Global, Regional, and National Burden of Blindness and Vision Loss in Individuals Aged 0 to 24 Years, 1990 to 2021: Divergent Trends, Inequalities and Projections Based on Global Burden of Disease 2021.

To analyze the trends in the disease burden of schistosomiasis in China from 1992 to 2021, and to project the disease burden of schistosomiasis in China from 2022 to 2030, so as to provide insights into the elimination of schistosomiasis in China. The prevalence, age-standardized prevalence, disability-adjusted life year (DALYs) rate and age-standardized DALYs rate of schistosomiasis, as well as the years lost due to disability (YLDs) rate and age-standardized YLDs rate of anemia attributable to Schistosoma infections in China, the world and different socio-demographic index (SDI) regions were captured from the Global Burden of Disease Study 2021 (GBD 2021) data resources, and the trends in the disease burden due to schistosomiasis were evaluated with estimated annual percentage change (EAPC) and its 95% confidence interval (CI). In addition, the age, period and cohort effects on the prevalence of schistosomiasis were examined in China using an age-period-cohort (APC) model, and the disease burden of schistosomiasis was predicted in China from 2022 to 2030 using a Bayesian age-period-cohort (BAPC) model. The age-standardized prevalence and DALYs rate of schistosomiasis, and the age-standardized YLDs rate of anemia attributable to Schistosoma infections were 761.32/105, 5.55/105 and 0.38/105 in China in 2021. These rates were all lower than the global levels (1 914.30/105, 21.90/105 and 3.36/105, respectively), as well as those in the medium SDI regions (1 413.61/105, 12.10/105 and 1.93/105, respectively), low-medium SDI regions (2 461.03/105, 26.81/105 and 4.48/105, respectively), and low SDI regions (5 832.77/105, 94.48/105 and 10.65/105, respectively), but higher than those in the high SDI regions (59.47/105, 0.49/105 and 0.05/105, respectively) and high-medium SDI regions (123.11/105, 1.20/105 and 0.12/105, respectively). The prevalence and DALYs rate of schistosomiasis were higher among men (820.79/105 and 5.86/105, respectively) than among women (697.96/105 and 5.23/105, respectively) in China in 2021, while the YLDs rate of anemia attributable to Schistosoma infections was higher among women (0.66/105) than among men (0.12/105). The prevalence of schistosomiasis peaked at ages of 30 to 34 years among both men and women, while the DALYs rate of schistosomiasis peaked among men at ages of 15 to 19 years and among women at ages of 20 to 24 years. The age-standardized prevalence of schistosomiasis showed a moderate decline in China from 1992 to 2021 relative to different SDI regions [EAPC = -1.51%, 95% CI: (-1.65%, -1.38%)], while the age-standardized DALYs rate [EAPC = -3.61%, 95% CI: (-3.90%, -3.33%)] and age-standardized YLDs rate of anemia attributable to Schistosoma infections [EAPC = -4.16%, 95% CI: (-4.38%, -3.94%)] appeared the fastest decline in China from1992 to 2021 relative to different SDI regions. APC modeling showed age, period, and cohort effects on the trends in the prevalence of schistosomiasis in China from 1992 to 2021, and the prevalence of schistosomiasis appeared a rise followed by decline with age, and reduced with period and cohort. BAPC modeling revealed that the age-standardized prevalence and age-standardized DALYs rate of schistosomiasis, and age-standardized YLDs rate of anemia attributable to Schistosoma infections all appeared a tendency towards a decline in China from 2022 to 2030, which reduced to 722.72/105 [95% CI: (538.74/105, 906.68/105)], 5.19/105 [95% CI: (3.54/105, 6.84/105)] and 0.30/105 [95% CI: (0.21/105, 0.39/105)] in 2030, respectively. The disease burden of schistosomiasis appeared a tendency towards a decline in China from 1992 to 2021, and is projected to appear a tendency towards a decline from 2022 to 2030. There are age, period and cohort effects on the prevalence of schistosomiasis in China. Precision schistosomiasis control is required with adaptations to current prevalence and elimination needs.

