The global and China endometriosis disease burden from 1990 to 2021: trend analysis and 2022 to 2040 forecast study_Chinese Journal of Evidence-Based Medicine

Authors：

SUN Yuchen ¹ , ZHAO Xiaobin ¹ , SHI Wei ² , WANG Runhan ¹ , WANG Zilu ¹ ,  DING Pingping ²

1. The First Clinical College of Shandong University of Traditional Chinese Medicine, Jinan 250014, P. R. China;
2. Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, P. R. China;

Corresponding?author：

DING Pingping, Email: ping727911@163.com

Keywords：

Endometriosis; Disease burden; Joinpoint regression model; ARIMA model; BAPC model; China; Global

DOI：

10.7507/1672-2531.202511051

Video：

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Objective To analyze temporal trends in the burden of endometriosis in China and globally from 1990 to 2021, and to project trends from 2022 to 2040. Methods Data on incidence, prevalence and disability-adjusted life years (DALYs) of endometriosis in China and worldwide from 1990 to 2021 were extracted from the Global Burden of Disease 2021 (GBD 2021) database. Joinpoint regression was used to estimate annual percentage changes. Autoregressive integrated moving average (ARIMA) models were constructed to forecast disease burden from 2022 to 2040, and Bayesian age-period-cohort (BAPC) models were applied for validation. Results From 1990 to 2021, the burden of endometriosis decreased both in China and globally, with a greater overall decline in China; however, age-standardized incidence and prevalence in China remained consistently higher than the global average. In China, the age pattern of onset showed a multimodal distribution, with peak ages occurring approximately 5-10 years later than those worldwide. ARIMA and BAPC projections suggested that from 2022 to 2040 all burden indicators in China will continue to decline steadily, while global indicators will also decrease but with smaller reductions and greater uncertainty. Conclusion The marked reduction in endometriosis burden in China reflects advances in medical care and supportive public health policies. Strengthening early screening and intervention during adolescence and the perimenopausal period is essential to further reduce the disease burden. Globally, more equitable allocation of medical resources and coordinated policy actions are needed to address the long-term challenges posed by endometriosis.

Citation： SUN Yuchen, ZHAO Xiaobin, SHI Wei, WANG Runhan, WANG Zilu, DING Pingping. The global and China endometriosis disease burden from 1990 to 2021: trend analysis and 2022 to 2040 forecast study. Chinese Journal of Evidence-Based Medicine, 2026, 26(4): 373-382. doi: 10.7507/1672-2531.202511051 Copy

