# Socioeconomic inequalities and dynamic changes in sex differences in lifetime risks of peptic ulcer disease

## TL;DR

This study shows that the risk of peptic ulcers has declined globally but reveals growing disparities by gender and socioeconomic status, with women now at higher risk in many regions.

## Contribution

The first comprehensive global assessment of lifetime risks of peptic ulcer disease by sex and socioeconomic index, revealing a reversal in risk patterns between men and women.

## Key findings

- Global lifetime risk of developing PUD decreased from 1990 to 2021, with faster declines among males than females.
- Sex ratios of PUD risk show inflection points where female risk surpassed male risk, occurring earlier in low-SDI regions.
- High-SDI regions had higher risk of developing PUD but lower risk of dying from it compared to low-SDI regions.

## Abstract

Peptic ulcer disease (PUD) is a common digestive system disorder and an important risk factor for gastric cancer. While previous studies have extensively focused on using traditional indicators, lifetime risks of PUD remain relatively scarce.

Using Global Burden of Disease (GBD) 2021 data, we estimated lifetime risks of developing and dying from PUD by lifetable method.Trends were assessed by calculating the average annual percent change (AAPC) from 1990 to 2021. By computing the sex ratios(male to female) of lifetime risks and plotting time-trend graphs, we analyzed the dynamic evolution of sex differences.

In 2021, the global lifetime risk of developing from PUD was 3.21% (95% CI, 3.20%-3.22%), declining from 1990 (AAPC: -1.24; 95% CI, -1.37 to -1.11), with a more pronounced decrease among males (AAPC: -1.43; 95% CI, -1.53 to -1.33) than females (AAPC: -1.00; 95% CI, -1.10 to -0.89). The lifetime risk of dying from PUD was 0.35% (95% CI, 0.34%-0.35%), with a faster decline (AAPC, -2.25; 95% CI, -2.57 to -1.93), again with greater in males (AAPC: -2.73; 95% CI, -2.86 to -2.60) than in females (AAPC: -1.80; 95% CI, -2.00 to -1.60). Marked socioeconomic disparities were observed: high-SDI regions had the highest lifetime risk of developing but the lowest risk of dying, whereas low-SDI regions showed the opposite pattern. Across different SDI regions, the sex ratios of lifetime risk of PUD exhibited unique inflection points over three decades.

Despite substantial global declines in lifetime risks of PUD over the past three decades, our findings reveal persistent inequities by SDI, geography, and sex. These disparities underscore that access to timely diagnosis, eradication therapy, and advanced endoscopic care remains uneven, particularly in low-SDI regions and among females.

The online version contains supplementary material available at 10.1186/s13293-026-00832-w.

This study presents the first comprehensive assessment of lifetime risks of developing and dying from peptic ulcer disease (PUD) across 21 GBD regions and 5 sociodemographic index (SDI) areas, revealing significant disparities, not only between different SDI regions but also between males and females. We also identified an important trend diverging from previous studies, a fundamental reversal in lifetime risks of PUD between the sexes. Specifically, for lifetime risk of developing PUD, the inflection point at which females risk surpassed that of males occurred in 1998 in low-middle SDI regions, 2013 in low-SDI regions, and 2019 in high-SDI regions. For lifetime risk of dying from PUD, the corresponding inflection points occurred in 2006 in low-middle SDI regions, 2012 in middle and low-SDI regions , and 2020 globally.

The online version contains supplementary material available at 10.1186/s13293-026-00832-w.

Our study investigated a person’s lifetime probability of developing or dying from a peptic ulcer. Using the most comprehensive global health data from 1990 to 2021, we calculated this “lifetime risk” for males and females across countries with varying development levels, with a specific focus on analyzing differences between the sexes.

Firstly, from a total population perspective, the lifetime risk of anyone developing or dying from an ulcer has significantly declined since 1990. Secondly, the differences between men and women have undergone dynamic changes over these three decades. While previous research consistently indicated a higher risk for men, our study reveals that this long-standing pattern has reversed. We identified “tipping points” after which women’s lifetime risk of peptic ulcers surpassed that of men. This reversal has already occurred in poorer regions and is now emerging in the wealthiest nations.

Our findings challenge the conventional belief that peptic ulcer disease is a “male disease.” The biology of this condition is closely intertwined with societal factors, and the shift in risk towards women is particularly pronounced in low-income regions. This research sounds an alarm: we can no longer overlook the increasing burden of peptic ulcers among women, and future efforts must prioritize addressing this risk in the female population.

The online version contains supplementary material available at 10.1186/s13293-026-00832-w.