Abstract
Background
Gastroesophageal reflux disease (GERD) is a common chronic digestive disorder with a growing epidemiological footprint worldwide. However, the specific characteristics and burden of GERD in East Asia, particularly in China, remain insufficiently documented.
Methods
This study conducted a comprehensive assessment of the incidence, disability-adjusted life years (DALYs), and prevalence of GERD in China and East Asia using data from the Global Burden of Disease (GBD) project from 1990 to 2021. We applied cross-national comparisons, longitudinal temporal analyses, and subgroup analyses to examine the disease burden in East Asia, particularly in China. Additionally, cutting-edge analytical methods were employed to forecast the disease burden trends from 2022 to 2046.
Results
In 2021, the East Asian recorded 396,791,145 new cases of GERD, accounting for 12.24% of the global total. China contributed 9.99%, 9.88%, and 9.85% of the global incidence, DALYs, and prevalence, respectively, establishing itself as the highest number of cases in East Asia. From 1990 to 2021, China experienced rising crude rates of incidence, DALYs, and prevalence, alongside a significant rise in total case numbers. The GERD burden was more pronounced in Chinese women than in men, particularly within the age groups of 50–59 and 30–34. The incidence for middle-aged and younger adults surpassed those reported in Japan and Republic of Korea. Projections suggest that, in contrast to the stable age-standardized incidence anticipated in Japan and Republic of Korea, both the total number of cases and the age-standardized incidence of GERD in China are expected to continue rising until 2046. Notably, a strong positive correlation was observed between the Socio-Demographic Index (SDI) and both age-standardized DALYs (r = 0.822, p < 0.001) and incidence(r = 0.824, p < 0.001).
Conclusion
GERD poses a substantial and growing public health challenge in East Asia, particularly in China, with high crude incidence, DALYs, and prevalence estimates. The burden is higher among young and middle-aged women in China, underscoring the need for targeted clinical and preventive strategies in this demographic.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12876-026-04635-6.
Keywords: Gastroesophageal reflux disease, Disease burden, Cutting-Edge analysis, Decomposition analysis, Predictive analysis
Introduction
Gastroesophageal reflux disease (GERD) is a chronic digestive disorder, displaying increasing epidemiological traits in East Asia [1, 2]. Patients often experience reflux-related symptoms that diminish their quality of life and impose a significant disease burden. Inadequately managed GERD may progress to reflux esophagitis and Barrett’s esophagus [3, 4], which are known precursors of esophageal adenocarcinoma [5].
While the recent Global Burden of Disease (GBD) 2021 analyses have documented GERD trends globally [6, 7], the disease burden in East Asia reveals distinctive patterns, characterized by a progressive “Westernization” in its epidemiological profile [1, 8].Currently, East Asia, especially China, the Republic of Korea, and Japan, is experiencing notable changes, including declining fertility, extended lifespans, and an aging demographic [9]. Several studies indicate that the impact of GERD differs significantly across regions and socioeconomic status [1, 10, 11]. The shared ethnic backgrounds and dietary customs among East Asian populations present a unique opportunity for comparative research that can inform region-specific clinical management and public health interventions.
In this study, we aimed to thoroughly examine the changes in GERD disease burden over time within China and East Asia, investigate variations between countries, and forecast future trends using the latest findings from the GBD 2021 report, thereby generating evidence to guide effective prevention and control strategies across the region.
Methods and materials
Data sources
In this study, we utilized data from the GBD 2021 database covering 1990–2021; it offers estimated metrics that span various indicators such as population figures, fertility rates, incidence, and mortality across 204 nations and regions globally [12]. Data were collected from five East Asian countries: China, Japan, Republic of Korea, Democratic People’s Republic of Korea, and Mongolia, along with global data. Specifically, the GBD 2021 data for China encompass 33 provincial-level administrative divisions, excluding the Xinjiang Production and Construction Corps, Hong Kong Special Administrative Region, and Taiwan Province.
