Abstract
Background
This study assessed hip osteoarthritis (HOA) and knee osteoarthritis (KOA) burden attributable to the aggregate GBD category “Metabolic risks” among women of reproductive age, using GBD 2021 estimates from 1990 to 2021.
Methods
We analyzed disability-adjusted life-years (DALYs) and years lived with disability (YLDs) for HOA and KOA in women aged 15–49 years across 204 countries and territories, with stratification by age, Socio-demographic Index (SDI), and GBD region. We calculated absolute numbers, age-standardized rates (ASRs), and estimated annual percentage changes (EAPCs); performed decomposition analyses; and used ARIMA and damped Holt exponential-smoothing models to describe possible burden trajectories from 2022 to 2050.
Results
From 1990 to 2021, global KOA DALYs attributable to metabolic risks increased from 118,483.85 to 342,005.11, an increase of approximately 188.7%, while the KOA ASR increased from 10.95 to 16.54 per 100,000, an increase of approximately 50.9% (EAPC 1.57%). HOA DALYs increased from 10,426.34 to 28,184.59, an increase of approximately 170.3%, while the HOA ASR increased from 0.93 to 1.37 per 100,000, an increase of approximately 47.0% (EAPC 1.32%). Both forecasting approaches suggested further increases through 2050, although the magnitude of the projected changes was model-dependent.
Interpretation
The burden of HOA and KOA attributable to metabolic risks increased substantially among women of reproductive age, with marked geographic and SDI-related heterogeneity. These findings support consideration of metabolic risk management within existing women’s health and noncommunicable disease (NCD) services.
Keywords: global burden of disease, osteoarthritis, reproductive age, women, metabolic risks, sociodemographic index, forecasting
Introduction
Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of articular cartilage, joint pain, stiffness, and functional impairment, and it represents a leading cause of disability worldwide.1 Among affected joints, the knee is the most commonly affected, followed by the hand and hip.2 Knee osteoarthritis (KOA) was the largest single-site contributor to combined OA prevalence, ranging from 34.6% to 66.2% across GBD regions, whereas hip osteoarthritis (HOA) contributed only 3.4–9.5%.3 GBD estimates indicate that the global number of OA cases increased by approximately 113% from 1990 to 2019.2 The global prevalence of OA is projected to continue rising with population aging and the increasing prevalence of metabolic risk factors such as obesity and high body-mass index (BMI).3 Increased BMI may exacerbate joint loading and may contribute to OA progression through inflammatory and metabolic pathways.4
The Global Burden of Disease Study (GBD) reported that the age-standardized prevalence of KOA was higher in women than in men (5.2% [95% UI 4.5 to 5.9] vs 3.5% [95% UI 3.0 to 4.0] in 2019).1,5 Hormonal changes, differences in muscle strength, and greater obesity-related risk have been used to explain the higher postmenopausal OA burden; these observations identify women as a high-risk population across the life course.6–8
Reproductive-aged women represent a distinct population in whom metabolic and hormonal conditions may change substantially across pregnancy, lactation, and interpregnancy periods. Pregnancy-related weight gain, changes in glucose and lipid metabolism, and subsequent weight retention may interact with obesity-related mechanical loading and low-grade systemic inflammation, pathways that are also relevant to OA pathophysiology.9,10 These considerations provide a biologically and epidemiologically plausible rationale for examining metabolically attributable OA burden specifically among women aged 15–49 years.
Although previous studies have described global OA trends, many have focused on all-age or general-population burden, specific OA subtypes, specific sexes, or selected regions.11–20 GBD 2021 provides an integrated assessment of 371 diseases and injuries across 204 countries and territories, enabling burden estimates to be examined by sex, age, SDI, and GBD region.21–23
Using GBD 2021 estimates for 1990–2021, this study provides a comprehensive analysis of HOA and KOA burden attributable to metabolic risks among women aged 15–49 years. We quantified temporal trends and age-, SDI-, and region-specific distributions, applied decomposition analysis to population growth, age-structure change, and epidemiological change, and used ARIMA and damped Holt exponential-smoothing (ES) models to explore burden trajectories through 2050. The findings are intended to inform prevention and metabolic risk management strategies; they do not support individual-level causal claims.
