Abstract
BACKGROUND: This study aims to systematically analyze the disease burden and epidemiological trends of mesothelioma at the global, regional, and national levels from 1990 to 2021, based on the Global Burden of Disease (GBD) 2021 database, and to explore its relationship with health inequality. METHOD: DALYs were calculated by integrating Years of Life Lost due to premature mortality (YLL) and Years Lost due to disability (YLD) to comprehensively assess the disease burden. Additionally, the study analyzes cross-country health inequalities using the Slope Index of Inequality (SII) and the Concentration Index (CI). RESULTS: Over the past 32 years, global mesothelioma prevalence, incidence, DALYs, and death cases have increased significantly. In 2021, prevalence and incidence rates were highest in the high SDI regions, while the fastest growth occurred in the middle SDI regions. At the national level, Qatar, Bahrain, and Kuwait experienced the largest increases. The 75–79 age group had the highest prevalence and death cases globally. The analysis of health inequity indicates that countries with higher SDI levels are facing a more severe disease burden. CONCLUSION: From 1990 to 2021, the disease burden of mesothelioma exhibited a sustained upward trend. The widening gap in DALYs rates between countries with the highest and lowest SDI levels highlights the growing health inequality. Therefore, there is an urgent need for effective public health policies aimed at reducing occupational exposure, alleviating disease burden, and narrowing health disparities between countries. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12885-025-14590-2.