Incidence Trends and Disease Burden of Vascular Intestinal Disorders: A Population-Based Study in China and Worldwide from 1990 to 2021

Abstract

Purpose

Vascular intestinal disorders (VID), characterized by inadequate intestinal perfusion, lead to severe complications like tissue ischemia, infarction, and inflammation. This study evaluates global and Chinese VID trends and burden from 1990 to 2021 using Global Burden of Disease (GBD) 2021 data.

Methods

Age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were extracted. Joinpoint regression analyzed temporal trends, computing average annual percentage changes (AAPC) and 95% confidence intervals. Subgroup analyses covered age, sex, and socio-demographic index.

Results

Globally, the age-standardized incidence rate (ASIR) declined from 18.81 to 15.98 per 100,000 (AAPC: −0.52%); in China, it fell from 5.92 to 5.03 (AAPC: −0.50%). However, China’s absolute cases nearly doubled due to demographic shifts. Significant gender and age disparities emerged: younger males showed higher ASIR and ASMR, while women ≥75 years had elevated morbidity and mortality.

Conclusion

Despite declining age-standardized rates, the absolute VID burden escalates globally and in China. Disparities disproportionately affect elderly women and younger males. Enhanced diagnostics, equitable access, and targeted prevention are urgent. Stakeholders must prioritize integrative VID prevention strategies within non-communicable disease frameworks to mitigate this growing concern.

Introduction

Vascular intestinal disease (VID) refers to a group of disorders caused by reduced blood flow to the intestines, which can result in ischemia, infarction, inflammation, and significant morbidity and mortality.^1,2 VID encompasses a spectrum of both acute and chronic conditions resulting from impaired intestinal blood flow, including acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), ischemic colitis, mesenteric venous thrombosis, and non-occlusive mesenteric ischemia (NOMI).^3,4 These disorders correspond to ICD‑10 codes K55.0–K55.3, K55.8, and K55.9, covering various forms of intestinal vascular pathology. AMI, the most severe form, is characterized by sudden onset of severe abdominal pain and can rapidly progress to intestinal necrosis if not promptly revascularized.^5,6 Ischemic colitis, in contrast, typically presents with mild-to-moderate abdominal pain and bloody diarrhea, and usually follows a more benign clinical course.⁵ CMI often manifests as postprandial pain and weight loss, reflecting chronic insufficient blood supply to the bowel.⁴ These distinct clinical entities share a common pathophysiological feature—intestinal hypoperfusion—but differ substantially in their etiology, management strategies, and prognosis.^7,8 Although less common than other gastrointestinal diseases, VID represents a critical and often life-threatening condition, with its clinical presentation including abdominal pain, gastrointestinal bleeding, and, in severe cases, sepsis or shock.⁷ Epidemiological data indicate that the incidence of acute mesenteric ischemia ranges from 6 to 10 cases per 100,000 person-years, while ischemic colitis has an estimated annual incidence of 4.5 to 44 cases per 100,000 person-years, varying by study population and diagnostic criteria.^9,10 Prompt clinical recognition and therapeutic intervention are paramount to minimize mortality risk and avert irreversible intestinal damage.⁸

The global burden of VID has been increasingly recognized, especially in high-income countries where advanced diagnostic and therapeutic strategies have improved survival rates.^9,10 Nevertheless, substantial healthcare disparities persist in resource-limited settings, where diagnostic delays and inadequate access to specialized interventions contribute to elevated morbidity and mortality rates.¹¹ Despite this, comprehensive, long-term analyses on the global and regional burden of VID are limited. Existing studies have mostly focused on individual conditions, such as ischemic colitis or mesenteric ischemia, but have not systematically analyzed VID as a collective disease entity. Moreover, while the Global Burden of Disease (GBD) database provides important insights into the global epidemiology of VID,¹² there is a lack of focused research examining the trends over time, particularly in countries like China where the disease burden is substantial but not well-characterized in the literature. In China, with its rapidly aging population and increasing burden of lifestyle-related diseases, VID has become an important public health concern. Epidemiological evidence indicates heightened susceptibility among elderly individuals to mesenteric ischemia, with concurrent increases in ischemic colitis incidence observed in recent decades.¹³ However, most available data on VID in China focuses primarily on specific diseases or localized studies, leaving a gap in understanding the broader trends of VID, including the distribution of disease burden by age and gender.