The key outcome measures were incidence, disability-adjusted life years (DALYs), years lived with disability (YLDs), and GERD prevalence. Data were categorized by year, sex, and age to illustrate the burden of GERD in East Asian countries from 1990 to 2021, including 95% uncertainty intervals (UI).
Key metrics and estimation procedures
The key metrics are outlined as follows: incidence is the frequency of new GERD cases in a specific population over a certain period. Prevalence refers to the proportion of individuals experiencing GERD at a specific time. YLDs calculation is based on the severity grading methods evaluated in GBD 2021 (for instance, Hoehn and Yahr staging) [13], which is achieved by multiplying the number of GERD cases of different severities by their respective disability weights. Years of life lost (YLLs) were determined by multiplying the number of deaths in each age category by the expected remaining lifespan for that age. DALYs are the sum of YLLs and YLDs and provide a comprehensive assessment of the disease burden [14]. Because GERD is a chronic nonfatal disease, the associated YLLs were regarded as zero. Therefore, the DALYs for GERD were equivalent to YLDs.
All burden estimates are presented as absolute (numbers and rates per 100,000 people). To assess uncertainty, the 95% UI was calculated from the 2.5th and 97.5th percentiles of the 1,000 ordered samples. To enable valid comparisons across countries and over time, we computed age-standardized incidence rates (ASIR) and age-standardized DALYs rates (ASDR) using the GBD world standard population reference. Additionally, both crude and age-standardized rates were analyzed in cross-national comparisons to provide complementary perspectives on disease burden.
Statistical analysis
We analyzed the disease burden of GERD, differentiated by age and sex, and assessed temporal trends from 1990 to 2021. The population was divided into 15 distinct age groups using 5-year intervals, with individuals < 20 and > 85 years of age aggregated into separate categories. To quantify temporal trends, we calculated the estimated annual percentage change (EAPC) through a linear regression model applied to the natural logarithm of the rate metric (y = α + βx + ε, where x represents the calendar year), with EAPC derived as (e^ β-1)×100 [14, 15]. The relative changes in burden between 1990 and 2021 were assessed using the following formula: [(2021 value-1990 value)/1990 value] × 100%.
The average annual percentage change (AAPC) and annual percentage change (APC) were analyzed using a joinpoint regression analysis, including their 95% confidence intervals (CI), to identify the inflection point of the trend [14]. The EAPC, APC, AAPC, and their corresponding 95% confidence intervals (CIs) were examined to identify trends. A CI > 0 signifies an increasing trend, a CI < 0 indicates a decreasing trend, and a CI including 0 reflects a stable trend. Decomposition analysis was conducted to ascertain the factors driving the incidence of GERD, including three main elements: population aging, population growth, and epidemiological changes [16]. The age-period-cohort model, utilized via the Norpred R package [15, 17], was used to forecast the number of GERD cases and ASIR by sex for the years 2022–2046, taking into account time-dependent trends and demographic changes.
Socio-demographic index analysis
The Socioeconomic Development Index (SDI) serves as a multifaceted measure that incorporates the total fertility rate, per capita income, and average educational attainment among individuals aged ≥ 15 years. Higher SDI scores indicate enhanced socio-economic conditions [13]. Pearson’s correlation analysis was used to explore the relationship between national SDI, age-standardized rates, and DALYs of GERD. Trend lines were incorporated to visualize the association between socio-economic development and GERD burden. All statistical evaluations were conducted using the open-source software R (version 4.4.2), and joinpoint analysis was performed using the Joinpoint Regression Program (version 4.9.1.0).
