GLOBAL HEALTH INEQUALITY ANALYSIS OF PREMATURE MORTALITY RELATED TO PEPTIC ULCER DISEASE: A SYSTEMATIC ANALYSIS BASED ON GLOBAL BURDEN OF DISEASE

Objectives: Despite the declining incidence and mortality rates of peptic ulcer disease (PUD) over the past three decades, there remains an uneven distribution of disease burden in countries with varying sociodemographic levels. This updated systematic analysis was conducted to investigate the association between changes in sociodemographic-related health inequalities and PUD premature mortality from 1990 to 2019.
Methods: We performed a secondary analysis by extracting cross-sectional data on PUD from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The age-standardized years of life lost(YLLs) were utilized to reflect premature mortality attributed to PUD. As recommended by the WHO, the slope index of inequality(SII) and the health concentration index were calculated to quantitatively measure absolute and relative changes in health inequalities, taking into account the socio-demographic indexes (SDI) level. The data was further analyzed across different sexes, age groups, and six WHO regions, and re-validated using the health-care access Index(HAQI). The population attributable fraction (PAF) of tobacco use to PUD YLLs was further extracted among different age groups.
Results: Global YLL of PUD premature mortality declined from 181.4 per 100,000 in 1990 to 69.2 per 100,000 in 2019. Countries with the lower 50% level of sociodemographic status accounted for 59.3% and 73.8% of the global PUD premature mortality in 1990 and 2019, respectively. Although the absolute cross-national inequality (SII) of YLL fell from -197.4 (95%CI: -227.6 to -167.2) in 1990 to -145.5 (95%CI: -164.9 to -126.2) in 2019, the relative inequality (concentration index) for global PUD premature mortality significantly increased from 1990 (−0.246, 95%CI: −0.306 to −0.187) to 2019 (−0.339, 95%CI: −0.394 to −0.285) (Figure 1 A and B). The observed increase in relative health inequity was statistically significant for both sexes and age groups, with consistently larger effects observed among women and the elderly when compared to men and younger individuals. The African region demonstrated a significant increase in both absolute and relative health inequality of PUD premature mortality, while the Southeastern Asia region exhibited improvements in both measures. The findings were similar in terms of the healthcare access perspective(Table 1). The global PUD premature mortality attributed to tobacco exposure remains high and is most prominently observed among individuals aged 60-64 years(Figure 1C).
Conclusion: Although there has been a decline in the global PUD premature mortality burden over the past three decades, this decline has been comparatively slower among female, elderly, and low SDI countries. The implementation of intervention measures like smoking cessation is still imperative to effectively reduce the global burden of PUD premature mortality.