This investigation seeks to address these research deficiencies by conducting a systematic evaluation of VID burden in China within the global context, utilizing GBD 2021 data. Specifically, we will examine temporal trends in VID mortality, Disability-Adjusted Life Years (DALYs), and age-standardized incidence rates from 1990 to 2021. We will implement joinpoint regression modeling to quantitatively evaluate temporal variations in these epidemiological indicators, facilitating a nuanced interpretation of VID burden dynamics. Furthermore, our investigation will include comparative analyses of sex-specific disparities in disease burden and age-stratified variations between 1990 and 2021. By analyzing these trends, we aim to provide insights that can inform targeted healthcare strategies and policy development for VID prevention and treatment in China and globally.

Methods

Data Sources

All epidemiological data used in this study were obtained from the Global Burden of Disease (GBD) 2021 dataset, which provides systematic estimates of disease burden across 204 countries and territories from 1990 to 2021. The GBD 2021 database contains comprehensively collated information on vascular intestinal disorders (VID), including incidence, prevalence, mortality, and disability-adjusted life years (DALYs), stratified by age group, sex, and geographic region. Case identification followed the International Classification of Diseases, 10th Revision (ICD-10), using codes K55.0-K55.3, K55.8, and K55.9. All data were extracted via the Global Health Data Exchange (GHDx) query tool (https://vizhub.healthdata.org/gbd-results/), which served as the data retrieval interface; no additional or independent data sources were used. Ethical approval was waived as the study relied entirely on anonymized, publicly available data.

Study Scope

This study focused on the burden of VID at the global level and in China specifically. Longitudinal trends spanning 1990 to 2021 were analyzed, with stratification by age groups and sex to characterize temporal variations in incidence, prevalence, mortality, and DALYs.

Statistical Analysis

For statistical evaluation, we computed age-standardized rates (ASR) per 100,000 individuals, accompanied by 95% uncertainty intervals (UI), following standardized Global Burden of Disease (GBD) protocols. Temporal patterns were analyzed through Joinpoint regression analysis (utilizing Joinpoint software version 5.1.0.0) to derive both average annual percentage change (AAPC) and annual percentage change (APC) estimates, each presented with corresponding 95% confidence intervals (CI). The analytical approach incorporated a log-linear regression framework expressed as ln(y)=α+βx+ε, where у denotes ASR and х represents the temporal variable (calendar year). Trend classifications (increasing, decreasing, or stable) were determined based on whether 95% CIs encompassed the null value. All data visualization procedures and inferential statistical analyses (including odds ratio calculations with 95% CIs) were executed using R statistical software (version 4.4.1).

Results

Description of the Burden of VID in China and Global

Incidence of VID in China and Global

In China, total VID incident cases increased from 52,567 (95% CI: 40,337–65,966) in 1990 to 100,165 (95% CI: 80,480–120,559) in 2021, representing a 90.55% increase. Globally, incident cases rose from 757,507 (95% CI: 647,682–879,672) to 1,347,021 (95% CI: 1,178,809–1,532,645), a 77.82% increase. Despite rising absolute case numbers, age-standardized incidence rates (ASIR) declined in both settings. The global ASIR decreased from 18.81 (95% CI: 16.07–21.72) to 15.98 (95% CI: 13.99–18.10) per 100,000 population, and China’s ASIR decreased from 5.92 (95% CI: 4.68–7.26) to 5.03 (95% CI: 4.11–5.97) per 100,000 (Table 1). Joinpoint regression revealed similar declining trends, with an AAPC of −0.50% (95% CI: −0.56 to −0.44) in China and −0.52% (95% CI: −0.55 to −0.50) globally (Table 2).

