Abstract
BACKGROUND: Endometriosis is highly prevalent but remains under-researched. This study, using the latest data, aims to provide a comprehensive assessment of the burden of endometriosis on a global scale. METHODS: Based on data from the Global Burden of Disease (GBD) 2021, we analyzed the disease burden of endometriosis in terms of incidence, prevalence, and disability-adjusted life years (DALYs), focusing regional distribution and associations with the Sociodemographic index (SDI), age distribution and temporal trends, and decomposition analysis. RESULTS: The disease burden of endometriosis globally and across most of countries and territories was increasing from 1990 to 2021, though the age-standardized prevalence rates (ASPR), age-standardized incidence rates (ASIR) and age-standardized DALY rates (ASR-DALY) reduced. Decomposition analysis indicates that population growth was the dominant increasing factor, while disease frequency was the primary factor reducing the burden. At the SDI level, the burden of endometriosis decreased with increasing SDI. In 15-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54 age groups, the disease burden increased slightly from 1990 to 2021 and may continue to rise through 2050, despite declining age-specific rates of prevalence, incidence, and DALYs. The highest incidence rates were recorded in the 20-24 age group and the disease burden peaked in the 25-29 age group, highlighting its impact on women of reproductive age. CONCLUSIONS: Despite declining age-standardized rates, the global burden of endometriosis has risen due to demographic growth and is closely linked to social development. Targeted efforts -- including early detection, timely intervention, and resource investment -- are essential, particularly for younger women at highest risk.