[Analysis and projection of the disease burden of endometriosis and polycystic ovary syndrome-related infertility among women aged 15-49 years in China and globally from 1990 to 2021].
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Objective: To investigate the burden of endometriosis (EMs)-related and polycystic ovary syndrome (PCOS)-related infertility among women aged 15-49 years in China and globally, and to project trends over the next 15 years. Methods: Data were sourced from the 2021 Global Burden of Disease (GBD) database. Disease burden indicators, including the age-standardized prevalence rate (ASPR) and age-standardized years lived with disability rate (ASYR) for EMs- and PCOS-related infertility, were calculated and analyzed among women aged 15-49 years in China and globally. Linear regression models and Joinpoint regression analysis were used to further analyze the trend changes in disease burden in China and globally. The Bayesian age-period-cohort (BAPC) model was employed to predict disease trends over the next 15 years. Results: From 1990 to 2021, ASPR and ASYR of EMs-related infertility among women aged 15-49 years in China and globally showed a declining trend. The ASPR of EMs-related infertility declined faster in China than globally, with an average annual percentage change (AAPC) of -1.42% in China and -0.95% globally. By 2021, the ASPR and ASYR for EMs-related infertility in Chinese women aged 15-49 years were lower than the global average and those of all sociodemographic index (SDI) regions. In 2021, the highest ASPR and ASYR were observed in Chinese women aged 40-44 years, while globally, the highest rates were in the 25-29 age group. From 1990 to 2021, the ASPR and ASYR of PCOS-related infertility among women aged 15-49 years showed an increasing trend in both China and globally. The increase in ASPR among Chinese women aged 15-49 years was significantly higher than the global average and that of all SDI regions, with an AAPC of 1.93% in China and 0.99% globally. In 2021, the highest ASPR for PCOS-related infertility in China was observed in women aged 25-29 years, while the fastest increases in ASPR and ASYR both globally and in China occurred in women aged 20-24 years. The BAPC model predicts that by 2036, the ASPR and ASYR of EMs-related infertility among women aged 15-49 years will decrease to 32.98 per 100 000 and 0.21 per 100 000 in China, and to 55.57 per 100 000 and 0.33 per 100 000 globally, respectively. In contrast, the ASPR and ASYR of PCOS-related infertility among women aged 15-49 years will increase to 620.39 per 100 000 and 3.46 per 100 000 in China, and to 774.34 per 100 000 and 4.45 per 100 000 globally, respectively. Conclusions: The ASPR and ASYR for EMs-related infertility among women aged 15-49 years are declining in China and globally, with China's burden lower than the global average, and this trend is expected to continue over the next 15 years. In contrast, the ASPR and ASYR for PCOS-related infertility among women aged 15-49 years are increasing persistently, with a faster increase in China than globally and across all SDI regions. This indicates that PCOS has become a key priority for the prevention and management of infertility among women aged 15-49 years in China, with particular attention needed for women aged 20-29 years, and underscoring the need for targeted interventions addressing age-specific and socioeconomic disparities.