Table 1.

All-Age Cases and Age-Standardized Incidence, Prevalence, Mortality, and DALY Rates of VID in China and Globally in 1990 and 2021

Location	Measure	1990		2021
		All-Ages Cases	Age-Standardized Rates Per 100,000 People	All-Ages Cases	Age-Standardized Rates Per 100,000 People
		n (95% CI)	n (95% CI)	n (95% CI)	n (95% CI)
China	Incidence	52,567 (40,337–65,966)	5.92 (4.68–7.26)	100,165 (80,480–120,559)	5.03 (4.11–5.97)
	Prevalence	6143 (4865–7704)	0.67 (0.55–0.82)	11,803 (9965–13,751)	0.60 (0.51–0.70)
	Deaths	652 (474–780)	0.11 (0.08–0.14)	818 (651–984)	0.05 (0.04–0.06)
	DALYs	20,170 (15,268–24,225)	2.45 (1.80–2.93)	17,820 (14,669–21,150)	0.96 (0.79–1.13)
Global	Incidence	757,507 (647,682–879,672)	18.81 (16.07–21.72)	1,347,021 (1,178,809–1,532,645)	15.98 (13.99–18.10)
	Prevalence	94,057 (84,225–105,988)	2.32 (2.10–2.58)	169,432 (155,127–185,189)	2.01 (1.84–2.20)
	Deaths	57,132 (52,755–62,010)	1.75 (1.60–1.90)	91,515 (81,930–98,538)	1.12 (1.00–1.21)
	DALYs	1168837 (1,083,807–1,283,676)	31.20 (28.71–34.12)	1,708,447 (1,580,468–1,836,379)	20.39 (18.78–21.94)

Table 2.

Average Annual Percentage Change (AAPC) in Age-Standardized Rates of VID in China and Globally, 1990–2021

Location	Measure	1990–2021 AAPC
		n (95% CI)
China	Incidence	−0.50 (−0.56 - −0.44)
	Prevalence	−0.38 (−0.45 - −0.30)
	Deaths	−2.77 (−3.05 - −2.50)
	DALYs	−3.02 (−3.27 - −2.76)
Global	Incidence	−0.52 (−0.55 - −0.50)
	Prevalence	−0.46 (−0.48 - −0.43)
	Deaths	−1.42 (−1.52 - −1.32)
	DALYs	−1.36 (−1.45 - −1.27)

Prevalence of VID in China and Global

An analysis of epidemiological data uncovers notable trends in the incidence of VID cases over the period from 1990 to 2021. In China, case numbers rose from 6143 (95% CI: 4865–7704) to 11,803 (95% CI: 9965–13,751), marking a 92.14% increase over this period. Comparatively, global prevalence showed an 80.14% growth, escalating from 94,057 (95% CI: 84,225–105,988) to 169,432 (95% CI: 155,127–185,189) cases. Notably, age-standardized prevalence rates (ASPR) demonstrated contrasting patterns. The global ASPR declined from 2.32 (95% CI: 2.10–2.58) to 2.01 (95% CI: 1.84–2.20) per 100,000 population. Similarly, China’s ASPR decreased from 0.67 (95% CI: 0.55–0.82) to 0.60 (95% CI: 0.51–0.70) per 100,000 population. (Table 1). Trend analysis using average annual percentage change (AAPC) revealed a global decrease of 0.46% (95% CI: −0.48 to −0.43), while China exhibited a slightly lower reduction of 0.38% (95% CI: −0.45 to −0.30). (Table 2). These findings suggest that the epidemiological trends in China are largely consistent with global patterns.