Methods
Data Source
This study used GBD 2021 estimates for HOA and KOA attributable to metabolic risks among women aged 15–49 years from 1990 to 2021. GBD 2021 provides estimates for 371 diseases and injuries across 21 GBD regions and 204 countries and territories.21,22 Data are publicly available from the Global Health Data Exchange (https://ghdx.healthdata.org/gbd-2021/sources). Details of the data sources, methods, and statistical models have been published previously.23
The downloaded attributable-burden series contained Global and location-level estimates for cause = Osteoarthritis hip or Osteoarthritis knee, sex = Female, risk = Metabolic risks, measures = DALYs and YLDs, metrics = Number and Rate, and years = 1990–2021. Overall burden estimates were extracted for women aged 15–49 years. Age-specific estimates available in the downloaded attributable-burden dataset were limited to the 30–34, 35–39, 40–44, and 45–49-year groups; no additional age-specific values were imputed for ages 15–29 years. All downloaded files contained only Female estimates; no male or both-sex estimates were present.
Outcome Measures
DALYs and YLDs were reported as absolute numbers and rates per 100,000 population. Rates for the overall population and SDI categories were age-standardized, whereas rates for individual age groups were age-specific. Burden estimates are presented with 95% uncertainty intervals (UIs), whereas EAPCs are presented with 95% confidence intervals (CIs). Forecast uncertainty is reported using model-based prediction intervals. Some lower bounds of the GBD-reported UIs crossed zero in the downloaded risk-attributable estimates. These values were retained as reported and should be interpreted as statistical uncertainty rather than negative observed disease burden.
Risk Attribution
The analysis used the aggregate GBD risk category “Metabolic risks” as provided in the downloaded attributable-burden data. Component-specific attributable estimates were not available in the study dataset and were therefore not analyzed separately.
Statistical Analysis
EAPCs were estimated by fitting a log-linear regression model, ln(ASR) = α + β × year.24 EAPC was calculated as 100 × [exp(β) − 1], and its 95% CI was derived from the standard error of β. Joinpoint regression was used to identify trend turning points.25 Descriptive and trend analyses were conducted using R version 4.2.1.
Decomposition Analysis
Using the Das Gupta method,26 we decomposed changes in DALYs between 1990 and 2021 into population growth, age-structure change, and epidemiological change. Because only female estimates were present, no sex decomposition was performed.
Predictive Models
Annual global observations from 1990 to 2021 were used for forecasting. For absolute burden, models were fitted to DALY numbers among women aged 15–49 years; for rates, models were fitted to the corresponding age-standardized DALY rates. ARIMA orders were selected automatically using the auto.arima() function in the R forecast package.27,28 The final ARIMA specifications were ARIMA(2,1,0) with drift for KOA DALY numbers, ARIMA(1,1,2) with drift for KOA ASRs, and ARIMA(0,2,0) for both HOA DALY numbers and HOA ASRs. Damped Holt exponential smoothing was fitted with a fixed damping parameter of φ=0.90.29,30 Both approaches generated forecasts for 2022–2050. Model performance was additionally evaluated using 2017–2021 as a hold-out period, with models trained on observations from 1990–2016. Model specifications and goodness-of-fit statistics, including AIC, AICc, BIC, RMSE, and MAE, are reported in Supplementary Table S3.
Forecasting analyses were refitted during revision using R version 4.6.1 and the forecast package (version 9.0.2). In the supplied attributable-burden series, DALYs and YLDs were numerically identical for every year and location; therefore, forecasting models were fitted to DALY series and separate YLD forecasts were not repeated.
