The global, regional, and national burden of paralytic ileus and intestinal obstruction, 1990 to 2021: a cross-sectional analysis from the 2021 global burden of disease study
Authors: Han Tingfen , Wang Tingting , Ye Yuping , Ying Cao , Wang Xuequan , Liu Shuai 
Published: December 2024

Background:
Paralytic ileus and intestinal obstruction (PIAIO) pose significant public health concerns, given the notable scarcity of current research on their disease burden and trends. This study evaluated the global burden of PIAIO from 1990 to 2021 and forecasted their future burden over the next three decades.

Methods:
Using the latest data from Global Burden of Disease Study (GBD) 2021, we obtained the prevalence, incidence, mortality and disability adjusted life years (DALYs) data for these conditions, along with their corresponding age-standardized rate (ASR) indicators. Data were stratified by time, location, age and socio-demographic index (SDI). This study employed comprehensive analyses over 32 years (1990-2021) to reveal trends in PIAIO, using advanced statistical methods including estimated Annual percentage change (EAPC), Joinpoint regression, health inequity analysis (slope index and concentration index), decomposition analysis, frontier analysis and predictive modeling (Nordpred method).

Results:
In 2021, the global age-standardized rates for prevalence (ASPR), incidence (ASIR), mortality (ASMR), and DALYs (ASDR) were 7.38 (95%UI: 7.12–7.65), 191.92 (95%UI: 185.41–198.80), 2.88 (95%UI: 2.52–3.22), and 84.49 (95%UI: 72.58–94.16), respectively. High SDI regions exhibited high ASPR, high ASIR, but low ASDR and ASMR. Males generally exhibited higher prevalence and incidence rates across most age groups, while females showed higher mortality and DALY rates in specific age brackets. The epidemiological indicators of the age group under 5 years old and the elderly are relatively high. The joinpoint regression analysis indicated fluctuating increases in ASPR and ASIR, and nearly linear declines in ASMR and ASDR over the past 32 years. Health inequity analyses of the slope indices of ASPR and ASIR suggested an exacerbation of inequality in certain health indicators over the past 32 years, while those of ASMR and ASDR indicate potential improvements in inequality in certain health outcomes. Concentration index analysis confirms a significant reduction in inequality for ASPR and ASIR, with marginal changes for ASMR and ASDR, highlighting persistent health disparities in certain areas despite overall improvements. The decomposition analysis of global and across SDI regions indicated that population and aging have increased the DALYs burden, while epidemiological changes have reduced the disease burden. The frontier analysis suggested greater potential for improvement in low SDI regions. Nordpred predictive analysis forecasts a slight increase in ASPR and ASIR by 2050, with a significant in ASMR.

Conclusion:
PIAIO represent substantial global health and economic challenges. Anticipated population growth and aging will exacerbate burdens, highlighting the urgency of addressing critical need for targeted prevention and control strategies. Health system managers should develop robust plans to mitigate these escalating health challenges.