BackgroundThe findings of the 2021 Global Burden of Disease (GBD) study can offer valuable insights for the development of screening and prevention strategies targeting ischemic heart disease (IHD). We aim to investigate trends in IHD incidence, mortality, and disability-adjusted life years (DALYs), while exploring associated risk factors for IHD-associated death from 1990 to 2021.MethodsThe cross-sectional study utilized data from the GBD 2021, covering 204 countries and regions. The analysis included individuals aged 55 and above. We analyzed the trends in IHD incidence, all cause and cause-specific deaths, DALYs, and corresponding estimated annual percentage changes (EAPCs) from 1990 to 2021. These indicators were further stratified by geographical region, country, age group, gender, and sociodemographic index (SDI).ResultsThe global incidence rate, mortality rate, and DALYs rate for individuals aged 55 and above with IHD have shown a decreasing trend. However, the number of incident cases, death cases, and DALYs has been increasing from 1990 to 2021. Both the high-middle and high SDI regions exhibit a significant decline in these rates from 1990 to 2021. However, the low SDI, low-middle SDI, and middle SDI regions show less noticeable changes. The region with low-middle SDI experiences the largest increase in mortality rate (EAPC: 0.38; 95%CI, 0.33–0.44) and DALYs rate (EAPC: 0.17; 95%CI, 0.12–0.22). The region with middle SDI experiences the largest increase in incidence rate (EAPC: 0.37; 95%CI, 0.27–0.46). Regionally, East Asia exhibits the greatest increase in incidence rate (EAPC: 0.94; 95% CI, 0.79–1.10), mortality rate (EAPC: 1.68; 95% CI, 1.40–1.94), and DALYs rate (EAPC: 0.94; 95% CI, 0.69–1.20). Among the 12 risk factors associated with mortality from IHD, high systolic blood pressure, dietary risks, high low-density lipoprotein (LDL) cholesterol levels, and air pollution are identified as the primary contributors to global mortality.ConclusionsThis study reveals that in high SDI regions, the incidence, mortality, and DALYs rate of IHD are declining. Conversely, in low to middle SDI regions, the disease burden of IHD is increasing. It highlights global inequality in IHD burden. Recommendations include early screening, risk management, and strengthening primary care, especially in middle and low SDI regions. Countries should also invest in environmental governance and air pollution control. Future research should focus on evaluating the effects of health policies in different countries, exploring the impact of socio-economic and cultural factors on the burden of IHD, and developing big data-based prediction models to optimize resource allocation and intervention strategies.

BackgroundType 2 diabetes mellitus (T2DM) increases the risk of liver cancer among people living with hepatitis B virus (HBV). Our study aimed to estimate the global burden and trends of liver cancer attributable to comorbid T2DM among people living with HBV from 1990 to 2019.MethodsWe calculated the population attributable fractions (PAFs) of liver cancer attributable to comorbid T2DM among the burden of HBV-related liver cancer. We applied the PAFs to the burden of HBV-related liver cancer derived from the Global Burden of Disease (GBD) 2019 database to obtain the burden of liver cancer attributable to HBV–T2DM comorbidity. The prevalence, disability-adjusted life year (DALY), and deaths of liver cancer attributable to the comorbidity were assessed at the global, regional, and country levels and then stratified by the sociodemographic index (SDI), sex, and age group. Estimated annual percentage changes (EAPCs) were calculated to quantify the temporal trends.ResultsIn 2019, the global age-standardized prevalence and DALY rates of liver cancer attributable to HBV–T2DM comorbidity were 9.9 (8.4–11.5) and 182.4 (154.9–212.7) per 10,000,000 individuals, respectively. High-income Asia Pacific and East Asia had the highest age-standardized prevalence and DALY rates of liver cancer attributable to HBV–T2DM comorbidity, respectively. From 1990 to 2019, age-standardized prevalence and DALY rates increased in 16 out of 21 GBD regions. High-income North America had the largest annual increases in both age-standardized prevalence rates (EAPC = 6.07; 95% UI, 5.59 to 6.56) and DALY rates (EAPC = 4.77; 95% UI, 4.35 to 5.20), followed by Australasia and Central Asia. Across all SDI regions, the high SDI region exhibited the most rapid increase in age-standardized prevalence and DALY rates from 1990 to 2019. Additionally, men had consistently higher disease burdens than women across all age groups. The patterns of mortality burden and trends are similar to those of DALYs.ConclusionsThe burden of liver cancer attributable to comorbid T2DM among people living with HBV has exhibited an increasing trend across most regions over the last three decades. Tailored prevention strategies targeting T2DM should be implemented among individuals living with HBV.