Mortality of VID in China and Global

The global burden of VID resulted in 91,515 fatalities (95% CI: 81,930–98,538) in 2021, marking a substantial 60.18% rise relative to 1990 levels. Notably, China experienced a more moderate 25.46% elevation in mortality during this three-decade period. Age-standardized mortality rates (ASMR) demonstrated a declining trend worldwide, falling from 1.75 (95% UI: 1.60–1.90) to 1.12 (95% UI: 1.00–1.21) deaths per 100,000 population between 1990 and 2021. This reduction was particularly pronounced in China, where ASMR values decreased from 0.11 (95% UI: 0.08–0.14) to 0.05 (95% UI: 0.04–0.06) per 100,000 population over the same timeframe (Table 1). Further analysis of temporal trends revealed that the average annual percentage change (AAPC) in mortality rates showed a global decline of 1.42% (95% CI: −1.52 to −1.32), while China exhibited a more rapid reduction of 2.77% (95% CI: −3.05 to −2.50) from 1990 through 2021, indicating a steeper mortality rate decline in China. (Table 2).

DALYs of VID in China and Global

Globally, disability-adjusted life years (DALYs) attributable to VID increased from 1,168,837 (95% CI: 1,083,807–1,283,676) in 1990 to 1,708,447 (95% CI: 1,580,468–1,836,379) in 2021, a 46.17% rise. In contrast, China’s DALYs decreased from 20,170 (95% CI: 15,268–24,225) to 17,820 (95% CI: 14,669–21,150), an 11.65% reduction (Table 1). Age-standardized DALY rates (ASDR) declined in both settings. The global ASDR decreased from 31.20 (95% CI: 28.71–34.12) to 20.39 (95% CI: 18.78–21.94) per 100,000, while China’s ASDR dropped from 2.45 (95% CI: 1.80–2.93) to 0.96 (95% CI: 0.79–1.13) per 100,000 (Table 1). The AAPC for ASDR was −3.02% (95% CI: −3.27 to −2.76) in China, more than double the global rate of −1.36% (95% CI: −1.45 to −1.27) (Table 2).

Joinpoint Regression Analysis of the Burden of VID in China and Global

Figures 1 and 2 present the Joinpoint regression analyses of for VID in China and globally from 1990 to 2021. In China, both ASIR and ASPR demonstrated significant decreasing trends during the observation period. Specifically, the ASIR exhibited a notable annual percentage change (APC) of −4.67% (P<0.05) between 2005 and 2010, while ASPR showed an APC of −3.91% (P<0.05) from 2006 to 2009. However, an earlier increasing pattern was observed from 2000 to 2005. A statistically significant reduction in ASIR was observed globally after the year 2000 (P<0.05). However, a slight upward trend in ASIR was noted between 1995 and 2000 (P<0.05). Similarly, a significant decrease in ASPR was detected globally after 1998 (P<0.05). In contrast, a modest yet significant rise in ASPR was evident during the period from 1990 to 1998 (P<0.05).

Figure 1.

The APC of ASIR, ASPR, ASMR, and ASDR of VID in China from 1990 to 2021. (A) ASIR; (B) ASPR; (C) ASMR; (D) ASDR. (* means p-values<0.05 and significant results).

Figure 2.

The APC of ASIR, ASPR, ASMR, and ASDR of VID in Global from 1990 to 2021 (A) ASIR; (B) ASPR; (C) ASMR; (D) ASDR. (* means p-values<0.05 and significant results).

Trends in Age-Standardized Rate of VID Disease in China and Global

From 1990 to 2021, the DALYs Rate for VID in both China and globally showed a declining trend. In China, it continued to decrease steadily from 2005 to 2015, while globally, it has been consistently declining. Meanwhile, the ASIR trend for VID in China significantly decreased from 2005 to 2010, then slowly increased after 2010, and stabilized after 2015, indicating an overall downward trend. In contrast, the global ASIR trend for VID remained stable from 1990 to 2010 and then began to decline after 2010. Additionally, both the ASMR and ASPR for VID in China and globally have remained stable (Figure 3).

Figure 3.

Trend comparison of ASIR, ASPR, ASMR, and ASDR of VID in China (A) and worldwide (B) from 1990 to 2021.

