Abstract
BACKGROUND: Unsafe sex remains a critical threat to the life and health of females. Following the latest Global Burden of Disease (GBD) 2021 estimates, this study updated the global spatiotemporal trends of disease burden attributable to unsafe sex in females, and firstly conducted forecasts to 2035, to guide the resource allocation and the development of public health strategies. METHODS: The number and age-standardized rates (ASRs) of unsafe-sex-related deaths and disability-adjusted life years (DALYs) in females from 1990 to 2021 were retrieved from GBD 2021. The estimated annual percentage change (EAPC) was calculated to quantify the temporal trends in rates. The Autoregressive Integrated Moving Average model was conducted to estimate the future burden. RESULTS: Globally, the absolute number of female burden due to unsafe sex peaked in the early 2000s and subsequently decreased to 619,130 deaths and 28,782,771 DALYs by 2021. The ASRs showed similar patterns. For age effects, the highest burden was observed among females aged 35-44 years. Besides, there were significant geographic disparities negatively associating with local SDI values, with the low-, low-middle- and middle-SDI regions accounting for nearly 80% of the total. The most severe situation always occurred in Sub-Sahara Africa in spite of downward trends observed with time, while Eastern Europe had a significant increase in the associated burden. Finally, the unsafe-sex-related ASRs was projected to continue declining modestly until 2035. CONCLUSIONS: Despite overall declines, unsafe sex remains a significant health threat to females, particularly in low- to middle-SDI regions and among females of reproductive age. The persistent high burden underscored the need for sustained and targeted public health strategies, including the promotion of safe sexual practices, HPV vaccination, and improved access to healthcare services.