Socioeconomic inequalities and dynamic changes in sex differences in lifetime risks of peptic ulcer disease

Peptic ulcer disease (PUD) is a common digestive system disorder and an important risk factor for gastric cancer. While previous studies have extensively focused on using traditional indicators, lifetime risks of PUD remain relatively scarce.

Using Global Burden of Disease (GBD) 2021 data, we estimated lifetime risks of developing and dying from PUD by lifetable method.Trends were assessed by calculating the average annual percent change (AAPC) from 1990 to 2021. By computing the sex ratios(male to female) of lifetime risks and plotting time-trend graphs, we analyzed the dynamic evolution of sex differences.

In 2021, the global lifetime risk of developing from PUD was 3.21% (95% CI, 3.20%-3.22%), declining from 1990 (AAPC: -1.24; 95% CI, -1.37 to -1.11), with a more pronounced decrease among males (AAPC: -1.43; 95% CI, -1.53 to -1.33) than females (AAPC: -1.00; 95% CI, -1.10 to -0.89). The lifetime risk of dying from PUD was 0.35% (95% CI, 0.34%-0.35%), with a faster decline (AAPC, -2.25; 95% CI, -2.57 to -1.93), again with greater in males (AAPC: -2.73; 95% CI, -2.86 to -2.60) than in females (AAPC: -1.80; 95% CI, -2.00 to -1.60). Marked socioeconomic disparities were observed: high-SDI regions had the highest lifetime risk of developing but the lowest risk of dying, whereas low-SDI regions showed the opposite pattern. Across different SDI regions, the sex ratios of lifetime risk of PUD exhibited unique inflection points over three decades.

Despite substantial global declines in lifetime risks of PUD over the past three decades, our findings reveal persistent inequities by SDI, geography, and sex. These disparities underscore that access to timely diagnosis, eradication therapy, and advanced endoscopic care remains uneven, particularly in low-SDI regions and among females.