Burden of VID in Different Age Groups in China in 1990 and 2021

Figure 4 presents a comparative analysis of epidemiological indicators for VID across various age cohorts in China during 1990 and 2021, including incidence, prevalence, mortality, and DALYs with their respective crude rates. The incidence data demonstrate widespread VID occurrence within the population, with the 45–89 years age range showing the highest disease burden. Analysis of crude incidence rates (CIR) revealed consistent patterns in the 0–39 age bracket between both study years, while the 40–84 age group displayed progressive increases and those above 84 years showed declining trends. Notably, the maximum incidence was recorded among individuals aged 80–84 years (Figure 4A). The epidemiological profile of VID prevalence shifted over time, with the 75–79 years cohort representing the peak prevalence group in 1990, transitioning to the 80–84 years group by 2021 (Figure 4B). Mortality patterns similarly evolved, with the highest absolute number of deaths moving from the 75–79 years group in 1990 to the 85–89 years demographic in 2021. However, the most elevated mortality rates consistently occurred in the nonagenarian population (95+ years) during both study periods (Figure 4C). Corresponding trends were observed in crude death rates (CDR), demonstrating an age-dependent escalation. Disability burden analysis indicated that maximum DALYs consistently clustered within the 70–74 years age group throughout the observation period (Figure 4D).

Figure 4.

Comparative of the incidence, prevalence, deaths, and DALYs counts, along with their crude rates, by age group in China from 1990 and 2021. (A) Incident cases and CIR; (B) Prevalent cases and CPR; (C) Death cases and CMR; (D) DALYs counts and CDR; Bar charts represent counts; lines represent crude rates.

Gender Disparities in the Burden of VID in Different Agegroups in China

Figures 5 and 6 present comparative analyses of age- and sex-specific epidemiological patterns for VID in China during 1990 and 2021, examining incidence, prevalence, mortality, and disability-adjusted life years (DALYs). The epidemiological data demonstrate distinct sex-based variations in disease burden patterns. Regarding incidence rates, the maximum burden among males was observed in the 65–69 years age cohort, whereas females exhibited peak incidence in the 70–74 years age group, followed by a progressive decline in incidence rates beyond 74 years of age. Comparative analysis between sexes revealed that males consistently showed higher incidence numbers than females across all age categories below 70 years during both study periods. However, this trend reversed in populations aged 70 years and above, where female cases predominated (Figures 5A and 6A).

Figure 5.

Comparison of the number of incidence, prevalence, mortality, and DALYs of VID in males and females of different age groups in China in 2021. (A) Incidence; (B) Prevalence; (C) Mortality; (D) DALYs.

Figure 6.

A comparative analysis of the incidence, prevalence, mortality, and DALYs of VID among males and females across various age groups in China in 1990. (A) Incidence; (B) Prevalence; (C) Mortality; (D) DALYs.

The prevalence data demonstrated distinct patterns: an initial minor peak in the pediatric population (0–14 years) was followed by progressive reduction. For males, prevalence rates escalated from the 30–34 years cohort, culminating in the 65–69 years group. Conversely, female prevalence showed sustained increase until the 70–74 years bracket. Notably, gender-specific prevalence patterns exhibited temporal variations - in 1990, males predominated below 70 years while females showed higher prevalence thereafter; this transition age shifted to 75 years in 2021 (Figures 5B and 6B).

Mortality analysis revealed consistent male predominance across all age groups below 90 years, with peak fatalities occurring in the 85–89 years cohort for both genders. The mortality curve exhibited an age-dependent rise followed by gradual attenuation (Figures5C and 6C). Disability-adjusted life year (DALY) metrics paralleled mortality trends, with persistent male excess. Temporal evolution was noted in DALY peak distributions: while both genders showed maximal burden in pediatric populations during 1990, by 2021 peak DALYs shifted to 75–79 years for females and 70–74 years for males (Figures 5D and 6D).

