Abstract:

Objective: To analyze the changing trends of the disease burden of ectopic pregnancy in China from 1990 to 2021, predict its future epidemic trends, and provide a basis for optimizing prevention and control strategies. Methods: Based on the data from Global Burden of Disease (GBD) 2021, data such as the incidence rate, prevalence rate, and disability-adjusted life year (DALY) rate of ectopic pregnancy were extracted. Joinpoint regression analysis was used to analyze the time trends, The age-period-cohort model was used to analyze the age, period, and cohort effects, and the autoregressive integrated moving average (ARIMA) model was used to predict the disease burden from 2022 to 2036. Results: In 2021, the number of new cases of ectopic pregnancy in China was 1.525 9 million, a decrease of 32.03% compared with 1990; the number of prevalent cases was 12 600, a decrease of 31.89% compared with 1990; and DALY caused by ectopic pregnancy was 5 900 person-years, a decrease of 63.58% compared with 1990. The average annual percentage changes (AAPC) of the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized DALY rate (ASDR) were -2.82%, -1.07%, and -1.07%, respectively, with statistically significant differences (all P<0.001), showing an overall downward trend. However, the ASIR and ASPR showed a phased rebound from 2010 to 2014 (annual percentage changes were 6.45% and 6.43%). The age effect showed that from 1990 to 2021, the DALY rate of ectopic pregnancy in China first increased and then decreased with age. The period effects showed a downward trend from 1992 to 2022, with the relative risk (RR) value decreasing by 0.83. The cohort effect showed that the RR value was relatively high from 1935 to 1950, and there was no significant change from 1955 to 2005. The prediction results of the ARIMA model showed that from 2022 to 2036, the ASIR and ASPR of ectopic pregnancy would show an upward trend, while the ASDR would show a downward trend. The ASDR would decrease from 0.46 per 100 000 in 2021 to 0.12 per 100 000 in 2036, the ASPR would increase from 0.91 per 100 000 to 1.08 per 100 000, an increase of about 18.68%, and the ASIR would increase from 110.95 per 100 000 to 130.62 per 100 000, an increase of 17.73%. Conclusions: From 1990 to 2021, the disease burden of ectopic pregnancy in China showed an overall downward trend, with a phased rebound from 2010 to 2014. It is predicted that the ASIR and ASPR may increase in the future. Currently, the disease burden is mainly concentrated among women of child-bearing age aged 30-34, suggesting that contraceptive guidance (such as long-acting reversible contraceptive measures) and reproductive health management for high-risk age group (30-34 years old) should be emphasized and screening. Primary-level diagnosis and treatment capabilities for high-risk birth cohorts should be strengthened to cope with the possible rebound of the disease burden in the future.

Key words: Pregnancy, ectopic, Cost of illness, Incidence, Prevalence, Quality-adjusted life years