Global, Regional, and National Prevalence of Inguinal, Femoral, and Abdominal Hernias from 1990 to 2021: Age-Period-Cohort Analysis with Future Burden Prediction

Abstract

BackgroundHernias remain a significant global health issue. It is estimated that approximately 20 million inguinal hernia repairs are performed annually worldwide. This figure is expected to increase as the global population continues to grow and age. Consequently, we utilized the Global Burden of Disease (GBD) database to analyze the current status of the global hernia burden and to project trends in this burden through 2035.MethodsWe analyzed the GBD 2021 database to assess the burden of inguinal, femoral, and ventral hernias across 204 countries and territories worldwide from 1990 to 2021. We collected data on incidence, mortality, age-standardized incidence rates (ASIR), and age-standardized mortality rates (ASMR). Additionally, we examined the effects of age, period, and cohort on the trends in hernia incidence and mortality using an age-period-cohort (APC) model. A total of 20 age cohorts were established using 5-year intervals for both age and time periods. Furthermore, we employed connected-point regression analysis to identify key years associated with changes in the age-standardized rates (ASR) of total hernias. Taking into account current and future demographic changes, we utilized Bayesian age-period cohort (BAPC) modeling to predict hernia incidence, the corresponding number of deaths, and ASR through 2035.ResultsThis study demonstrated that from 1990 to 2021, the global incidence of hernia cases increased by 25.49%, reaching a total of 7.24 million cases, while the corresponding ASR decreased by 16%. Additionally, the global mortality rate associated with hernias rose by 13.99%, despite a 45.16% reduction in the ASMR. Between 1990 and 2021, significant downward trends in both the ASIR and ASMR were observed across most Socio-Demographic Index (SDI) regions. The prognosis for hernias is more favorable in populations residing in areas with high SDI. Furthermore, the global prevalence of hernias is significantly higher in men than in women, with both morbidity and mortality progressively increasing with age. Older adults, particularly men aged 60 to 70 years, exhibit a higher incidence of hernias, while the highest mortality rates are observed in individuals around the age of 80 years. Projections from 1990 to 2035 indicate that by 2035, global hernia morbidity and mortality will continue to rise, while ASIR and ASMR are expected to decline.ConclusionsThe results of this study indicate that global morbidity and mortality associated with inguinal, femoral, and ventral hernias continue to rise. The burden of these conditions varies across different regions and countries. Incidence and mortality rates for hernias remain higher among older adults and men. In conclusion, inguinal, femoral, and ventral hernias represent a significant public health challenge that must not be overlooked. Therefore, healthcare strategies aimed at reducing the incidence of inguinal, femoral, and abdominal hernias should be further developed and implemented.

Keywords: hernia, the global burden of disease, the bayesian age-period cohort, age standardized rate, the sociodemographic index, the age-period-cohort model