# Global temporal trends and projections of gastroesophageal reflux disease prevalence: Age-period-cohort analysis 2021

## TL;DR

This study analyzes global trends in gastroesophageal reflux disease (GERD) from 1990 to 2021, revealing rising prevalence and health disparities, with projections to 2036.

## Contribution

The novel contribution is a comprehensive age-period-cohort analysis of GERD prevalence and health inequalities using Global Burden of Disease data.

## Key findings

- Global GERD prevalence increased from 450 million in 1990 to 825 million in 2021.
- Middle SDI regions showed the steepest annual ASPR increase (0.22%), while high SDI regions declined.
- Populations aged 25–34 years experienced the fastest GERD prevalence growth (>0.3% annually).

## Abstract

Gastroesophageal reflux disease (GERD) represents a major global health challenge with varied regional epidemiological patterns. This study aimed to comprehensively analyze temporal trends, health inequalities, and driving factors of GERD.

Using Global Burden of Disease 2021 data, we extracted GERD prevalence across 204 territories. Age-standardized prevalence rate (ASPR) was calculated and analyzed using age-period-cohort framework. An autoregressive integrated moving average model was employed to project future trends to 2036. Health inequalities were assessed using slope index and concentration index.

Global GERD prevalence surged from 450,765,455 cases in 1990–825,603,654 in 2021, with an annual percentage change of 0.04% in ASPR. Significant regional disparities were observed across Socio-demographic Index (SDI) quintiles: middle SDI regions exhibited the steepest ASPR increase (0.22% annually), contrasting with declining trends in high-middle (−0.26%) and high SDI regions (−0.18%). Latin American countries demonstrated the highest burden, with Paraguay, Brazil, and El Salvador leading globally. The United States and China revealed notable post-2010 prevalence rebounds. Notably, populations aged 25–34 years showed the most rapid prevalence growth (>0.3% annually), challenging traditional age-risk paradigms. The slope index increased from −1978.5 to −2053.4, signifying worsening absolute health disparities, with low SDI nations bearing a disproportionate GERD burden.

The increasing prevalence of GERD has resulted in major health burdens over the past three decades. Future strategies should prioritize targeted interventions for high-risk populations and modifiable risk factors, enhanced healthcare accessibility, and integration of GERD management within non-communicable disease frameworks to address this emerging public health challenge.