Figure 7 presents a comprehensive analysis of gender-specific trends in VID burden across China from 1990 to 2021. The ASIR demonstrated distinct patterns between sexes (Figure 7A), with the most pronounced gender disparity observed in 2005 followed by a progressive convergence in subsequent years. Prevalence rates demonstrated stable ASPR values for both genders throughout the 1990s, followed by a slight increase from 2001 to 2005, a decline until 2010, and subsequent stabilization, with male prevalence consistently higher than female rates (Figure 7B). The analysis of mortality showed notable gender differences in both absolute death counts and ASMR, with males exhibiting consistently higher mortality rates throughout the study period (Figure 7C). Notably, the observed gender gap in mortality progressively narrowed over time, paralleling an overall reduction in ASMR across the population. The DALY trends paralleled mortality patterns, with persistently higher age-standardized DALY rates (ASDR) in males throughout the study period, although the gender gap also demonstrated a narrowing trend over time (Figure 7D).

Figure 7.

Comparison of full-age cases and age-standardized rates of incidence, prevalence, mortality and DALYs among men and women in China from 1990 to 2021. (A) Incident cases and ASIR; (B) Prevalent cases and ASPR; (C) Death cases and ASMR; (D) DALYs counts and ASDR. (Bar charts represent counts; lines represent age-standardized rates.).

In this study, we comprehensively evaluated the incidence, prevalence, mortality, and DALYs of VID in China and worldwide over the past 31 years, based on the GBD 2021 database. We compared the differences in disease burden of VID in China by age and gender. The study findings indicate a general reduction in VID-related disease burden metrics in both China and globally during the study period. However, unique temporal trends were observed within the Chinese population: ASIR and ASPR showed temporary increases from 2000 to 2005, whereas ASMR and ASDR displayed comparable upward trends between 1998 and 2004 before returning to their downward trajectories. The age-stratified analysis identified notable epidemiological trends. VID incidence was most prevalent among middle-aged and elderly populations, with mortality rates markedly higher in advanced age groups. Gender disparities were particularly pronounced in individuals aged over 70, as female patients exhibited greater disease susceptibility and higher post-diagnosis mortality risks compared to males. Additionally, an alarming trend was detected in pediatric populations (ages 0–14), where both incidence and mortality rates reached their highest levels.

Discussion

The present study provides a comprehensive analysis of the epidemiological trends of vascular intestinal disorders (VID) in China and globally from 1990 to 2021, utilizing data from the Global Burden of Disease (GBD) 2021 database. By examining age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs), this research highlights critical disparities in disease burden between China and global patterns, identifies age- and gender-specific vulnerabilities, and underscores the evolving challenges posed by VIDs in an era of demographic and lifestyle transitions. The findings reveal nuanced trends that warrant detailed discussion in the context of existing literature, potential mechanistic drivers, clinical implications, and public health priorities.

Global and Regional Trends in VID Burden

Declining Age-Standardized Rates Amid Rising Absolute Cases

Globally, the age-standardized incidence rate (ASIR) of VID decreased from 18.81 to 15.98 per 100,000 population between 1990 and 2021, while China exhibited a comparable decline from 5.92 to 5.03 per 100,000. Similar trends were observed for age-standardized prevalence (ASPR), mortality (ASMR), and DALY rates (ASDR). These declines likely reflect advancements in diagnostic techniques, such as dual phase CT angiography,¹⁴ improved management of cardiovascular risk factors (eg, hypertension, diabetes), and enhanced surgical interventions for conditions like mesenteric ischemia and ischemic colitis.¹⁵ However, the absolute number of cases surged globally (77.82% increase) and in China (90.55% increase), driven by population growth and aging. This dichotomy—reduced age-adjusted rates but escalating absolute burden—mirrors trends observed in other non-communicable diseases (NCDs) such as ischemic heart disease and stroke,¹⁶ underscoring the dual challenge of improving healthcare quality while addressing demographic shifts.

The steeper decline in ASMR in China (−2.77% AAPC) compared to the global average (−1.42%) may reflect targeted public health initiatives, including earlier detection through expanded endoscopy access and improved critical care infrastructure.¹⁷ Conversely, the slower decline in global ASPR (−0.46% vs China’s −0.38%) suggests persistent gaps in managing chronic VID complications, particularly in low-resource settings where access to specialized care remains limited.