Results
Global Burden Trends
From 1990 to 2021, HOA DALYs attributable to metabolic risks among women aged 15–49 years increased by approximately 170.3%, from 10,426.34 (95% UI −837.35 to 29,064.81) to 28,184.59 (95% UI −2,550.10 to 77,531.33). The HOA ASR increased by approximately 47.0%, from 0.93 to 1.37 per 100,000, with an EAPC of 1.32% (95% CI 1.29–1.35) (Table 1 and Figure 1A).
Table 1.
DALY Burden of Hip Osteoarthritis Attributable to Metabolic Risks Among Women of Reproductive Age in 1990 and 2021
| Category | 1990 DALY Number (95% UI) |
1990 Rate per 100,000 (95% UI) |
2021 DALY Number (95% UI) |
2021 Rate per 100,000 (95% UI) |
EAPC (95% CI) |
|---|---|---|---|---|---|
| Global (women aged 15–49 years) | 10,426.34 (−837.35-29064.81) | 0.93 (−0.08-2.6) | 28,184.59 (−2550.1-77531.33) | 1.37 (−0.12-3.77) | 1.32 (1.29–1.35) |
| Age group | |||||
| 30–34 years | 1158.59 (−88.66-3499.38) | 0.61 (−0.05-1.84) | 2852.97 (−250.47-8064.08) | 0.95 (−0.08-2.7) | 1.62 (1.54–1.71) |
| 35–39 years | 1956.63 (−149.85-5358.54) | 1.13 (−0.09-3.09) | 4923.2 (−414.42-13729) | 1.77 (−0.15-4.94) | 1.53 (1.45–1.62) |
| 40–44 years | 2962.18 (−232.07-7978.05) | 2.11 (−0.17-5.69) | 7886.11 (−722.14-21312.58) | 3.18 (−0.29-8.59) | 1.4 (1.34–1.47) |
| 45–49 years | 4348.94 (−366.77-12228.85) | 3.82 (−0.32-10.75) | 12,522.31 (−1163.07-34425.67) | 5.31 (−0.49-14.61) | 1.12 (1.08–1.16) |
| SDI region | |||||
| High-middle SDI | 2372.22 (−194.78-6777.29) | 0.97 (−0.08-2.78) | 5474.89 (−496.38-15142.61) | 1.4 (−0.13-3.86) | 1.2 (1.13–1.27) |
| High SDI | 3908.15 (−334.27-10852.95) | 1.65 (−0.14-4.57) | 6871.54 (−680.03-18830.72) | 2.29 (−0.23-6.27) | 1.16 (1.1–1.21) |
| Low-middle SDI | 1379.96 (−103.6-3889.75) | 0.65 (−0.05-1.83) | 5739.26 (−505.83-15867.56) | 1.24 (−0.11-3.42) | 2.34 (2.24–2.43) |
| Low SDI | 465.14 (−31.34-1330.95) | 0.56 (−0.04-1.61) | 1851.85 (−140.38-5219.16) | 0.89 (−0.07-2.5) | 1.61 (1.53–1.69) |
| Middle SDI | 2288.36 (−173.11-6380.04) | 0.67 (−0.05-1.85) | 8223.1 (−718.92-22731.19) | 1.19 (−0.1-3.3) | 1.98 (1.94–2.01) |
Notes: Rates are age-standardized for the Global and SDI categories and age-specific for individual age groups. Values were extracted from the GBD 2021 attributable-to-metabolic-risks series for women aged 15–49 years. DALYs and YLDs were numerically identical in the supplied attributable-burden series; DALYs are therefore presented as the primary burden measure in the main tables, with complete DALY and YLD estimates provided in the Supplementary Material. Some GBD-reported UI lower bounds crossed zero and were retained as reported.
Abbreviations: ASR, age-standardized rate; CI, confidence interval; DALY, disability-adjusted life year; EAPC, estimated annual percentage change; UI, uncertainty interval.
Figure 1.
