Table 1_Global, regional, and national burden of endocrine, metabolic, blood, and immune disorders from 1990 to 2021, and projections to 2050: a systematic analysis of the global burden of disease study.xlsx

BackgroundEndocrine, metabolic, blood, and immune disorders (EMBID) are a leading cause of morbidity and mortality worldwide, with substantial regional disparities. Despite advancements in diagnosis and treatment, the burden of EMBID continues to rise. This study aimed to comprehensively assess the global, regional, and national burden of EMBID from 1990 to 2021, with projections to 2050.
MethodsWe conducted a systematic analysis using data from the GBD 2021, covering 204 countries and territories, 21 GBD regions, and five Socio-demographic Index (SDI) groups. Age-standardized rates of incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for EMBID were estimated using the GBD analytical framework. Temporal trends were assessed using estimated annual percentage change (EAPC) derived from log-linear regression. Bayesian age-period-cohort (BAPC) models were applied for projections to 2050. Decomposition analysis attributed changes in disease burden to population growth, aging, and epidemiological shifts.
ResultsIn 2021, the global incidence of EMBID was 79.47 million (95% UI 63.34–98.63 million), with an age-standardized rate of 957.58 (95% UI 766.99–1,183.95) per 100,000, showing a slight decline (EAPC: -0.24% [95% CI -0.35 – -0.12]). Prevalence reached 475.78 million (95% UI 381.23–591.19 million), while deaths rose to 175,902 (95% UI 154,306–190,755; EAPC: 0.75% [95% CI 0.67–0.83]). DALYs totaled 12.86 million (95% UI 9.94–16.98 million), with an age-standardized rate of 157.66 (95% UI 122.38–206.92) per 100,000 (EAPC: -0.09% [95% CI -0.16 – -0.02]). Females had higher incidence and prevalence, while males showed higher mortality. Older adults (≥70 years) experienced the highest burden. Decomposition analysis attributed rising DALYs to population aging (26.02%) and growth (85.83%). Regionally, high-SDI regions showed declining incidence, while low-SDI regions had limited progress. Projections to 2050 indicate declining incidence and prevalence but rising mortality among older adults.
ConclusionThe global burden of EMBID has demonstrated substantial geographical and temporal variability, with lower-SDI regions bearing the highest burden. Addressing these disparities requires enhanced preventive measures, improved healthcare access, and targeted interventions, particularly in low- and middle-income countries.

背景 内分泌、代谢、血液及免疫疾病（Endocrine, metabolic, blood, and immune disorders, EMBID）是全球范围内导致发病与死亡的首要病因，且存在显著的区域差异。尽管诊断与治疗技术已取得进展，但该类疾病的疾病负担仍持续攀升。本研究旨在全面评估1990年至2021年内分泌、代谢、血液及免疫疾病的全球、区域与国家层面疾病负担，并对2050年的疾病负担进行预测。
方法 本研究基于2021年全球疾病负担研究（Global Burden of Disease Study 2021, GBD 2021）的数据开展系统性分析，涵盖204个国家与地区、21个GBD区域以及5个社会人口指数（Socio-demographic Index, SDI）分组。本研究采用GBD分析框架，估算了内分泌、代谢、血液及免疫疾病的年龄标准化发病率、患病率、死亡率与伤残调整生命年（disability-adjusted life years, DALYs）。通过对数线性回归得到的估计年度百分比变化（estimated annual percentage change, EAPC）分析时间趋势；采用贝叶斯年龄-时期-队列（Bayesian age-period-cohort, BAPC）模型对2050年的疾病负担进行预测。通过分解分析，将疾病负担的变化归因于人口增长、人口老龄化与流行病学转变。
结果 2021年，全球内分泌、代谢、血液及免疫疾病的新发例数为7947万（95%不确定性区间[UI]：6334万~9863万），年龄标准化发病率为每10万人957.58例（95% UI：766.99~1183.95），呈小幅下降趋势（估计年度百分比变化EAPC：-0.24%，95%置信区间[CI]：-0.35%~-0.12%）。患病率达47578万（95% UI：38123万~59119万），死亡人数升至175902例（95% UI：154306~190755；EAPC：0.75%，95% CI：0.67%~0.83%）。伤残调整生命年（DALYs）总数为1286万（95% UI：994万~1698万），年龄标准化率为每10万人157.66个（95% UI：122.38~206.92），EAPC为-0.09%（95% CI：-0.16%~-0.02%）。女性的发病率与患病率均高于男性，而男性的死亡率更高。老年人群（≥70岁）的疾病负担最重。分解分析结果显示，伤残调整生命年的上升可归因于人口老龄化（26.02%）与人口增长（85.83%）。区域层面，高SDI区域的发病率呈下降趋势，而低SDI区域进展有限。对2050年的预测结果显示，发病率与患病率将呈下降趋势，但老年人群的死亡率将上升。
结论 全球内分泌、代谢、血液及免疫疾病的疾病负担呈现显著的地理与时间异质性，低SDI区域承担了最重的疾病负担。要缓解这类疾病负担差异，需要强化预防措施、改善医疗服务可及性并开展针对性干预，尤其在中低收入国家。