Results
Burden of GERD in China and East Asian countries
In 2021, East Asia recorded 396,791,145 new instances of GERD, representing 12.24% of the global total (95% UI: 34,241,606.62-44,931,908.14). China alone accounted for 32,387,866 new cases, leading to 626,248 DALYs and 81,327,260 prevalent cases, corresponding to 9.99%, 9.88%, and 9.85% of the respective global totals. From 1990 to 2021, China experienced a 55.24% increase in new cases (EAPC = 1.39, 95% CI: 1.31–1.48). Although this growth rate was lower than that in most other East Asian nations, except Japan (EAPC = 0.7, 95% CI: 0.64 to 0.75), the number of cases was the highest in East Asia (Table 1). A similar pattern was observed for DALYs, with absolute numbers remaining the highest in the region, despite a slower growth rate than that of most counterparts, except Japan. The prevalence of GERD in China rose by 60.62% over the same period (EAPC = 1.49, 95% CI: 1.4–1.59), a rate comparable to that in the Democratic People’s Republic of Korea, lower than that in the Republic of Korea and Mongolia, but higher than the rate in Japan (Table 1).
Table 1.
The incidence, DALYs, YLDs, prevalence (in cases) of gastroesophageal reflux disease in East Asia countries from 1990 to 2021
| Incidence | DALY | YLD | Prevalence | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| location | 1990 | 2021 |
EAPC (1990–2021) |
Change | 1990 | 2021 |
EAPC (1990–2021) |
Change | 1990 | 2021 |
EAPC (1990–2021) |
Change | 1990 | 2021 |
EAPC (1990–2021) |
Change |
| Global |
180018233.4 (158660995.2 to 199950073.4) |
324139599.3 (287693228.7 to 358912516) |
1.92 (1.91 to 1.93) |
80.06% |
3472702.58 (1752692.84 to 6128627.19) |
6336161.7 (3189793.94 to 11241352.5) |
1.96 (1.94 to 1.98) |
82.46% |
3472702.58 (1752692.84 to 6128627.19) |
6336161.7 (3189793.94 to 11241352.5) |
1.96 (1.94 to 1.98) |
82.46% |
450765454.69 (397478515.38 to 511638409.85) |
825603654.11 (732989499.88 to 925555127.88) |
1.97 (1.95 to 1.99) |
83.16% |
| People’s Republic of China |
20863746.98 (18034678.7 to 23688720.91) |
32387865.91 (27851900.26 to 36711149.96) |
1.39 (1.31 to 1.48) |
55.24% |
393857.55 (199884.14 to 694580.36) |
626247.52 (311713.8 to 1115891.99) |
1.46 (1.37 to 1.55) |
59.00% |
393857.55 (199884.14 to 694580.36) |
626247.52 (311713.8 to 1115891.99) |
1.46 (1.37 to 1.55) |
59.00% |
50632181.12 (44030373.19 to 58122909.37) |
81327260.27 (70795878.93 to 91949300.71) |
1.49 (1.4 to 1.59) |
60.62% |
| Japan |
3742860.14 (3264949.34 to 4210086.14) |
4575260.82 (4020331.56 to 5143124.66) |
0.7 (0.64 to 0.75) |
22.24% |
71125.82 (35589.74 to 129704.98) |
88025.22 (43549.05 to 158492.12) |
0.75 (0.69 to 0.81) |
23.76% |
71125.82 (35589.74 to 129704.98) |
88025.22 (43549.05 to 158492.12) |
0.75 (0.69 to 0.81) |
23.76% |
9220094.79 (8029756.46 to 10433987.95) |
11548084.1 (10152156.89 to 13106493.23) |
0.79 (0.73 to 0.85) |
25.25% |
| Republic of Korea |
1193868.59 (1031695.03 to 1341693.65) |
1981931.26 (1730332.99 to 2248220.06) |
1.99 (1.77 to 2.21) |
66.01% |
22337.44 (11164.43 to 39383.65) |
38079.92 (19226.01 to 68269.74) |
2.18 (1.9 to 2.47) |
70.48% |
22337.44 (11164.43 to 39383.65) |
38079.92 (19226.01 to 68269.74) |
2.18 (1.9 to 2.47) |
70.48% |