Numbers and age-standardized rates of DALYs attributable to metabolic risks among women of reproductive age from 1990 to 2021: (A) HOA; (B) KOA. Bars represent absolute DALY numbers on the left y-axis, whereas lines represent age-standardized DALY rates per 100,000 on the right y-axis.
Abbreviations: DALY, disability-adjusted life year; HOA, hip osteoarthritis; KOA, knee osteoarthritis.
From 1990 to 2021, KOA DALYs attributable to metabolic risks among women aged 15–49 years increased by approximately 188.7%, from 118,483.85 (95% UI −10,258.01 to 327,305.17) to 342,005.11 (95% UI −32,718.94 to 915,646.95). The corresponding ASR increased by approximately 50.9%, from 10.95 to 16.54 per 100,000, with an EAPC of 1.57% (95% CI 1.46–1.69) (Table 2 and Figure 1B). The more rapid relative increase in KOA than HOA is consistent with greater metabolic-risk-related burden on weight-bearing joints.
Table 2.
DALY Burden of Knee Osteoarthritis Attributable to Metabolic Risks Among Women of Reproductive Age in 1990 and 2021
| Category | 1990 DALY Number (95% UI) |
1990 Rate per 100,000 (95% UI) |
2021 DALY Number (95% UI) |
2021 Rate per 100,000 (95% UI) |
EAPC (95% CI) |
|---|---|---|---|---|---|
| Global (women aged 15–49 years) | 118,483.85 (−10258.01-327305.17) | 10.95 (−0.95-30.22) | 342,005.11 (−32718.94-915646.95) | 16.54 (−1.58-44.3) | 1.57 (1.46–1.69) |
| Age group | |||||
| 30–34 years | 1548.9 (−128.21-4421.72) | 0.81 (−0.07-2.33) | 3820 (−341.42-11075.33) | 1.28 (−0.11-3.7) | 1.69 (1.58–1.8) |
| 35–39 years | 14,511.18 (−1181.95-41141.56) | 8.37 (−0.68-23.72) | 35,850.5 (−3175.14-101260.78) | 12.91 (−1.14-36.45) | 1.64 (1.5–1.77) |
| 40–44 years | 36,978.04 (−3123.71-104408.63) | 26.37 (−2.23-74.46) | 98,806.46 (−9209.57-269390.15) | 39.83 (−3.71-108.59) | 1.63 (1.49–1.78) |
| 45–49 years | 65,445.73 (−5824.14-177333.26) | 57.51 (−5.12-155.83) | 203,528.15 (−19992.81-533920.69) | 86.37 (−8.48-226.58) | 1.53 (1.43–1.63) |
| SDI region | |||||
| High-middle SDI | 27,020.96 (−2380.16-75406) | 11.46 (−1.01-31.93) | 75,349.67 (−7166.87-197224.51) | 18.62 (−1.76-48.85) | 1.84 (1.71–1.97) |
| High SDI | 32,718.44 (−2910.5-90162.49) | 13.85 (−1.23-38.15) | 57,645.88 (−5852.68-151777.77) | 18.74 (−1.9-49.42) | 1.16 (1.1–1.23) |
| Low-middle SDI | 16,450.19 (−1416-45761.99) | 8.07 (−0.7-22.43) | 61,732.84 (−5845.93-169528.03) | 13.55 (−1.29-37.18) | 1.89 (1.79–1.99) |
| Low SDI | 5135.15 (−404.38-14403.54) | 6.55 (−0.52-18.32) | 19,478.68 (−1649.38-54852.69) | 9.76 (−0.83-27.43) | 1.42 (1.35–1.48) |
| Middle SDI | 37,034.95 (−3164.64-102364.94) | 11.37 (−0.97-31.34) | 127,536.77 (−12200.35-344389.03) | 18.21 (−1.74-49.21) | 1.8 (1.65–1.94) |
Notes: Rates are age-standardized for the Global and SDI categories and age-specific for individual age groups. Values were extracted from the GBD 2021 attributable-to-metabolic-risks series for women aged 15–49 years. DALYs and YLDs were numerically identical in the supplied attributable-burden series; DALYs are therefore presented as the primary burden measure in the main tables, with complete DALY and YLD estimates provided in the Supplementary Material. Some GBD-reported UI lower bounds crossed zero and were retained as reported.