1.	Saunders PTK, Whitaker LHR, Horne AW. Endometriosis: improvements and challenges in diagnosis and symptom management. Cell Rep Med, 2024, 5(6): 101596.
2.	Nnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril, 2011, 96(2): 366-373.
3.	Bonavina G, Taylor HS. Endometriosis-associated infertility: From pathophysiology to tailored treatment. Front Endocrinol (Lausanne), 2022, 13: 1020827.
4.	Xu S, Zhang Y, Ye P, et al. Global, regional, and national burden of endometriosis among women of childbearing age from 1990 to 2021: a cross-sectional analysis from the 2021 global burden of disease study. Int J Surg, 2025, 111(9): 5927-5940.
5.	薛芳芳, 王紅艷, 王穩瑩, 等. 基于年齡-時期-隊列模型的1990~2019年中國子宮內膜異位癥疾病負擔研究. 實用婦產科雜志, 2024, 40(12): 1013-1018.
6.	Chapron C, Marcellin L, Borghese B, et al. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol, 2019, 15(11): 666-682.
7.	GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2133-2161.
8.	Nong J, Su C, Li C, et al. Global, regional, and national epidemiology of childhood neuroblastoma (1990-2021): a statistical analysis of incidence, mortality, and DALYs. EClinicalMedicine, 2024, 79: 102964.
9.	Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 2000, 19(3): 335-351.
10.	Shafrir AL, Farland LV, Shah DK, et al. Risk for and consequences of endometriosis: a critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol, 2018, 51: 1-15.
11.	Shigesi N, Kvaskoff M, Kirtley S, et al. The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis. Hum Reprod Update, 2019, 25(4): 486-503.
12.	侯巖, 胡國臣, 主編. 中國衛生年鑒. 北京: 人民衛生出版社, 2010: 7-8.
13.	Huhtinen K, Suvitie P, Hiissa J, et al. Serum HE4 concentration differentiates malignant ovarian tumours from ovarian endometriotic cysts. Br J Cancer, 2009, 100(8): 1315-1319.
14.	Mckinnon B, Mueller MD, Nirgianakis K, et al. Comparison of ovarian cancer markers in endometriosis favours HE4 over CA125. Mol Med Rep, 2015, 12(4): 5179-5184.
15.	中國醫師協會婦產科醫師分會, 中華醫學會婦產科學分會子宮內膜異位癥協作組. 子宮內膜異位癥診治指南(第三版). 中華婦產科雜志, 2021, 56(12): 812-824.
16.	黃少安. 理性認識中國人口總量和結構變化. 江海學刊, 2024, (3): 69-78.
17.	肖贏成, 賈英男, 等. 20~39歲育齡女性婦科癥狀現狀及就醫行為影響因素分析. 中國婦幼保健, 2024, 39(16): 3125-3129.
18.	孫剛, 張宇瑤, 等. 成年女性對婦科檢查的認知情況研究. 中國醫藥導報, 2018, 15(29): 50-53.
19.	樊子暄. 我國婦女常見病的流行現狀、檢查參與率及就醫選擇研究. 北京: 北京協和醫學院, 2024.
20.	Agarwal SK, Chapron C, Giudice LC, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol, 2019, 220(4): 354.e1-354. e1-354.
21.	郭冬生, 林煒靜. 第四次世界婦女大會以來我國婦女教育研究綜述. 中華女子學院學報, 2024, 36(2): 49-57.
22.	葛懷舉, 董士紅, 蘇文鈺, 等. 流動人口中孕齡期女性健康教育現狀及其影響因素分析—基于東、中、西部地區差異的比較分析. 中國衛生事業管理, 2024, 41(11): 1275-1279.
23.	Luo D, Yan X, Xu R, et al. Chinese trends in adolescent marriage and fertility between 1990 and 2015: a systematic synthesis of national and subnational population data. Lancet Glob Health, 2020, 8(7): e954-e964.
24.	Lan M, Kuang Y. Evolutionary trends in fertility among Chinese women, 1990-2015. Reprod Health, 2021, 18(1): 64.
25.	Levy L, Tsaltas J. Recent advances in benign gynecological laparoscopic surgery. Fac Rev, 2021, 10: 60.
26.	Piriyev E, Schiermeier S, R?mer T. Hormonal treatment of endometriosis: a narrative review. Pharmaceuticals (Basel), 2025, 18(4): 588.
27.	Shen DY, Li J, Hu P, et al. Global, regional, and national prevalence and disability-adjusted life-years for endometriosis in 204 countries and territories, 1990-2019: findings from a global burden of disease study. Eur J Obstet Gynecol Reprod Biol X, 2024, 25: 100363.
28.	Li R, Zhang L, Liu Y. Global and regional trends in the burden of surgically confirmed endometriosis from 1990 to 2021. Reprod Biol Endocrinol, 2025, 23(1): 88.
29.	Sun X, He L, Wang S. Knowledge and awareness of endometriosis among women in Southwest China: a cross-sectional study. BMC Womens Health, 2025, 25(1): 113.
30.	Westwood S, Fannin M, Ali F, et al. Disparities in women with endometriosis regarding access to care, diagnosis, treatment, and management in the United States: a scoping review. Cureus, 2023, 15(5): e38765.

