Persistent health inequality in the global burden of digestive diseases attributable to risk factors: a systematic analysis for the Global Burden of Disease Study 2021

Background Digestive diseases are a major cause of health burden globally. Understanding the relative contribution of various risk factors to this burden is essential for developing effective reduction strategies. However, there is a gap in knowledge regarding the global burden of digestive diseases attributable to risk factors. Objective This study aimed to assess the global burden of digestive diseases attributable to risk factors from 1990 to 2021. Design We analysed data from the Global Burden of Diseases 2021, covering 12 digestive diseases and 10 risk factors across 204 countries and territories. Age-standardised rates of disability-adjusted life-years (DALYs) were estimated. The estimated annual percentage change determined annual percent change. Results In 2021, there were 3.30 million deaths and 116.73 million DALYs from digestive diseases globally, accounting for 43.3% and 45.9% of all digestive disease deaths and DALYs, respectively. Males accounted for 74.42 million digestive disease DALYs attributable to risk factors, representing 49.1% of total DALYs in males, whereas females accounted for 42.31 million DALYs, representing 41.1%. Unsafe water, sanitation, and handwashing was the leading risk factor in both males and females (26.95 million and 17.8% in males; 24.67 million and 24.0% in females). The age-standardised DALY rates of digestive diseases attributable to environmental and occupational risks and behavioural risks decreased, while that attributable to metabolic risks increased. Conclusion The risk factors highly associated with economic and social development caused a substantial digestive disease burden. The highest burdens of environmental and occupational and behavioural risks were concentrated in countries in sub-Saharan Africa. More global cooperation is needed in the field of digestive diseases to promote health equity and achieve the Sustainable Development Goals.