Generational Shifts in the Burden of IBD Among Women of Reproductive Age, 1990–2021: A Multilevel Modeling Study

Background Inflammatory bowel disease (IBD), comprising Crohn’s disease and ulcerative colitis, is a chronic immune-mediated condition with increasing global prevalence. Among women of reproductive age, the burden intersects with fertility, pregnancy, and caregiving, yet remains insufficiently characterized. Methods We analyzed estimates from the Global Burden of Disease 2021 study to assess incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of IBD among women aged 15–49 years in 204 countries from 1990 to 2021. Age–period–cohort modeling, decomposition, inequality measures, and frontier efficiency analysis were applied. Bayesian projections were generated through 2035. Results Between 1990 and 2021, DALYs in women of reproductive age rose from 193,090 to 281,580 and prevalence from 604,755 to 866,997, while age-standardized rates remained stable. Incidence increased modestly, whereas mortality stayed low. High-SDI regions showed high prevalence but lower DALY rates, reflecting effective disease control; low-SDI regions displayed the reverse. DALYs peaked at ages 45–49 in high-SDI regions but earlier in low-SDI regions. Decomposition indicated DALY increases in high-SDI countries were mainly attributable to population aging, partially offset by epidemiological improvements, whereas population growth predominated in low-SDI regions. Projections suggest DALYs will peak around 2025 and then decline, while prevalence decreases more slowly. Conclusions Among women of reproductive age, IBD is shifting from premature mortality toward chronic morbidity. Although mortality remains low, the absolute numbers of DALYs and cases are rising. These findings highlight the need for strategies that address disability, bridge diagnostic and care gaps, and support gender-sensitive, equitable approaches to long-term IBD management.