Abbreviations: ASR, age-standardized rate; CI, confidence interval; DALY, disability-adjusted life year; EAPC, estimated annual percentage change; UI, uncertainty interval.
Complete DALY and YLD estimates for HOA and KOA are provided in Supplementary Table S1 and S2, respectively.
Global Distribution and Trends
Country-level ASRs and absolute burdens varied widely in 2021. The largest absolute HOA and KOA DALYs occurred in populous countries, including China, India, and the United States of America, whereas Bangladesh and Viet Nam had among the highest EAPCs for both HOA and KOA (Figures 2 and 3; Supplementary Table S1 and S2). These patterns indicate a distinction between current burden size and the pace of relative increase, particularly in South and Southeast Asia.
Figure 2.
Age-standardized DALY rates of HOA and KOA attributable to metabolic risks among women of reproductive age worldwide in 2021: (A) HOA; (B) KOA.
Figure 3.
![Two world maps showing EAPCs of age-standardized DALY rates for HOA and KOA from 1990 to 2021. Two thematic world maps showing estimated annual percentage changes (EAPCs) in age-standardized disability-adjusted life year (DALY) rates attributable to metabolic risks among women aged 15–49 years from 1990 to 2021. Panel A shows hip osteoarthritis (HOA), and Panel B shows knee osteoarthritis (KOA). In both panels, countries are grouped into EAPC categories of [0,0.5], (0.5,1], (1,1.5], (1.5,2], (2,2.5], (2.5,3], (3,3.5], and (3.5,4.5], with unavailable values shown as NA. Regional inset maps provide enlarged views of the Caribbean and Central America, Persian Gulf, Balkan Peninsula, Southeast Asia, Northern Europe, Eastern Mediterranean, and West Africa.](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fc99/13640991/63b2329d30d2/IJWH-18-614974-g0003.webp)
EAPCs of age-standardized DALY rates for HOA and KOA attributable to metabolic risks among women of reproductive age from 1990 to 2021: (A) HOA; (B) KOA.
Abbreviation: EAPC, estimated annual percentage change.
Regional and SDI Stratification
Burden and trends also differed by SDI. In 2021, absolute KOA and HOA burden was highest in middle and high-middle SDI settings, while low-middle SDI settings had the highest EAPCs for both diseases (KOA 1.89%; HOA 2.34%) (Figures 4 and 5; Tables 1 and 2).
Figure 4.
DALY burden attributable to metabolic risks among women of reproductive age in 204 countries and territories in 2021, by GBD region: (A) HOA ASR; (B) HOA DALY number; (C) KOA ASR; (D) KOA DALY number.
Figure 5.
DALY burden attributable to metabolic risks among women of reproductive age by SDI quintile. (A) HOA DALY numbers in 2021; (B) HOA age-standardized DALY rates from 1990 to 2021; (C) KOA DALY numbers in 2021; (D) KOA age-standardized DALY rates from 1990 to 2021.
Abbreviation: SDI, Socio-demographic Index.
Age-Specific Burden
Age-specific rows were available for women aged 30–34, 35–39, 40–44, and 45–49 years. Age-specific DALY rates and numbers increased with age, and the 45–49-year group carried the largest absolute burden in 2021 (KOA DALYs exceeded 200,000) (Figure 6). The 30–34-year group showed the highest EAPCs for both HOA (1.62%) and KOA (1.69%). Age-specific estimates below 30 years were not available in the downloaded series, and no values were imputed.
Figure 6.