2877620.35 (2507834.52 to 3289027.06) |
4967563.76 (4317772.6 to 5609500) |
2.22 (1.94 to 2.51) |
72.63% |
| Democratic People’s Republic of Korea |
384032.4 (331410.85 to 436301.59) |
598621.71 (521171.38 to 677760.65) |
1.45 (1.41 to 1.5) |
55.88% |
7199.54 (3647.07 to 12686.47) |
11360.47 (5746.69 to 20006.75) |
1.49 (1.45 to 1.54) |
57.79% |
7199.54 (3647.07 to 12686.47) |
11360.47 (5746.69 to 20006.75) |
1.49 (1.45 to 1.54) |
57.79% |
925058.97 (806649.54 to 1054075.44) |
1466504.99 (1282593.82 to 1656015.42) |
1.5 (1.46 to 1.55) |
58.53% |
| Mongolia |
67499.35 (58924.77 to 75719.24) |
135435.23 (117870.44 to 151652.81) |
2.35 (2.31 to 2.38) |
100.65% |
1269.63 (647.72 to 2244.46) |
2626.97 (1325.54 to 4664.18) |
2.47 (2.43 to 2.5) |
106.91% |
1269.63 (647.72 to 2244.46) |
2626.97 (1325.54 to 4664.18) |
2.47 (2.43 to 2.5) |
106.91% |
163568.46 (141638.44 to 185829.73) |
339741.32 (293011.23 to 387522.35) |
2.47 (2.44 to 2.51) |
107.71% |
Change (%) = [(2021 values − 1990 values) / 1990 values] × 100%
EAPC Estimated annual percentage change
Decomposition analysis indicated that compared to the global average, population aging has a more pronounced impact on the disease burden of GERD in China, Japan, and the Republic of Korea. Consequently, the crude rates were incorporated into our assessment (Additional files-Table S3). From 1990 to 2021, China’s age-standardized incidence rate of GERD decreased marginally (EAPC = -0.08, 95% CI: -0.2–0.04), representing a 0.40% decline, the lowest in East Asia. Similarly, the age-standardized DALY rate declined from 35.27 to 35.12 per 100,000 individuals (EAPC = -0.09, 95% CI: -0.22–0.05; 0.43% reduction) (Additional file Table S1). In contrast, China’s crude incidence rate reached 2,276.43 per 100,000 in 2021, ranking fourth among the five East Asian countries. The crude incidence increased by 28.36% from 1990 to 2021 (EAPC = 0.8, 95% CI: 0.72–0.89), while crude DALYs rose by 31.48% (EAPC = 0.87, 95% CI: 0.78–0.96). These increases in crude incidence, DALYs, and prevalence in China were greater than the corresponding global averages of 21.70%, 23.32%, and 23.79%, respectively (Additional files-Table S2).
Burden trends of GERD
Analysis of age-standardized rates for GERD incidence, DALYs, YLDs, and prevalence from 1990 to 2021 revealed that most East Asian countries maintained values below the global average, with Mongolia being the exception. When ranked by magnitude, the Republic of Korea consistently showed the highest rates, followed by Japan, Democratic People’s Republic of Korea, and China. Notably, China experienced a modest decline in age-standardized incidence between 2005 and 2010, followed by a gradual increase from 2010 to 2019, ultimately returning to levels comparable to those in 1990 by 2021. A similar pattern was observed for DALYs and prevalence. In contrast, the Republic of Korea exhibited a distinct trajectory: a steady decline until 2005, a sharp rise that peaked around 2015, and a subsequent gradual decline, returning to 1990 levels by 2021. Japan, the Democratic People’s Republic of Korea, and Mongolia demonstrated relatively stable trends throughout the study period (Fig. 1, Additional files-Figure S1).
Fig. 1.
