{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T20:13:18Z","timestamp":1787170398899,"version":"build-2736575974"},"reference-count":47,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"unspecified","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Health Appropriate Technology Development and Application Project","award":["S2024117"],"award-info":[{"award-number":["S2024117"]}]},{"name":"Guangxi Zhuang Autonomous Region Health Commission of Scientific Research","award":["Z-A20220125"],"award-info":[{"award-number":["Z-A20220125"]}]},{"name":"Guangxi Zhuang Autonomous Region Health Commission of Scientific Research","award":["Z-A20230161"],"award-info":[{"award-number":["Z-A20230161"]}]},{"name":"Guangxi Natural Science Foundation","award":["2023GXNSFBA026056"],"award-info":[{"award-number":["2023GXNSFBA026056"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,25]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Data on health inequalities in inflammatory bowel disease (IBD) among women of childbearing age (WCBA, 15\u201349 years) across different countries are lacking. We aimed to assess the global incidence, disability-adjusted life year (DALY) burden and cross-country inequalities of IBD in WCBA from 1990 to 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Data were extracted from the Global Burden of Disease Study 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Women aged 15\u201349 years diagnosed with IBD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcomes were the total numbers and age-standardised rates of incidence and DALYs. Secondary outcomes included (1) temporal trends, assessed using estimated annual percentage change (EAPC); (2) periods of significant change identified through joinpoint regression analysis and (3) health inequalities by sociodemographic index (SDI), assessed using the slope index of inequality (SII) and the concentration index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Globally, from 1990 to 2021, the number of incident IBD cases among WCBA increased from 60\u2009926 (95% uncertainty interval (UI) 50\u2009342 to 74\u2009910) to 98\u2009975 (95% UI 80\u2009568 to 124\u2009089), and DALYs increased from 193\u2009091 (95% UI 145\u2009850 to 245\u2009244) to 281\u2009580 (95% UI 223\u2009989 to 349\u2009966). During the same period, the age-standardised incidence rate (ASIR) increased significantly (EAPC 0.22, 95% UI 0.1 to 0.34), whereas the age-standardised DALY rate (ASDR) decreased significantly (EAPC \u22120.28, 95% UI \u22120.35 to \u22120.21). In 2021, the highest ASIR (14.93 per 100\u2009000, 95% UI 11.52 to 18.97) and ASDR (27.94 per 100\u2009000, 95% UI 19.97 to 37.87) were observed in high-SDI regions. In contrast, the fastest increase in ASIR (EAPC 1.69, 95% UI 1.48 to 1.90) occurred in middle-SDI regions. High-middle-SDI regions exhibited the most pronounced decrease in ASDR (EAPC \u22120.8, 95% UI \u22120.92 to \u22120.67), whereas a notable upward trend in ASDR was found solely in low-SDI regions (EAPC 0.14, 95% UI 0.07 to 0.21). The SII for ASIR increased from 4.83 (95% CI 3.63 to 6.03) in 1990 to 6.26 (95% CI 4.90 to 7.63) in 2021, whereas the concentration index decreased from 0.35 (95% CI 0.25 to 0.44) to 0.24 (95% CI 0.16 to 0.33). The SII for ASDR decreased from 7.37 (95% CI 2.07 to 12.67) in 1990 to 5.97 (95% CI 1.38 to 10.56) in 2021, and the concentration index shifted from 0.13 (95% CI 0.06 to 0.2) in 1990 to \u22120.03 (95% CI \u22120.1 to 0.05) in 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In 2021, the global incidence and ASDR burden remained concentrated in high-SDI countries, with significant regional disparities. From 1990 to 2021, health inequality in DALYs gradually shifted from high-income to low-income countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-103432","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T10:25:30Z","timestamp":1760437530000},"page":"e103432","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Shifting burden of inflammatory bowel disease in women of childbearing age: from high-income to low-income countries (1990\u20132021)"],"prefix":"10.1136","volume":"15","author":[{"given":"Xiaofang","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Guangxi Hospital Division of The First Affiliated Hospital of Sun Yat-sen University, Nanning, Guangxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhixi","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of 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