ObjectiveTo determine the patterns and trends in the global, regional, and national burden of oral disorders among adolescents and young adults (AYA) from 1990 to 2021.MethodsThis is an epidemiological observational study that analyzed annual prevalence and disability-adjusted life years (DALYs) for oral disorders—including dental caries, periodontal disease, edentulism, and other oral conditions—among adolescents and young adults (ages 10–24) from 1990 to 2021. Data were sourced from the Global Burden of Disease Study (GBD) 2021. To assess temporal trends, the estimated annual percentage changes (EAPC) in age-standardized prevalence and DALY rates were calculated at global, regional, and national levels. The GBD 2021 also provides sociodemographic index (SDI) data across 204 countries and territories. Pearson correlation analyses were conducted to explore the relationships between age-standardized prevalence and DALY rates with the SDI and their respective EAPCs.ResultsGlobally, the prevalent cases of oral disorders increased by 17.1%, from 549.2 million in 1990 to 643.3 million in 2021, and DALYs rose by 22.2%, from 1.4 million in 1990 to 1.7 million in 2021. The overall age-standardized prevalence rate (EAPC = − 0.07 [95% CI, − 0.12 to − 0.03]) decreased, while the age-standardized DALY rate (EAPC = 0.06 [0.02 to 0.11]) increased over the same period. While the burden of dental caries declined, the burden of periodontitis and edentulism significantly increased. A negative correlation was observed between age-standardized prevalence and DALY rates and SDI, while a positive correlation was found between the EAPC of age-standardized DALY rates and SDI.ConclusionsThe prevalence and DALYs of oral disorders among AYA have risen over the past three decades, particularly due to the growing burden of periodontitis and edentulism. Notably, the most significant increases have been observed in Southern Latin America and South Asia. While the global decline in dental caries has led to a reduction in ASPR, the escalating burden of periodontal disease and edentulism remains a critical concern. These trends emphasize the urgent need for innovative prevention and intervention strategies to improve oral health for this demographic worldwide.

To investigate the trends in the global burden due to cystic echinococcosis from 1990 to 2021, and to predict the global burden of cystic echinococcosis from 2022 to 2035, so as to provide insights into formulation of the cystic echinococcosis control strategy. The global age-standardized prevalence, mortality, disability-adjusted life years (DALYs) rates and their 95% uncertainty intervals (UI) of cystic echinococcosis from 1990 to 2021 were captured from the Global Burden of Disease Study 2021 (GBD 2021) database, and the trends in the global burden of cystic echinococcosis from 1990 to 2021 were analyzed using the Joinpoint regression model. The associations between the global burden of cystic echinococcosis and socio-demographic index (SDI) were examined using a smoothing spline model and frontier analysis, and the global burden of cystic echinococcosis was projected from 2022 to 2035 using the Bayesian age-period-cohort (BAPC) model. The global agestandardized prevalence, mortality and DALYs rates of cystic echinococcosis were 7.69/105 [95% UI: (6.27/105, 9.51/105)], 0.02/105 [95% UI: (0.01/105, 0.02/105)], and 1.32/105 [95% UI: (0.99/105, 1.69/105)] in 2021. The global age-standardized prevalence of cystic echinococcosis appeared a tendency towards a rise by 0.14% per year from 1990 to 2021, and the global age-standardized mortality and DALYs rates of cystic echinococcosis appeared a tendency towards a decline by 4.68% and 4.01% per year from 1990 to 2021, respectively. Joinpoint regression analysis showed that global age-standardized prevalence of cystic echinococcosis appeared a tendency towards a decline from 1990 to 2000 [annual percent change (APC) = -0.66%, 95% confidence interval (CI): (-0.70%, -0.61%)] and from 2005 to 2015 [APC = -0.88%, 95% CI: (-0.93%, -0.82%)], and towards a rise from 2000 to 2005 [APC = 3.68%, 95% CI: (3.49%, 3.87%)] and from 2015 to 2021 [APC=0.30%, 95%CI: (0.19%, 0.40%)].Theagestandardized prevalence (r = -0.17, P < 0.05), mortality (r = -0.67, P < 0.05) and DALYs rates of cystic echinococcosis (r = -0.60, P < 0.05) all correlated negatively with SDI across 21 geographical regions from 1990 to 2021, and the age-standardized mortality (r = -0.61, P < 0.05) and DALYs rates (r = -0.44, P < 0.05) both correlated negatively with SDI across 204 countries and territories in 2021. Frontier analysis revealed that the age-standardized DALYs rate of cystic echinococcosis was still not in line with the frontier in some high-SDI countries or territories. In addition, the global age-standardized prevalence was projected with the BAPC model to appear a tendency towards a rise among both men [estimated annual percent change (EAPC) = 0.18%, 95% CI: (0.13%, 0.23%)] and women [EAPC = 0.29%, 95% CI: (0.24%, 0.34%)] from 2022 to 2035, and the global age-standardized mortality [men: EAPC = -4.71%, 95% CI: (-4.71%, -4.37%); women: EAPC = -4.74%, 95% CI: (-4.74%, -4.74%)] and DALYs rates [men: EAPC = -3.35%, 95% CI: (-3.36%, -3.34%); women: EAPC = -3.17%, 95% CI: (-3.18%, -3.16%)] were projected to appear a tendency towards a decline among both men and women. The global burden of cystic echinococcosis appeared an overall tendency towards a decline from 1990 to 2021; however, the global prevalence of cystic echinococcosis is projected to appear a tendency towards a rise from 2022 to 2035. Intensified cystic echinococcosis control programmes are recommended.

