Global burden of gallbladder and biliary diseases in adolescents and young adults, 1990–2021, with projections to 2040: an analysis of the global burden of disease study 2021

BACKGROUND: Gallbladder and biliary diseases are assessed across all ages, obscuring their burden before age 40. We assessed burden, trends, disparities, attributable risks, and projections to 2040 among adolescents and young adults. METHODS: We conducted a repeated cross-sectional analysis using the Global Burden of Disease (GBD) Study 2021. Age-standardized prevalence, incidence, and disability-adjusted life-year (DALY) rates were estimated for ages 15-39 years during 1990-2021. Trends were quantified using estimated annual percentage changes (EAPCs) and examined by sex, Socio-demographic Index (SDI) quintiles and geographic regions. Age-specific patterns, associations with SDI, attributable DALY fractions, and projections to 2040 were assessed. RESULTS: From 1990 to 2021, global age-standardized prevalence, incidence, and DALY rates decreased by 13.0%, 12.1%, and 16.9%, respectively. However, absolute burdens increased: prevalent cases by 24.9%, incident cases by 26.3%, and DALYs by 19.2%. Prevalence increased in high- and high-middle-SDI quintiles and most rapidly in East Asia, and incidence increased in higher-SDI settings. Females and individuals aged 35-39 years had higher rates. The fraction of DALYs attributable to high body-mass index increased from 21.2% to 31.7%, whereas the smoking-attributable fraction declined from 4.4% to 3.3%. By 2040, age-standardized prevalence and incidence rates were projected to remain near 2021 levels, but prevalent and incident cases were projected to increase by 7.6% and 11.1%, respectively. CONCLUSIONS: Global age-standardized rates declined, but these trends concealed sex, age, socioeconomic, and geographical disparities. The increasing contribution of high body-mass index and projected growth in absolute case numbers support prevention and service planning before mid-adulthood.