1. Saunders PTK, Whitaker LHR, Horne AW. Endometriosis: improvements and challenges in diagnosis and symptom management. Cell Rep Med, 2024, 5(6): 101596.
2. Nnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril, 2011, 96(2): 366-373.
3. Bonavina G, Taylor HS. Endometriosis-associated infertility: From pathophysiology to tailored treatment. Front Endocrinol (Lausanne), 2022, 13: 1020827.
4. Xu S, Zhang Y, Ye P, et al. Global, regional, and national burden of endometriosis among women of childbearing age from 1990 to 2021: a cross-sectional analysis from the 2021 global burden of disease study. Int J Surg, 2025, 111(9): 5927-5940.
5. 薛芳芳, 王紅艷, 王穩瑩, 等. 基于年齡-時期-隊列模型的1990~2019年中國子宮內膜異位癥疾病負擔研究. 實用婦產科雜志, 2024, 40(12): 1013-1018.
6. Chapron C, Marcellin L, Borghese B, et al. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol, 2019, 15(11): 666-682.
7. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2133-2161.
8. Nong J, Su C, Li C, et al. Global, regional, and national epidemiology of childhood neuroblastoma (1990-2021): a statistical analysis of incidence, mortality, and DALYs. EClinicalMedicine, 2024, 79: 102964.
9. Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 2000, 19(3): 335-351.
10. Shafrir AL, Farland LV, Shah DK, et al. Risk for and consequences of endometriosis: a critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol, 2018, 51: 1-15.
11. Shigesi N, Kvaskoff M, Kirtley S, et al. The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis. Hum Reprod Update, 2019, 25(4): 486-503.
12. 侯巖, 胡國臣, 主編. 中國衛生年鑒. 北京: 人民衛生出版社, 2010: 7-8.
13. Huhtinen K, Suvitie P, Hiissa J, et al. Serum HE4 concentration differentiates malignant ovarian tumours from ovarian endometriotic cysts. Br J Cancer, 2009, 100(8): 1315-1319.
14. Mckinnon B, Mueller MD, Nirgianakis K, et al. Comparison of ovarian cancer markers in endometriosis favours HE4 over CA125. Mol Med Rep, 2015, 12(4): 5179-5184.
15. 中國醫師協會婦產科醫師分會, 中華醫學會婦產科學分會子宮內膜異位癥協作組. 子宮內膜異位癥診治指南(第三版). 中華婦產科雜志, 2021, 56(12): 812-824.
16. 黃少安. 理性認識中國人口總量和結構變化. 江海學刊, 2024, (3): 69-78.
17. 肖贏成, 賈英男, 等. 20~39歲育齡女性婦科癥狀現狀及就醫行為影響因素分析. 中國婦幼保健, 2024, 39(16): 3125-3129.
18. 孫剛, 張宇瑤, 等. 成年女性對婦科檢查的認知情況研究. 中國醫藥導報, 2018, 15(29): 50-53.
19. 樊子暄. 我國婦女常見病的流行現狀、檢查參與率及就醫選擇研究. 北京: 北京協和醫學院, 2024.
20. Agarwal SK, Chapron C, Giudice LC, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol, 2019, 220(4): 354.e1-354. e1-354.
21. 郭冬生, 林煒靜. 第四次世界婦女大會以來我國婦女教育研究綜述. 中華女子學院學報, 2024, 36(2): 49-57.
22. 葛懷舉, 董士紅, 蘇文鈺, 等. 流動人口中孕齡期女性健康教育現狀及其影響因素分析—基于東、中、西部地區差異的比較分析. 中國衛生事業管理, 2024, 41(11): 1275-1279.
23. Luo D, Yan X, Xu R, et al. Chinese trends in adolescent marriage and fertility between 1990 and 2015: a systematic synthesis of national and subnational population data. Lancet Glob Health, 2020, 8(7): e954-e964.
24. Lan M, Kuang Y. Evolutionary trends in fertility among Chinese women, 1990-2015. Reprod Health, 2021, 18(1): 64.
25. Levy L, Tsaltas J. Recent advances in benign gynecological laparoscopic surgery. Fac Rev, 2021, 10: 60.
26. Piriyev E, Schiermeier S, R?mer T. Hormonal treatment of endometriosis: a narrative review. Pharmaceuticals (Basel), 2025, 18(4): 588.
27. Shen DY, Li J, Hu P, et al. Global, regional, and national prevalence and disability-adjusted life-years for endometriosis in 204 countries and territories, 1990-2019: findings from a global burden of disease study. Eur J Obstet Gynecol Reprod Biol X, 2024, 25: 100363.
28. Li R, Zhang L, Liu Y. Global and regional trends in the burden of surgically confirmed endometriosis from 1990 to 2021. Reprod Biol Endocrinol, 2025, 23(1): 88.
29. Sun X, He L, Wang S. Knowledge and awareness of endometriosis among women in Southwest China: a cross-sectional study. BMC Womens Health, 2025, 25(1): 113.
30. Westwood S, Fannin M, Ali F, et al. Disparities in women with endometriosis regarding access to care, diagnosis, treatment, and management in the United States: a scoping review. Cureus, 2023, 15(5): e38765.

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