Age-specific burden of hip and knee osteoarthritis attributable to metabolic risks among women of reproductive age in 1990 and 2021: (A) HOA age-specific DALY rates per 100,000; (B) HOA DALY numbers; (C) KOA age-specific DALY rates per 100,000; (D) KOA DALY numbers. Available age groups were 30–34, 35–39, 40–44, and 45–49 years.
Abbreviations: DALY, disability-adjusted life year; HOA, hip osteoarthritis; KOA, knee osteoarthritis.
Decomposition
Across SDI quintiles, population growth and epidemiological change were the dominant positive contributors to the increase in HOA and KOA DALYs, whereas age-structure change was smaller and was negative in some higher-SDI settings. Population growth contributed relatively more in low-SDI settings (Figure 7).
Figure 7.
Decomposition of changes in HOA and KOA DALYs attributable to metabolic risks from 1990 to 2021 according to population growth, age-structure change, and epidemiological change at the global level and across SDI quintiles. (A) HOA; (B) KOA.
Abbreviations: DALY, disability-adjusted life year; HOA, hip osteoarthritis; KOA, knee osteoarthritis; SDI, Socio-demographic Index.
Future Projections
For KOA DALYs, the projected increase from 2021 to 2050 was approximately 57.2% under ARIMA and 11.1% under damped Holt ES; the corresponding ASR increases were approximately 26.1% and 5.4%. For HOA DALYs, the projected increases were approximately 52.2% and 15.4%, and the ASR increases were approximately 29.2% and 8.2%, respectively (Figure 8 and Supplementary Table S3). Both approaches therefore suggested continued increases in HOA and KOA burden through 2050, although the projected magnitude was model-dependent.
Figure 8.
Forecasts of global OA burden among women aged 15–49 years from 2022 to 2050 using ARIMA and damped Holt exponential-smoothing models: (A) KOA DALY numbers; (B) KOA age-standardized DALY rates; (C) HOA DALY numbers; (D) HOA age-standardized DALY rates. Shaded bands represent 80% and 95% prediction intervals. Each panel has an independent y-axis.
Abbreviations: ARIMA, autoregressive integrated moving average; DALY, disability-adjusted life year; HOA, hip osteoarthritis; KOA, knee osteoarthritis.
Discussion
This study provides a global assessment of HOA and KOA burden attributable to metabolic risks among women aged 15–49 years across 204 countries and territories. From 1990 to 2021, HOA and KOA DALYs attributable to metabolic risks increased by approximately 170.3% and 188.7%, respectively; the corresponding ASRs increased by approximately 47.0% and 50.9%. These increases were not uniform: SDI-related and geographic heterogeneity was marked, and the largest EAPCs were observed in several low- and lower-middle-SDI settings.
Previous studies have described associations between metabolic risks and OA progression, including obesity-related mechanical loading, local joint pressure, adipokine and inflammatory-cytokine pathways, and metabolic effects on cartilage.31–33 Such associations are plausible explanations for the burden patterns observed here, but ecological burden data cannot establish individual-level causal effects.
Compared with other populations, women of reproductive age may experience hormone-related changes, metabolic stress during the childbearing period, weight fluctuation, and immune-system variation.34,35 These factors may interact with obesity-related mechanical and inflammatory pathways relevant to joint health. The current analysis was restricted to female estimates because the underlying attributable-burden download contained only Female values; no sex comparison could be made from these data.
Both the ARIMA and damped Holt exponential-smoothing models projected further increases in HOA and KOA burden through 2050, although the magnitude of the projected increases differed substantially between models. ARIMA projected larger 2021–2050 increases (KOA DALYs +57.2%, KOA ASR +26.1%, HOA DALYs +52.2%, HOA ASR +29.2%) than damped Holt ES (KOA DALYs +11.1%, KOA ASR +5.4%, HOA DALYs +15.4%, HOA ASR +8.2%). In-sample information criteria generally favored ARIMA across the four primary series, whereas hold-out performance varied by outcome. These differences indicate that the magnitude of long-term projections is model-dependent and should be interpreted as forecasting uncertainty rather than as evidence of intervention effects.
