Global Burden of Pelvic Organ Prolapse, 1990-2021: An Ecological Study and Mendelian Randomization Analysis

Pelvic organ prolapse (POP) represents a major global health challenge for women. This study systematically analyzed the global disease burden of POP and associated risk factors from 1990 to 2021, including projections of future trends.

The data were derived from the Global Burden of Disease (GBD) 2021 database and genome-wide association studies (GWAS). Additionally, we combined the age-period-cohort (APC) model with the autoregressive integrated moving average (ARIMA) model to analyze the driving factors and project future disease burden trends. Furthermore, we performed a two-sample Mendelian randomization (MR) analysis to assess whether genetic liability to selected traits is associated with POP.

From 1990 to 2021, the global crude incidence, prevalence, and disability-adjusted life years (DALYs) of POP increased by 66.2%, 68.7%, and 67.5%, respectively. However, in 2021, the global age-standardized DALY rate (ASDR) of POP was 18.4% lower than in 1990. Notably, regions with a low sociodemographic index exhibited a statistically significant elevation in disease burden. Furthermore, observational analyzes and MR suggest a probable causal contribution of obesity and related traits to POP risk, while higher genetically proxied educational attainment appears protective. According to the ARIMA model, global POP cases are projected to reach 148 million by 2036, while the age-standardized prevalence rate (ASPR) and ASDR are expected to decline further by 10.8% and 18.4%, respectively.

With aging and socioeconomic disparities aggravating the POP burden, efforts should prioritize global surveillance, optimized resource allocation, and targeted prevention for high‑risk groups.