs from 21 regions in 2019 are represented by circles. The size of the circles increased with the cases of prevalence, incidence, deaths, and DALYs.).
Figure 8.
Pearson correlation analysis between the SDI and ASR of prevalence (A), incidence (B), deaths (C), and DALYs (D) for inguinal, femoral, and abdominal hernias at the country and territorial levels in 2019 (The cases of prevalence, incidence, deaths, and DALYs from 204 countries and territories in 2019 are represented by circles. The size of the circles increased with the cases of prevalence, incidence, deaths, and DALYs.).
Frontier analysis
In the comprehensive frontier analysis based on SDI and ASRs of inguinal, femoral, and abdominal hernias spanning from 1990 to 2019 across 204 countries and territories, distinct trends emerged. For prevalence, as the SDI value ascended from 0.0 to 1.0, there was an overall decline in ASR for hernias, characterized by a progressive density shift from lighter to darker shades over the years, indicative of a general reduction in prevalence. Similarly, the death rate due to hernias presented a downward trend with increasing SDI, while the DALYs followed a similar pattern, revealing that as developmental progress occurs, the burden of hernias tends to diminish (Fig. 9).
Figure 9.
Frontier analysis, represented by the solid black lines, explores the relationship between Socio-Demographic Index (SDI) and Age-Standardized Rate (ASR) for prevalence (A, B), deaths (C, D), and DALYs (E, F) in the context of inguinal, femoral, and abdominal hernias. The color gradient in graphs A, C, and E illustrates the progression of years, ranging from light shades representing 1990 to the darkest shades denoting 2019. In graphs B, D, and F, each dot signifies a specific country or territory for the year 2019, with the top 15 countries displaying the most significant deviation from the frontier labeled in black. Countries with low SDI (> 0.455) and minimal deviation from the frontier are highlighted in blue, while those with high SDI (> 0.805) and notable deviation for their developmental level are emphasized in red. The direction of change from 1990 to 2019 in ASR is indicated by the color of the dots: decrease dots represents a decrease, while increase dots signifies an increase.
Turning our attention to the frontier analysis results from 2019, the visual representations delineated clear distinctions among countries and territories. For prevalence, 15 countries such as Haiti, Zimbabwe, and Guatemala, among others, were observed to have significantly higher rates, placing them distant from the frontier. In contrast, countries like Somalia, Yemen, Popua New Guinea, and the Solomon Islands were closer to the frontier, suggesting optimal outcomes given their SDI. When assessing the death rates, nations like the Central African Republic, Burkina Faso, and Burundi exhibited larger gaps from the frontier. Interestingly, high SDI countries such as Qatar, the United Kingdom, and Slovakia showed relatively high effective differences for their developmental stage. Lastly, in the DALYs analysis, countries like Somalia, Yemen, and the Solomon Islands depicted rates closer to the aspirational benchmark set by the frontier (Fig. 9).
Trends of inguinal, femoral, and abdominal hernias from 1990 to 2030
From 1990 to 2030, data on inguinal, femoral, and abdominal hernias reveals discernible trends in both prevalence and incidence. The combined prevalence in numbers for both sexes is characterized by a steady rise, with males showing a consistent increase and females a more subtle uptick. The ASR of prevalence for both sexes initially declines, stabilizes, and then modestly climbs in later years. Specifically, the male ASR aligns with this pattern, while the female ASR undergoes a decline until 2015, rebounding gradually thereafter. In terms of the numbers of incidence, there is a marked upswing for both genders combined, more pronounced in males, spanning from 1990 to 2030. In contrast, female incidence began to diminish in 2018 and is projected to maintain this downward trajectory. The ASR of incidence for both sexes remains fairly constant, with males reflecting this stability and females expected to experience a slight dip in the coming years (Figs 10–11).
Figure 10.
Projected numbers and ASR of prevalence for inguinal, femoral, and abdominal hernias by gender (both, male, and female) from 1990 to 2030 based on the BAPC model.
Figure 11.
Projected numbers and ASR of incidence for inguinal, femoral, and abdominal hernias by gender (both, male, and female) from 1990 to 2030 based on the BAPC model.
Regarding death and DALY trends associated with these hernias from 1990 to 2030, both sexes combined consistently display a decline in the ASR of deaths, projected to continue till 2030. Males mirror this decline, while females consistently record a marginally lower ASR. Even with declining rates, the absolute death count has exhibited fluctuations, particularly a sharp increase since 2010. By 2030, the death count for both sexes is projected to rise, with males predominantly leading. Simultaneously, the ASR of DALYs has continuously decreased across the general population, with this downward trend also being consistent in both males and females. Despite the male populace often having a higher rate, the total DALYs count for both sexes is increasing, with projections indicating a continuation of this trend in the ensuing decade (Figs 12–13).
Figure 12.
Projected ASR (A) and numbers (B) of deaths for inguinal, femoral, and abdominal hernias by gender (both, male, and female) from 1990 to 2030 based on the BAPC model.
Figure 13.