The incidence (A), DALYs (B), YLDs (C), prevalence (D) (in age-standardized rates) of gastroesophageal reflux disease in East Asia countries from 1990 to 2021. Shading indicates the 95% UI for the rates. DALYs, disability adjusted life years; ASR, age-standardized rate; YLDs, years lived with disability. Notably, China experienced a modest decline in age-standardized incidence between 2005 and 2010, followed by a gradual increase from 2010 to 2019, ultimately returning to levels comparable to those in 1990 by 2021
Heatmap visualization further indicated that Mongolia had the most rapid increase in crude GERD incidence and overall burden in East Asia over the past three decades (Additional files-Figures S1 and S2). Joinpoint regression identified significant inflection points in age-standardized incidence trends: 2005, 2010, and 2018 in China; 2000 and 2010 in Japan; and 2001, 2005, 2015, and 2019 in the Republic of Korea (Additional files-Figure S3). Overall, China’s burden metrics remained lower than those of the Republic of Korea, Japan, and Mongolia, showing a gradual upward trajectory over time. Corresponding to age-standardized rates, the rate of incidence and DALYs in the Republic of Korea peaked in 2015 (Additional files-Figure S2).
Subgroup analysis of sex-specific GERD disease burden
In China, sex-stratified analysis of GERD incidence revealed that the rates remained consistently higher in women than in men from 1990 to 2021. By 2021, the number of female cases was 1.15 times that of male cases, and a more rapid growth rate was observed among women (Fig. 2). The overall global disease burden was generally higher in women than in men, consistent with the pattern observed in China (Supplementary Figure S4). Notably, Japan exhibited a distinct sex-specific pattern: The number of GERD cases increased from 1990 to 2010 before stabilizing, with a consistently higher prevalence in men than in women, a trend that contrasts with most other countries (Supplementary Figure S5). In the Republic of Korea, both sexes experienced similar temporal trends, although women had a higher overall disease burden than men throughout the study period (Supplementary Figure S6).
Fig. 2.
The incidence (A), DALYs (B), YLDs (C), prevalence (D) (in cases and age-standardized rates) of gastroesophageal reflux disease by gender (both, male, and female) in China from 1990 to 2021. DALYs, disability adjusted life years; ASR, age-standardized rate; YLDs, years lived with disability. In China, gender-stratified analysis of GERD incidence revealed that rates remained consistently higher in women than in men from 1990 to 2021
Analysis of GERD disease burden by age subgroups
In 2021, the majority of GERD cases in China were concentrated in the 30–74 age range, with a peak prevalence observed at 50–54 years for males and 55–59 years for females. From 30 to 34 years onward, female patients consistently outnumbered male patients, with the disparity being most pronounced in the 55–59 and 65–69 age groups. Age-standardized incidence increased with advancing age, peaking in the 75–79 age group, a pattern consistent across DALYs, YLDs, and prevalence metrics. While the incidence of GERD in China was lower than the global average among young and middle-aged adults, it remained high overall and displayed a dual-peak distribution, with rates in these groups exceeding those in Japan and the Republic of Korea (Fig. 3).
Fig. 3.
The incidence (A), DALYs (B), YLDs (C), prevalence (D) (in cases and age-standardized rates) of gastroesophageal reflux disease by age in China in 2021. DALYs, disability adjusted life years; ASR, age-standardized rate; YLDs, years lived with disability. In 2021, the majority of GERD cases in China were concentrated in the 30-74 age range, with peak incidence observed at 50-54 years for males and 55-59 years for females. From age 30–34 onward, female cases consistently outnumbered male cases, with the disparity being most pronounced in the 55-59 and 65-69 age groups
Trend analysis from 1990 to 2021 revealed a marked decline in incidence among individuals < 20 years of age in all three countries. In China, the rates decreased in the 20–49 age group but increased among those aged 60–64 and 85 + years, with this rise occurring later than in Japan (65 + years) and the Republic of Korea (70 + years) (Additional files-Figures S8, S9). DALYs rates increased only in the 60–64 age group in China, but increased across all age groups in Japan. The prevalence trends closely mirrored those of incidence (Additional files-Figure S10).