Global burden and risk factors of musculoskeletal disorders among adolescents and young adults in 204 countries and territories, 1990–2019

BackgroundThe zoonotic infectious diseases of poverty (zIDPs) are a group of diseases contributing to global poverty, with significant impacts on a substantial population. This study aims to describe the global, regional, and national burden of zIDPs—schistosomiasis, cystic echinococcosis, cysticercosis, and food-borne trematodiases (FBTs)—to support policy making and resource allocation for their control and elimination.MethodsData of zIDPs from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 were retrieved from 1990 to 2021. The age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rate were described and the estimated annual percentage changes (EAPCs) were calculated to quantify their burden and temporal trends. Spearman correlation analysis was conducted to examine the relationship between age-standardized rates and Socio-demographic Index (SDI).ResultsIn 2021, these zIDPs exhibited a certain level of ASPRs and age-standardized DALY rates, while maintaining relatively low ASMRs. Noticeably, schistosomiasis presented the highest ASPR of 1914.299 (95% UI: 1378.920, 2510.853 per 100,000 population) and an age-standardized DALY rate of 21.895 (95% UI: 12.937, 37.278 per 100,000 population) among the zIDPs. The tapestry of burden—woven predominantly through low and lower-middle SDI regions—stretched across Africa, Latin America, and parts of Asia. From 1990 to 2021, a kaleidoscopic shift was observed globally as ASPRs, ASMRs, and age-standardized DALY rates declined significantly, as reflected by the EAPC values. Negative correlations were observed between the ASPRs, ASMRs, age-standardized DALY rates of schistosomiasis (r value = − 0.610, − 0.622 and − 0.610), cystic echinococcosis (− 0.676 of ASMR, − 0.550 of age-standardized DALYs), cysticercosis (− 0.420, − 0.797 and − 0.591) and the SDI. In contrast, a slight positive correlation was noted between the ASPR, age-standardized DALY rates of FBTs and SDI with r value of 0.221 and 0.213, respectively.ConclusionThe burden of zIDPs declined across almost all endemic regions from 1990 to 2021, yet still predominated in low and low-middle SDI regions. Substantial challenges exist to achieve the goal of control and elimination of zIDPs, and integrated approaches based on One Health need to be strengthened to improve health outcomes.Graphical

Global burden of Multiple Myeloma in Adolescents and Young Adults, 1990-2021

Global burden due to modifiable risk factors for autoimmune diseases, 1990–2021: Temporal trends and socio-demographic inequalities