At the health-system level, metabolic risk assessment could be integrated into existing NCD and women’s health services, with referral to evidence-based weight-management, physical-activity, and rehabilitation programs where clinically appropriate.36–42 However, the present ecological burden analysis cannot establish the effectiveness or cost-effectiveness of specific OA screening programs.43 Such strategies should therefore be pilot-tested and evaluated for feasibility, equity, effectiveness, and cost-effectiveness before wider implementation.
Strengths and Limitations
This study provides a global assessment of HOA and KOA burden attributable to metabolic risks specifically among women of reproductive age across 204 countries and territories. The combination of temporal, geographic, SDI, age-specific, decomposition, and forecasting analyses provides a multidimensional description of burden heterogeneity.
Several limitations should be considered. First, GBD estimates are model-based and may underrepresent burden in data-sparse regions. Second, this is an ecological analysis and cannot establish individual-level causality. Third, parity and pregnancy-history stratification were not available. Fourth, age-specific estimates below 30 years were not available in the downloaded attributable-burden series, limiting age-resolved interpretation across the full 15–49-year range. Fifth, the current attributable dataset contains only the aggregate “Metabolic risks” category and cannot independently estimate individual metabolic-risk proportions such as the contribution of high BMI. Sixth, forecasts depend on model assumptions, and the projected 2050 values are model-dependent. Seventh, observed estimates end in 2021; although newer GBD estimates have subsequently become available, GBD 2021 was the release used for the present analysis. Accordingly, observed estimates in this study extend through 2021, and the reported patterns should be reassessed using subsequent GBD releases.
Overall, the burden of HOA and KOA attributable to metabolic risks among women aged 15–49 years increased substantially from 1990 to 2021, and forecasts based on the observed series suggest that absolute burden may continue to increase through 2050. The quantitative interpretation of these projections should be cautious, and future analyses should use newer GBD releases to validate whether the observed trends continue.
Conclusions
In summary, the burden of HOA and KOA attributable to metabolic risks among women aged 15–49 years increased substantially from 1990 to 2021, with particularly rapid growth in several low- and lower-middle-SDI settings. Forecasts based on the 1990–2021 series suggest that the absolute burden may continue to increase through 2050, although the magnitude of projected changes varies by forecasting model. Because observed GBD estimates ended in 2021, post-2021 patterns should be reassessed using subsequent GBD releases. These findings support consideration of metabolic risk management within existing women’s health and NCD services, while prospective studies are needed to evaluate the effectiveness and cost-effectiveness of specific interventions.
Funding Statement
This work was supported by the Application Basic Research Program of the Department of Science and Technology of Liaoning Province (2022JH2101300095) and the Application Basic Research Program of the Department of Science and Technology of Liaoning Province (2023JH2101700222). The source of funds had no role in the design, execution, analysis, data interpretation, or decision to submit the results.
Data Sharing Statement
Data can be obtained from the Global Health Data Exchange GBD results tool (http://ghdx.healthdata.org/gbd-results-tool).
Ethics Approval
This study was reviewed by the Ethics Committee of the Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine. The Committee determined that the study met the criteria for exemption from ethical review because it used lawfully obtained publicly available data. The exemption was determined in accordance with Artic 32 (Items 1 and 2) of the Measures for Ethical Review of Life Science and Medical Research Involving Human Subjects (China, February 18, 2023). The exemption determination was issued on September 7, 2026. The study involved no identifiable personal information and no direct interaction with human participants; therefore,informed consent was not applicable.
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 declare no competing interests.
An early version of this paper was uploaded to assets-eu.researchsquare as a preprint: https://assets-eu.researchsquare.com/files/rs-6740462/v1_covered_153453c1-7f0b-405b-873b-07ea522c38e3.pdf?c=1758189345
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data can be obtained from the Global Health Data Exchange GBD results tool (http://ghdx.healthdata.org/gbd-results-tool).