Sex-specific analyses showed that in China, the incidence in males declined before the age of 59 years but rose in the 60–64, 80–84, and 85 + age groups. In contrast, Japanese and Korean males experienced an increase only in the 85 + group. DALYs increased among Chinese males aged 60–69 years, across all ages in Japan, and in most adult age groups in Korea, with the steepest increase in older adults (Additional files-Figure S11). Among Chinese women, the incidence declined in the younger groups but rose substantially after age 75, particularly in the 85 + group, with DALYs increasing most notably in the 75–84 age range. DALYs increased across age groups in Japanese women, while Korean women only in the 20–24 and 50–54 age groups experienced a decline (Additional file: Figure S12).
Predictive analysis of GERD trends up to 2046
Projections indicate that both the number of cases and age-standardized incidence of GERD in China are expected to continue rising through 2046, with a gradual deceleration and stabilization anticipated after 2040. By 2046, the projected number of cases is expected to reach approximately 39,223,013, representing a 25.50% increase from that in 2021. Age-standardized incidence rates are forecasted to rise to 1,869.47 per 100,000 for males and 2,061.56 for females. In contrast, Japan’s age-standardized incidence is projected to stabilize alongside a reduction in case numbers, whereas the Republic of Korea is expected to experience a decline in both standardized rates and absolute case counts. The projected trends in all three countries are expected to progress slower than the global average (Fig. 4, Additional files- FigureS14).
Fig. 4.
Projected numbers and ASR of incidence for gastroesophageal reflux disease by gender (both, male, and female) in worldwide (A), China (B), Japan (C) and Republic of Korea (D) from 1990 to 2046. ASR, age-standardized rate. Projections indicate that both the prevalence and age-standardized incidence of GERD in China are expected to continue rising through 2046, with a gradual deceleration and stabilization anticipated after 2040
Association between SDI and GERD disease burden
Analysis of the relationship between Socio-demographic Index (SDI) and GERD burden revealed significant cross-national variations. A strong positive correlation was observed between the SDI and both age-standardized incidence (r = 0.824, p < 0.001) and age-standardized DALY rates (r = 0.822, p < 0.001). Between 1990 and 2021, China had the most rapid SDI growth among East Asian countries. During this period, China’s GERD burden initially declined before transitioning to an increasing trend. In contrast, Japan and the Republic of Korea maintained substantially higher age-standardized incidence and DALY rates than China and the Democratic People’s Republic of Korea throughout the study period (Fig. 5, Additional files-Figure S13).
Fig. 5.
Frontier analysis based on SDI and age-standardized gastroesophageal reflux disease DALYs rates from 1990 to 2021 in East Asia countries. The scatter trend chart displaying DALYs and SDI for GERD from 1990 to 2021, featuring 32 scatter points for each group. The legend on the right indicates the corresponding relationship between color graphics and countries. SDI, socio-demographic index; DALYs, disability adjusted life years; GERD, gastroesophageal reflux disease. A strong positive correlation was observed between SDI and both age-standardized incidence (r = 0.824, p < 0.001) and age-standardized DALY rates (r = 0.822, p < 0.001). Between 1990 and 2021, China demonstrated the most rapid SDI growth among East Asian countries
Discussion
This comprehensive analysis of GERD in East Asia from 1990 to 2021 revealed that the region recorded 396,791,145 new GERD cases in 2021, representing 12.24% of the worldwide total, with China alone contributing 10% of the total. During this period, China experienced noticeable increases in crude incidence, DALYs, and overall number of cases, with consistently higher rates in women than in men. A distinctive bimodal age pattern emerged in China, predominantly affecting older adults, followed by middle-aged and younger populations, contrasting sharply with the unimodal distribution concentrated in older populations in Japan and the Republic of Korea. Projections indicate a continued growth in China’s GERD burden, potentially reaching approximately 39,223,013 cases by 2046. Regarding global patterns, East Asia’s future trends are expected to be more gradual.
