Endometriosis Burden Among Adolescents and Young Adult Women in China and the Western Pacific Region from 1990 to 2023: A Systematic Analysis for the GBD 2023

Xiaoxi Niu, Xiaolei Zhang, Xiao Jiang, Lijie WangDepartment of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People’s Republic of ChinaCorrespondence: Lijie Wang, Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People’s Republic of China, Email [email protected]: Endometriosis often becomes symptomatic early in reproductive life, yet estimates for younger females are subsumed within broader reproductive-age populations. We assessed burden among females aged 15– 29 years in China and the Western Pacific Region (WPR).Methods: We analyzed GBD 2023 estimates of incidence, prevalence, and years lived with disability (YLDs) from 1990 to 2023. Analyses included the WPR and 31 countries and areas. We assessed age-standardized rates (ASR), EAPCs, Joinpoint trends, age-specific and Socio-demographic Index (SDI) patterns, and demographic contributions to changes in absolute burden.Results: At the WPR level, prevalent cases decreased from 1,876,232 (95% UI, 1,104,449 to 2,841,601) to 1,333,780 (95% UI: 794,707 to 1,989,545); incident cases and YLDs decreased by 32.3% and 28.7%, respectively. In 2023, New Zealand had the highest ASR, whereas China had the lowest rates but largest absolute burden. Temporal trends were non-linear despite overall declines. Across incidence, prevalence, and YLDs, AAPCs ranged from − 0.57% to − 0.52% in China and from − 0.36% to − 0.31% in the WPR and all 95% confidence intervals excluded zero. In 2023, age-specific prevalence and YLDs rate increased from ages 15– 19 to 25– 29 years in China, the WPR, and all SDI categories. Incidence was highest at ages 20– 24 years in the WPR and 25– 29 years in China. SDI was inversely correlated with ASR (P < 0.001). LOESS curves indicated non-linear relationships. Decomposition attributed most of the decline in absolute burden to population change.Conclusion: Endometriosis burden became increasingly apparent from adolescence into young adulthood despite declines in rates and numbers. Contrasting high-rate Pacific settings with populous high-number settings supports locally adapted reproductive health planning. Declining estimates should not be equated with proportional reductions in clinical need. Earlier recognition and youth responsive assessment and management of persistent pelvic pain warrant consideration across the region.Keywords: endometriosis, global burden of disease, western pacific region, China, adolescents and young women, reproductive health