[Long-term evolution, effect analysis and future trend of the burden of gastritis and duodenitis in China: An...

To explore the evolutionary trends of the disease burden of gastritis and duodenitis (GD) in China from 1990 to 2023, to clarify the driving factors of changes in this burden, to predict the disease burden situation from 2024 to 2040, and to provide data support for formulating GD prevention and control strategies.

Based on the Global Burden of Disease Study (GBD) 2023 data, the Joinpoint regression model was applied to analyze the annual average percentage change (AAPC) of age-standardized incidence rate, age-standardized prevalence rate, age-standardized mortality rate, and age-standardized disability-adjusted life years (DALY) rate of GD in China from 1990 to 2023. The age-period-cohort model was used to investigate the effects of age, period, and cohort on incidence, prevalence, and mortality risks. Three factors-population structure change, epidemiological change, and population growth-were identified to determine their driving effects on the disease burden. The auto-regressive integrated moving average (ARIMA) time series model was employed to forecast the future disease burden.

From 1990 to 2023, the number of GD incident cases in China increased from 6.158 8 million to 9.354 5 million, the number of prevalent cases rose from 8.770 6 million to 13.145 9 million, the number of deaths decreased from 19 800 to 17 200, and the number of DALY slightly declined from 902 400 person-years to 851 600 person-years. The AAPCs of age-standardized incidence rate, age-standardized prevalence rate, age-standardized mortality rate, and age-standardized DALY rate were -1.08%, -1.18%, -3.81%, and -2.89%, respectively (all P < 0.001). Joinpoint regression analysis showed that all age-standardized rates presented a phased downward trend. Age-period-cohort model analysis revealed that the incidence and prevalence risks peaked in the 55-59 years age group, while the mortality risk increased significantly with age. The period effect of incidence and prevalence risks first increased and then decreased, whereas the period effect of mortality risk showed a conti-nuous downward trend; the cohort risk exhibited a decreasing trend across all the groups. Decomposition analysis indicated that population growth and structural change promoted the increase in incident and prevalent cases (the overall contribution rates to the incident cases were 165.66% and 167.00%, respectively), while epidemiological change was the main factor driving their decrease (with an overall contribution rate of -232.66% to the incident cases). Additionally, epidemiological change was the core factor for the reduction in deaths (with an overall contribution rate of 490.07%). The ARIMA time series model predicted that by 2040, the number of incident cases would rise to 11.086 1 million, the number of prevalent cases to 15.279 6 million, the mortality rate to 0.48 per 100 000 population, and the DALY rate to 26.18 per 100 000 population.

From 1990 to 2023, the age-standardized disease burden of GD in China was significantly alleviated, with population factors and epidemiological changes jointly driving the burden changes. Although the number of incident and prevalent cases will increase in the future, the mortality and disability burden will continue to decrease. It is necessary to formulate targeted prevention and control strategies based on age, cohort characteristics, and driving factors.