Despite China’s lower age-standardized GERD incidence rate compared to other East Asian nations, its total number of cases remains substantially higher, a paradox attributable to its large population base and aging structure. Although age-standardized metrics [1, 10, 18] facilitate cross-country comparison and suggest a milder burden relative to global and regional averages [6, 7], they likely underestimate the actual disease impact. In contrast, a clear increase in crude incidence and absolute number of cases more accurately reflect a growing disease burden. These findings highlight the importance of incorporating both crude and standardized rates in assessing GERD burden, particularly in large aging populations such as those in China [11, 19–21].
Over the past three decades, China has exhibited a consistently elevated GERD burden among women compared to men, a pattern also observed globally and in the Republic of Korea. This sex-based disparity, previously documented [11, 18], may be explained by several factors, including hormonal changes during pregnancy, work-related stress, and lifestyle modifications during the reproductive years [22, 23], as well as rising obesity rates across East Asia and worldwide [21], with abdominal obesity recently identified as having a particularly strong effect on GERD risk in women [24]. In contrast, Japan’s historically low obesity prevalence, combined with a slower rate of increase in women than in men, may account for its distinct pattern of higher incidence of GERD in men. Age-specific analysis further revealed that middle-aged and older adults, particularly women, constitute the most affected demographic in China, similar to trends in Japan and the Republic of Korea, although GERD incidence among older adults is less pronounced in the latter two countries. Notably, existing GERD research is primarily focused on older populations [25–27], often overlooking the symptoms and healthcare needs of middle-aged and younger women, and underscoring the importance of prioritizing this underserved group in future clinical screening and management strategies.
The similar incidence of GERD in middle-aged and young adults compared o older adults may be associated with symptom sensitivity, educational attainment, symptom typicality and health consciousness [28, 29]. This phenomenon may also stem from obesity [11, 19, 20], unhealthy lifestyle habits such as smoking and alcohol abuse [29], late evening meals, increasing life stressors, and psychological influences [30–32]. According to global obesity data published in 2025 by The Lancet, obesity prevalence surged significantly in China, Japan, and South Korea from 1990 to 2021 [21]. This may have contributed to the rising incidence of GERD in China.
We observed that the ASIR of GERD in China declined at an accelerated pace between 2005 and 2010 compared to previous years, subsequently rising steadily after 2010, with the rate of increase stabilizing between 2018 and 2021. Therefore, forecasts suggest a continuous increase in the incidence of GERD in China, leading to increasing healthcare burden. The incorporation of PPIs into GERD management following the 2004 Asia-Pacific consensus may have been associated with the decline beginning in 2005 [33]. In contrast, Japan and South Korea introduced PPIs before 1998, which could be linked to reduced GERD burden before 2005 [34, 35]. The potassium-competitive acid blocker (P-CAB) vonoprazan was introduced in 2019 for conditions related to gastroesophageal reflux in China [36, 37], and a consensus on GERD diagnosis and management was released in 2023 [2]. Despite increasing awareness, the rapidly rising disease burden indicates a need for more effective control measures. In Japan, the GERD detection rate has increased since 2005, owing to advances in endoscopic technology [38].Its incidence is expected to plateau, a trend supported by the release of evidence-based clinical guidelines in 2009 and their update in 2015, along with the early introduction of vonoprazan [39]. The Republic of Korea has demonstrated a similar level of concern. A 2008 study revealed that GERD burden in the Republic of Korea escalated rapidly over the last three decades [40], and P-CAB was therefore made available in 2018 for GERD treatment [41, 42]. In summary, a correlation exists between GERD control in Japan and the Republic of Korea and the introduction and promotion of acid-suppressing medications. As a pioneer among developing nations, China’s economy and way of life will increasingly align with those of Asia’s developed economies, such as Japan and the Republic of Korea. The healthcare measures implemented in these two countries have enabled them to maintain or even reduce the burden of GERD, making their strategies worthy of emulation. Moreover, the health challenges currently confronting China are likely to emerge in other East Asian nations, particularly densely populated developing countries. Consequently, our analytical findings and future interventions addressing GERD burden in China will provide invaluable insights and a reference for these nations. Nevertheless, it should be noted that the present study is intended as an exclusive reference for other countries. It is imperative that specific issues be analyzed in light of national circumstances.