Occupational exposure to polycyclic aromatic hydrocarbons (PAHs) is a known risk factor for tracheal, bronchus, and lung (TBL) cancer. However, evidence of its global burden particularly across different socio-demographic index (SDI) regions has been limited. Based on results from the global burden of disease (GBD) study, we conducted a comprehensive analysis of age-standardized death rates (ASDR) and age-standardized disability-adjusted life-years (DALYs) rates due to TBL cancer attributed to occupational exposure to PAHs. This study examined the trends, sex differences, age-specific burden, and regional disparities in TBL cancer burden attributed to occupational PAH exposure from 1990 to 2021 globally and across different SDI regions. Age-period-cohort analysis was also performed to evaluate the influence of age, cohort, and period effects. Globally, both ASDR and DALYs rates showed slight increases from 1990 to 2021, with estimated annual percentage changes (EAPCs) of 0.76% and 0.54%, respectively. Low and middle SDI regions experienced more significant increases in death rates and health burden, while high SDI regions exhibited declining trends. Age-specific analyses revealed higher death rates in older populations, particularly those aged 55-74 years, with rising trends observed in low and middle SDI regions. For high SDI regions, younger age groups (<60 years) showed declining trends, while older age groups (>75 years) showed increasing trends. Age-period-cohort analyses indicated that the period effect contributed substantially to rising death rates in low and middle SDI regions, while high SDI regions experienced slower increases in the period effect. The study highlights a widening disparity in the burden of TBL cancer due to occupational exposure to PAHs, with lower SDI regions facing greater increases in death rates and DALYs, especially among older populations. Nevertheless, given the inherent limitations of GBD estimation methods and data scarcity in LMICs, the observed disparities should be interpreted with caution and warrant further primary research.

BackgroundOccupational exposure to polycyclic aromatic hydrocarbons (PAHs) is a known risk factor for tracheal, bronchus, and lung (TBL) cancer. However, evidence of its global burden particularly across different socio-demographic index (SDI) regions has been limited.MethodsBased on results from the global burden of disease (GBD) study, we conducted a comprehensive analysis of age-standardized death rates (ASDR) and age-standardized disability-adjusted life-years (DALYs) rates due to TBL cancer attributed to occupational exposure to PAHs. This study examined the trends, sex differences, age-specific burden, and regional disparities in TBL cancer burden attributed to occupational PAH exposure from 1990 to 2021 globally and across different SDI regions. Age-period-cohort analysis was also performed to evaluate the influence of age, cohort, and period effects.ResultsGlobally, both ASDR and DALYs rates showed slight increases from 1990 to 2021, with estimated annual percentage changes (EAPCs) of 0.76% and 0.54%, respectively. Low and middle SDI regions experienced more significant increases in death rates and health burden, while high SDI regions exhibited declining trends. Age-specific analyses revealed higher death rates in older populations, particularly those aged 55–74 years, with rising trends observed in low and middle SDI regions. For high SDI regions, younger age groups (<60 years) showed declining trends, while older age groups (>75 years) showed increasing trends. Age-period-cohort analyses indicated that the period effect contributed substantially to rising death rates in low and middle SDI regions, while high SDI regions experienced slower increases in the period effect.ConclusionsThe study highlights a widening disparity in the burden of TBL cancer due to occupational exposure to PAHs, with lower SDI regions facing greater increases in death rates and DALYs, especially among older populations. Nevertheless, given the inherent limitations of GBD estimation methods and data scarcity in LMICs, the observed disparities should be interpreted with caution and warrant further primary research.

Burden of Asthma Among Childhood: Based on the Global Burden of Disease Study 2021.

BackgroundChildhood and adolescent obesity has become a major public health concern, contributing to the increasing burden of asthma. However, the global and regional trends of asthma attributable to high BMI in this population remain unclear. This study aimed to assess the burden of asthma due to high BMI among children and adolescents from 1990 to 2021, exploring disparities across different sex groups and Socio-Demographic Index (SDI) regions and projecting future trends.MethodsData were extracted from the Global Burden of Disease (GBD) 2021 database. The analysis in this study covers the following indicators: age-standardized mortality rate (ASMR), age-standardized disability-adjusted life year rate (ASDR), years lived with disability (YLDs), years of life lost (YLLs), as well as crude mortality rate, crude disability-adjusted life year rate, and their respective percentage change (PC) and estimated annual percentage change (EAPC) from 1990 to 2021. Inequality in disease burden across SDI regions was quantified using the Slope Index of Inequality (SII) and Concentration Index (CI). Future burden projections were conducted using the Autoregressive Integrated Moving Average (ARIMA) model. The percentage of DALYs attributable to risk factors is reported among all age groups and individuals under 20 years.ResultsFrom 1990 to 2021, globally, the mortality rates and numbers of asthma cases caused by high body mass index (BMI) decreased, while the numbers and rates of disability-adjusted life years (DALYs) increased. The number and rate of DALY showed different trends in SDI regions and sex groups. Statistical analysis showed a significant correlation between SDI and asthma burden (P < 0.001), with the overall disease burden increasing as SDI rose. However, this trend was not entirely consistent, as country variations were observed. Otherwise the higher the SDI, the lower the age-standardized mortality rate of asthma usually is. Future projections show that without effective intervention measures, the absolute burden will continue to increase.ConclusionDespite regional differences, the global burden of asthma attributable to high BMI among children and adolescents remains substantial, with notable disparities across SDI regions. Given the projected increase in burden, urgent public health strategies targeting childhood obesity prevention and early intervention are essential to mitigate the long-term respiratory health consequences.

