Global, regional, and national burden of injury associated internal hemorrhage in the abdomen and pelvis from 1990-2021

Abstract Background Injury associated internal hemorrhage in the abdomen and pelvis (IAIHAP) is a major cause of preventable deaths, particularly in conflict zones. However, its global burden remains inadequately investigated. This study aimed to assess the burden of IAIHAP from 1990 to 2021. Method Using data from Global Burden of Disease Study 2021, this study analyzed IAIHAP burden across 204 countries and territories. Incidence, prevalence, and Years Lived with Disability (YLDs) were estimated. Temporal trends were analyzed using join-point regression. Burden estimates were stratified by sex, age, region, and socio-demographic index (SDI). Results Despite a significant decline in global age-standardized-incidence-rate (ASIR) from 186.44 to 135.40 per 100,000 population between 1990 and 2021 Average Annual Percent Change (AAPC): −1.74, IAIHAP remains a substantial health challenge in 2021 with 10.59 million incident cases and 0.69 million YLDs. The decline is more pronounced in males (AAPC: −2.58) compared to females (AAPC: −0.92). High-middle SDI regions demonstrate the largest decline (AAPC: −2.35), while low SDI regions show modest decreases (AAPC: −0.72) with greater fluctuation. Conflict-affected countries, predominantly in low SDI regions, experience significant increases, with Afghanistan showing the highest rise (AAPC: 8.31). Conclusions While global IAIHAP burden has declined over the past three decades, significant disparities persist across regions and development levels. The burden remains particularly high in conflict-affected and low-resource settings, highlighting the need for targeted interventions and improved emergency care infrastructure in vulnerable regions. Clinical trial number Not applicable