BMC Gastroenterology (Apr 2025)
Global burden of gallbladder and biliary diseases (1990–2021) with healthcare workforce analysis and projections to 2035
Abstract
Abstract Background Gallbladder and biliary tract diseases pose a significant global health burden, yet comprehensive analyses of their long-term epidemiological trends and future projections remain limited. This study aims to examine the temporal and spatial patterns of these diseases globally from 1990 to 2021, analyze healthcare workforce distribution relative to disease burden, and project the disease burden to 2035. Methods Using data from the Global Burden of Disease Study 2021, we analyzed incidence, prevalence, disability-adjusted life years (DALYs), and mortality for gallbladder and biliary tract diseases. We employed the Estimated Annual Percentage Change (EAPC) to assess trends, decomposition analysis to identify drivers of change, health inequality analysis to evaluate distributional disparities, and the Bayesian Age-Period-Cohort (BAPC) model for projections to 2035. Additionally, we examined correlations between healthcare workforce density and disease burden across countries. Results The global age-standardized incidence rate decreased by 12.84% from 1990 to 865.4 per 100,000 population in 2021, while the absolute number of cases increased by 60.11%. Age-standardized prevalence decreased by 13.31%, DALYs by 20.98%, and mortality by 28%. Decomposition analysis revealed that population aging contributed 95.37% and population growth 73.96% to the increase in global deaths, while epidemiological improvements offset 69.33% of this increase. High SDI regions had significantly higher disease burden, with Western Europe showing the highest prevalence (4,009.85 per 100,000). Our healthcare workforce analysis revealed substantial disparities; high-burden Honduras had only 48.3 health workers per 10,000 population (8.4 physicians), while Austria had 385.5 (45.6 physicians), despite similar disease prevalence. Health inequality increased between 1990 and 2021, with the concentration index for mortality rising from 0.24 to 0.31. By 2035, despite decreasing age-standardized rates, the absolute number of cases is projected to increase by 20.3%, DALYs by 26.1%, and deaths by 36.9%, primarily driven by demographic changes. Conclusion The increasing absolute burden of gallbladder and biliary diseases despite improvements in age-standardized rates necessitates targeted interventions. Health systems should implement enhanced screening programs for high-risk populations, expand surgical workforce capacity in underserved regions, develop region-specific clinical guidelines for early intervention, and adopt policies addressing modifiable risk factors such as obesity and diet. Strategic healthcare workforce planning is crucial, as our analysis revealed significant imbalances in both the density and composition of healthcare personnel relative to disease burden.
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