Temporal Fluctuations and Joinpoint Analysis

Joinpoint regression revealed dynamic temporal patterns. In China, ASIR and ASPR exhibited an unexpected rise from 2000 to 2005, followed by sharp declines post-2005. This transient increase coincides with rapid urbanization and dietary shifts in China during the early 2000s, including increased consumption of processed foods and sedentary lifestyles, which are known risk factors for atherosclerosis and subsequent mesenteric ischemia.¹⁸ Similar trends have been documented in studies linking Westernized diets to rising cardiovascular disease rates in Asia.¹⁹ The subsequent decline after 2005 may correlate with national health campaigns, such as the inclusion of vascular health screenings in routine check-ups²⁰ and the widespread adoption of statins for dyslipidemia management.²¹

Age-Specific Burden and Demographic Transition and Shifting Peaks in Older Age Groups

VIDs disproportionately affect older populations, with incidence and mortality peaking in the 80–84 and 85–89 age groups, respectively. This aligns with the pathophysiology of VIDs, which are often secondary to age-related vascular degeneration, atrial fibrillation (a risk factor for embolic mesenteric ischemia), and comorbidities such as chronic kidney disease. The shift in prevalence peaks from 75–79 (1990) to 80–84 (2021) in China reflects increased life expectancy, a phenomenon also observed in Japan and Western Europe. However, the persistently high mortality in the 95+ age group underscores the challenges of managing acute VID complications in frail elderly patients, where invasive interventions carry prohibitive risks.²²

Notably, the DALY burden peaked earlier (70–74 years) than mortality (85–89 years), suggesting that non-fatal VID complications—such as chronic intestinal ischemia requiring repeated hospitalizations—impose significant disability on younger elderly populations. This finding emphasizes the need for rehabilitative care and long-term management strategies to reduce DALYs in this demographic.²³

The Paradox of Pediatric Burden

A striking yet underdiscussed finding is the elevated incidence and mortality of VIDs in the 0–14 age group. While rare, pediatric VIDs often arise from congenital vascular anomalies, trauma, or vasculitides like Henoch-Schönlein purpura. The high DALY peak in this group (Figure 4D) reflects the catastrophic impact of VID-related complications, such as intestinal necrosis, on children’s developmental trajectories. This aligns with studies reporting poor long-term outcomes in pediatric mesenteric ischemia survivors, necessitating heightened clinical vigilance and specialized pediatric vascular services.²⁴

Gender Disparities: Biological and Sociocultural Determinants

Male Predominance in Younger Cohorts, Female Excess in Older Adults

Males exhibited higher VID incidence and mortality in the 0–74 age groups, consistent with global patterns of male predominance in cardiovascular diseases due to higher rates of smoking, alcohol use, and occupational hazards.^25–27 However, females surpassed males in VID burden after age 75, a reversal likely driven by longer life expectancy and postmenopausal hormonal changes that exacerbate endothelial dysfunction.^28,29 Estrogen’s vasoprotective effects diminish after menopause, increasing susceptibility to atherosclerosis and thrombosis.^30,31

Divergent Trends in ASIR and ASMR

The gender gap in ASIR narrowed post-2005 (Figure 7A), coinciding with rising smoking rates among Chinese women and urbanization-related stress, both of which erode traditional gender-specific risk profiles. Conversely, the persistent male excess in ASMR (Figure 7C) highlights systemic biases in healthcare-seeking behavior; men are less likely to seek early medical attention for nonspecific symptoms like abdominal pain, leading to delayed diagnoses and poorer outcomes. Public health campaigns targeting male health literacy and proactive screening could mitigate this disparity.

Mechanistic Insights and Risk Factor Dynamics

Role of Atherosclerosis and Comorbidities

The rising VID burden in middle-aged and elderly populations is inextri cably linked to the global epidemic of atherosclerosis. Dyslipidemia, hypertension, and diabetes—key drivers of endothelial injury—have surged in China due to dietary transitions and reduced physical activity. Notably, the stabilization of ASIR after 2015 (Figure 3) may reflect the delayed benefits of nationwide antihypertensive and lipid-lowering therapies initiated in the early 2000s.