To estimate the rates of incidence, death, and disability-adjusted life years (DALYs) of ischemic stroke in young adults aged 15-49 years and the relevant risk factors by sex, age group, and sociodemographic index (SDI) in 204 countries and territories. Data from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2019 study were used. The estimated annual percentage changes (EAPCs) were calculated to evaluate the temporal trends from 1990 to 2019. We also estimated the risk factors contributing to DALYs resulting from ischemic stroke. From 1990 to 2019, the global age-standardized incidence (EAPC = -0.97), death (EAPC = -0.11), and DALYs rates (EAPC = -0.55) of ischemic stroke in young adults decreased. The largest increases in age-standardized incidence, death, and DALYs rates were observed in the low and low-middle SDI quintiles. At the regional level, North Africa and the Middle East and Southeast Asia showed the largest increases in the age-standardized incidence, death, and DALYs rates of ischemic stroke. The age-standardized incidence rate was higher among young women than among young men in 2019. Globally, a high environmental temperature, high body mass index (BMI), and a high fasting plasma glucose contributed to the largest increases in age-standardized DALYs rates between 1990 and 2019. In the same period, the largest increases in the age-standardized DALYs rates in high-SDI and low-SDI regions were attributable to high environmental temperatures and alcohol use, respectively. The burden of ischemic stroke in young adults continues to increase in low-SDI regions such as North Africa and the Middle East and Southeast Asia. There were differences in the primary risk factors related to the burden of ischemic stroke in different SDI regions. Targeted implementation of cost-effective policies and interventions is an urgent need to reduce the burden of ischemic stroke in young adults.

To evaluate the age-standardized incidence (ASIR), prevalence (ASPR), death (ASDR), and disability-adjusted life year (DALY) rates of rheumatoid arthritis (RA) among the working-age population from 1990 to 2021. The data is sourced from the Global Burden of Disease 2021. Estimated annual percentage change (EAPC) was utilized to assess temporal trends. Decomposition analysis was conducted to identify the driving factors underlying burden changes. The Slope Index of Inequality and the Concentration Index were employed to evaluate cross-country inequalities. In 2021, there were 11.88 million cases of RA in the working-age population globally and an ASPR of 222.68 per 100,000 population. The ASIR was 14.09 per 100,000 population (95% uncertainty interval [UI]: 8.97 - 20.19), while the ASDR was 0.13 per 100,000 population (95% UI: 0.11-0.15), with an EAPC of -1.59 (95% confidence interval [CI]: -1.73 to -1.45), indicating a sustained decline in RA ASDR. The age-standardized DALYs rate was 34.54 per 100,000 population (95% UI: 23.90 - 48.67), with an EAPC of 0.15 (95% CI: 0.10 to 0.20). Regionally, high Socio-Demographic Index (SDI) regions exhibited the highest ASPR, ASIR, and age-standardized DALYs rates, suggesting a greater overall burden of RA. Interestingly, middle SDI regions showed the highest ASDR, potentially indicating differences in disease management and access to care that impact mortality despite a lower overall burden compared to high SDI regions. Decomposition analysis identified population growth as the primary driver of the increasing RA burden. Cross-national inequality analysis revealed that RA burden remains concentrated in high SDI countries, though overall health inequality has declined. The substantial global burden and regional disparities of RA in the working-age population necessitate targeted interventions. High SDI regions require strategies focusing on early diagnosis and optimal management to reduce the high burden. Elevated mortality in middle SDI regions demands improved access to effective treatment. These findings underscore the need for SDI-tailored public health approaches to address the specific challenges in each context.