Projected ASR (A) and numbers (B) of DALYs for inguinal, femoral, and abdominal hernias by gender (both, male, and female) from 1990 to 2030 based on the BAPC model.
Discussion
From 1990 to 2019, the global prevalence of hernia cases rose by 36% to 32.5 million, while ASRs dropped 16.46%. Absolute incidence spiked 63.67%, but its age-standardized measure was stable. Mortality rose 19.77%, but age-standardized mortality dropped 40.39%. Males had higher rates, but both sexes saw reduced ASRs. Elderly individuals, especially ages 65–69, showed a higher prevalence. Andean Latin America had 2019’s highest prevalence, with notable regional variations. High-SDIs linked to better hernia outcomes. Frontier analysis from 1990 to 2019 across 204 countries showed decreasing hernia rates with rising SDIs. Countries like Haiti and Guatemala had high prevalence, while Somalia and Yemen fared better relative to their SDIs. Surprisingly, high-SDI countries like Qatar and the UK had elevated rates. Data from 1990 to 2030 showed rising male hernia prevalence and fluctuating ASRs. The numbers of incidence increased for both sexes, with a forecasted female decline post-2019. Hernia-related deaths and DALYs between 1990 and 2030 indicate falling ASRs but rising absolute counts by 2030, mainly in males. The age-standardized DALY rate’s decline slowed significantly post-2015, but total DALYs are expected to rise.
The 36% rise in global hernia cases from 1990 to 2019, juxtaposed with a 16.46% decrease in ASRs, paints a complex picture of hernia epidemiology. This contrast suggests that while the total number of hernia cases has increased, likely due to factors such as lifestyle changes, dietary shifts, and enhanced diagnostic capabilities, the age-specific incidence is declining, possibly reflecting the impact of improved public health measures and healthcare advancements18,19. These insights reveal a nuanced narrative of hernia management: despite the overall rise in cases, there are encouraging signs of progress and opportunities for targeted healthcare strategies and research.
From 1990 to 2019, both males and females experienced a decline in ASRs for hernias, though males consistently exhibited higher rates, likely due to anatomical differences20,21. Females saw a pronounced decrease, particularly between 2017 and 2019, where the APC in hernia incidence was −1.91%, suggesting more effective healthcare interventions and possibly societal shifts toward less physically demanding roles for women, alongside improved health awareness. While global health strategies seem to have successfully reduced DALYs for both sexes, the greater declines in male mortality and DALYs imply that men might be reaping more benefits from these healthcare advancements. Despite these advances, the increase in absolute hernia cases highlights the impact of population growth and better reporting practices, indicating the need for ongoing sex-specific research to further refine prevention and treatment strategies.
The hernia trends across various regions and nations over the past three decades underscore a complex interplay of socio-demographic, economic, and healthcare determinants22,23. Andean Latin America’s high prevalence ASR contrasts starkly with high-income North America, suggesting that regional differences in factors like genetic predisposition, healthcare accessibility, and environmental factors might be at play24–26. South Asia’s substantial decline, potentially linked to improving healthcare systems and advancements in hernia management strategies, contrasts Central Sub-Saharan Africa’s uptick, perhaps attributable to increasing population ages or a lag in medical advancements27,28. The dramatic reduction in mortality ASR observed in Central Europe may point toward the efficacy of their healthcare protocols and accessibility to timely treatment. Conversely, the surge in mortality in regions like Tropical Latin America warrants an in-depth investigation into potential gaps in healthcare delivery or emerging risk factors.
At a national level, the striking growth in hernia-related metrics for Qatar raises questions about changing lifestyle factors, potentially accelerated urbanization, or perhaps increased diagnostic capabilities18. Mongolia’s notable reduction in mortality and DALYs signifies effective health interventions and possible shifts in public health priorities. However, the upward trajectories observed in countries like Georgia and Burundi call for an urgent need to address potential epidemiological changes, health system constraints, or socio-economic factors that may be influencing these trends. The diverse patterns observed across regions and countries emphasize the importance of tailor-made health strategies, accounting for each area’s unique challenges and strengths.
The relationship between the SDI and hernia health outcomes is strikingly negative, particularly for hernia-related deaths and DALYs, underscoring the beneficial impact of higher SDIs on reducing mortality and morbidity from hernias. This correlation is likely attributable to the superior healthcare systems, increased access to medical care, and higher health literacy typically found in regions with higher SDIs22,29. The connection between SDI and hernia prevalence or incidence, however, is less pronounced at the regional levels, indicating that additional factors such as genetics, environment, or occupation may also play significant roles. Nevertheless, the data affirms that socio-demographic progress is crucial for enhancing hernia health outcomes, highlighting the importance of improving SDI as a central goal in health policies30.
