Spatiotemporal Epidemiology of Endometriosis: Global, Regional, and National Trends from 1990 to 2019

Abstract

Purpose This study utilized 1990–2019 data from the Global Burden of Disease (GBD) 2019 study to comprehensively evaluate global and regional temporal trends of endometriosis burden. Patients and Methods Age-standardized incidence rates (ASIR) and disability-adjusted life year (DALY) rates were extracted from GBD 2019. Using the DisMod-MR 2.1 modeling framework, we analyzed three-decade trends across 204 countries and territories. Results Globally, endometriosis presented opposing trends in age-standardized incidence rate (ASIR) and age-standardized DALY rate from 1990 to 2019. The global age-standardized DALY rate declined markedly, with an EAPC of −0.82, while the ASIR rose steadily (EAPC = 0.46). Stratified by Socio-Demographic Index (SDI), high-SDI regions witnessed the most prominent growth in ASIR, with an EAPC of 0.54. Among the 21 GBD geographic regions, High-income North America had the fastest ASIR growth (EAPC = 0.65). Eastern Europe was the only region with rising age-standardized DALY rates (EAPC = 0.16). Oceania bore the world’s largest overall endometriosis burden, with the highest ASIR and age-standardized DALY rates globally. At the national level, New Zealand had the highest disease burden, whereas San Marino and Sweden showed the steepest increases in incidence rates. Conclusion These findings reveal persistent global growth in endometriosis incidence coupled with stark interregional disparities. The paradox of rising incidence alongside declining disability warrants further investigation, particularly given Oceania’s disproportionately high burden despite its advanced SDI status.