This study has specific limitations. First, it relies on the GBD study, which has the limitations mentioned in the GBD 2021 report. Second, we focused on China for both horizontal and vertical evaluations, which, while crucial for understanding global GERD prevalence, directly affects East Asian comparisons. Furthermore, although we have discussed the impact of lifestyle, obesity, dietary habits, and stress on GERD, our investigation did not include an in-depth examination of how these factors affect it. Therefore, we could not explore the underlying reasons for the differences in GERD rates among East Asian countries. Finally, given the selection of predictive models and the extended time horizon of the projections, we cannot rule out the influence of other factors. Consequently, although projections of disease burden trends based on future population structures hold some reference values, they must be interpreted and applied with caution.
This study shows rising GERD incidence in East Asia from 1990 to 2021, with variations by sex, age, and nation. Given China’s economic progress, increasing population, and aging society, GERD burden will predictably continue to escalate, leading to a more significant health burden in China. Consequently, strong prevention and management initiatives targeting specific populations are essential, along with the adoption of efficient and focused health approaches. Additionally, countries in East Asia should collaborate to share insights on GERD diagnosis, treatment, and prevention, while further refining health policies grounded in empirical research and scientific findings.
Supplementary Information
Acknowledgements
We want to acknowledge the participants and investigators of the GBD 2021 Study. We would also like to thank Editage (www.editage.cn) for English language editing.
Data transparency statement
To download GBD data used in the analyses in this article please visit the Global Health Data Exchange GBD 2021 website, further inquiries can be directed to the corresponding author.
Abbreviations
- GERD
Gastroesophageal reflux disease
- GBD
Global Burden of Disease
- DALYs
Disability adjusted life years
- YLDs
Years lived with disability
- EAPC
Estimated annual percentage change
- AAPC
Average annual percent change
- APC
Annual percentage change
- CI
Confidence Interval
- SDI
Socio-Demographic Index
- ASIR
Age-standardized incidence rates
- ASDR
Age-standardized DALYs rate
- PPI
Proton-pump inhibitor
Authors’ contributions
Rong Wan, Weiliang Jiang, Changjie Zhao and Wenqin Xiao designed the study. Chengying Zhu; Zeming Le and Zhanjun Lu conceptualized and wrote this Article. Guo Yu, Zihao Guo and Zhiyuan Cheng took the work of data curation. Chengying Zhu took on the work of methodology and data calculation. Zeming Le and Zhanjun Lu checked the integrity and plausibility of data analysis. Rong Wan, Weiliang Jiang, Changjie Zhao and Wenqin Xiao critically reviewed the manuscript. All authors had full access to all the data in the study and accepted responsibility for the decision to submit the manuscript for publication.
Funding
This research was supported by the National Natural Science Foundation of China (82100683).
Data availability
To download GBD data used in the analyses in this article please visit the Global Health Data Exchange GBD 2021 website, further inquiries can be directed to the corresponding author.
Declarations
Ethics approval and consent to participate
No further ethical clearance was required because the data collection process for this study relied solely on publicly available data, which had been approved by the respective institutional ethics review boards.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Chengying Zhu and Zeming Le contributed equally to this article and are joint first authors.
Changjie Zhao, Rong Wan, Weiliang Jiang and Wenqin Xiao joint corresponding senior authors contributed equally to this work.
Contributor Information
Changjie Zhao, Email: 2984698534@qq.com.
Rong Wan, Email: doctorwanrong1970@126.com.
Weiliang Jiang, Email: weiliang.jiang1@shgh.cn.
Wenqin Xiao, Email: zhunikaixin_xwq@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
To download GBD data used in the analyses in this article please visit the Global Health Data Exchange GBD 2021 website, further inquiries can be directed to the corresponding author.