The frontier analysis, anchored on the SDI and ASRs of hernias, offers pivotal insights into the trajectory of hernia trends from 1990 to 2019 across the globe. The overarching narrative paints a clear picture: as socio-demographic indices climb, the weight of hernias—whether gauged through prevalence, death rates, or DALYs—lightens. Yet, a deeper dive into the 2019 data unveils nuanced disparities among nations. It is striking that countries like Haiti, Zimbabwe, and Guatemala, despite their varied socio-demographic backdrops, all grapple with inflated prevalence rates, distancing them from the optimal frontier. Conversely, nations like Somalia and Yemen, often mired in socio-political challenges, appear to fare better in hernia outcomes vis-à-vis their SDI, inching closer to the frontier’s aspirational benchmark. This disparity underscores the multifaceted nature of healthcare outcomes, suggesting that while SDI is a significant influencer, other latent factors—be they environmental, genetic, or healthcare system intricacies—also play pivotal roles in shaping hernia trends.
Over the 30 years, the rising incidence numbers of hernias has highlighted a critical public health issue, with a more significant impact on males yet displaying a recent decline in females post-2018, pointing to the need for further research into the reasons behind these sex differences. While age-standardized prevalence rates have fluctuated, indicating decreases and stabilization, an expected upward trend raises concerns about the effects of an aging population on disease incidence. Although the increase in raw mortality figures since 2010 is alarming, the downward trend in age-standardized death rates reflects improvements in hernia management and medical treatments. Nevertheless, the steady rate of DALYs since 2015, alongside rising total DALY figures, underscores a persistent morbidity, stressing the importance of enhancing life quality after treatment. These trends underscore the urgency for nuanced health policies that focus on reducing the incidence and improving long-term outcomes for hernia patients.
Our study undoubtedly has inherent limitations. While we have endeavored to provide a comprehensive analysis, the accuracy and consistency of data across diverse regions can vary, potentially introducing biases or inaccuracies. Furthermore, our projections up to 2030, though based on rigorous statistical models, rest on certain assumptions, which external factors could influence. Additionally, the historical span of our research, encompassing data from 1990 onwards, might be affected by evolving diagnostic criteria and medical technologies over the years. Hence, while our findings shed valuable light on global hernia trends, they should be interpreted with caution, acknowledging the nuanced intricacies and potential deviations embedded within the broader landscape of our research.
Conclusions
Our research highlights key patterns linking hernia trends with socio-demographic factors, offering critical insights for health policy and practice. Findings indicate that regions with higher socio-demographic indices report fewer hernia-related deaths and better outcomes, though disparities persist. Given the ongoing global burden of hernias, the need for continuous monitoring and adaptive health strategies is evident. Effective reduction in hernia impact will require persistent research and proactive healthcare approaches.
Ethical approval
Our research involved a secondary evaluation of the publicly accessible GBD Study dataset, without primary data collection. Hence, no ethical approval was necessary.
Consent
No informed consent was required since our research is a secondary analysis of public data.
Sources of funding
No funding supported.
Author contribution
In this research effort, W.F. and L.X.L. provided critical data curation and analysis, validating the findings, and drafting the initial manuscript; M.B.Z. was instrumental in conceptualizing the study framework, honing the methodology, and supervising the project, in addition to refining the manuscript through substantive review and editing; M.Q.Y. supported the research with essential data curation, software handling, and contributed to the visualization of results, also participating in the manuscript’s refinement. As the corresponding author, L.X.L. orchestrated the study’s design and coordination, managed project administration, and led the methodology development and validation processes. Her role was pivotal in the manuscript’s final review, ensuring the integrity and accuracy of the work presented.
Conflicts of interest disclosure
All the authors have no conflicts of interest.
Research registration unique identifying number (UIN)
Name of the registry: not applicable.
Unique identifying number or registration ID: not applicable.
Hyperlink to your specific registration (must be publicly accessible and will be checked): not applicable.
Guarantor
Xiaoli Liu, Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Number 5 Jingyuan Road, Shijingshan District, Beijing 100043, People’s Republic of China. E-mail: xiaolil916@163.com
Data availability statement
The data comes from a public database, can through this link: https://vizhub.healthdata.org/gbd-results/ for the relevant data.
Provenance and peer review
Our paper was not invited. Not commissioned, externally peer reviewed.
Supplementary Material
Acknowledgements
The authors extend our profound appreciation to the individuals and teams involved in the GBD Study for providing a comprehensive dataset that formed the backbone of our research. Our gratitude also goes to the data scientists and statisticians for their meticulous efforts in data analysis, utilizing advanced tools like R software, and the application of rigorous statistical methodologies such as Joinpoint Regression Analysis and the Bayesian Age-Period-Cohort model. The authors acknowledge the valuable contributions of our peer researchers and medical professionals who offered critical insights that enriched our understanding of hernia trends.
Footnotes
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Supplemental Digital Content is available for this article. Direct URL citations are provided in the HTML and PDF versions of this article on the journal’s website, www.lww.com/international-journal-of-surgery.
Published online 23 January 2024
Contributor Information
Fan Wang, Email: wolf_ie@126.com.
Bangzhen Ma, Email: mabangzhen@163.com.
Qiuyue Ma, Email: mqyue101@163.com.
Xiaoli Liu, Email: xiaolil916@163.com.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data comes from a public database, can through this link: https://vizhub.healthdata.org/gbd-results/ for the relevant data.