Impact of Climate and Environmental Factors

Emerging evidence suggests that extreme temperatures and air pollution exacerbate VID risk by inducing systemic inflammation and hypercoagulability.^32–34 China’s rapid industrialization and episodic air quality crises may thus partially explain the transient ASIR rise from 2000 to 2005, a period marked by unregulated coal consumption and urbanization.

Clinical and Public Health Implications

Strengthening Early Diagnosis and Multidisciplinary Care

The nonspecific symptomatology of VIDs—abdominal pain, weight loss, diarrhea—often leads to diagnostic delays, as evidenced by the high mortality rates (up to 50%).³⁵ Expanding access to advanced imaging (eg, CT angiography) and promoting biomarker research (eg, intestinal fatty acid-binding protein) could improve early detection. Additionally, multidisciplinary teams comprising gastroenterologists, vascular surgeons, and intensivists are essential for managing complex cases, particularly in elderly patients with comorbidities.³⁶

Targeting High-Risk Populations

The concentration of VID burden in older adults and males under 75 necessitates tailored interventions. For the elderly, frailty assessments and individualized risk-benefit analyses for surgical interventions are critical. For younger males, workplace health programs addressing smoking cessation and stress management could reduce incident cases.

Global Health Equity

The slower decline in ASPR and ASMR in low-income regions underscores the need for equitable access to diagnostics and therapies. International collaborations, such as telemedicine partnerships and subsidized endovascular equipment, could bridge these gaps.

Limitations and Future Directions

Data Constraints and Methodological Caveats

This study relies on GBD estimates, which may underrepresent VID burden in regions with limited healthcare infrastructure. For example, ischemic colitis is often misclassified as infectious diarrhea in resource-poor settings. Additionally, the GBD’s reliance on hospital-based data may exclude undiagnosed cases, particularly in rural China.

Unexplored Risk Factors

Future studies should investigate the role of gut microbiota dysbiosis, genetic polymorphisms (eg, Factor V Leiden), and socioeconomic determinants (eg, income inequality) in VID pathogenesis. Longitudinal cohorts tracking dietary patterns and environmental exposures could elucidate modifiable risk factors.

Technological Innovations

Artificial intelligence (AI)-assisted diagnostic tools and wearable devices for real-time monitoring of abdominal perfusion could revolutionize VID management. Randomized trials evaluating endovascular versus open surgical outcomes in elderly populations are also urgently needed.

Conclusion

This study delineates the evolving epidemiology of VIDs, characterized by declining age-standardized rates but rising absolute burdens, pronounced age and gender disparities, and complex temporal trends shaped by demographic, environmental, and healthcare factors. While China has made remarkable progress in reducing VID mortality, persistent challenges—such as pediatric DALYs and gender inequities—demand targeted action. Globally, the findings underscore the imperative of integrating VID prevention into broader NCD control strategies, leveraging technological advancements, and prioritizing health equity. By addressing these multifaceted challenges, policymakers and clinicians can mitigate the growing burden of VIDs in aging societies worldwide.

Ethics Approval and Consent to Participate

This study was approved by the Research Ethics Committee of the Affiliated Hospital of Jinggangshan University (approval number: JDFY2026MNWK0127-1). The committee determined that the research protocol meets the ethical requirements of the Declaration of Helsinki and the Measures for Ethical Review of Life Science and Medical Research Involving Human Subjects (National Health Commission of China, 2023). As the study uses only de‑identified, publicly available population‑level data and does not involve direct contact with individuals or sensitive personal information, the ethics committee granted a waiver of informed consent. All data were accessed and analysed in accordance with the relevant data use agreements and ethical standards.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work. No financial or personal relationships with other people or organizations have inappropriately influenced the study design, data analysis, interpretation, or manuscript preparation. All authors have declared that they have no competing financial, professional, or personal interests that could be construed as influencing the results or discussion presented in this paper.