# The burden of peptic ulcer disease in China, 1990–2021: update from the GBD 2021 study

## TL;DR

Peptic ulcer disease in China has declined significantly since 1990, but remains a major health issue for older adults and males.

## Contribution

This study provides an updated analysis of PUD burden in China using GBD 2021 data and projects future trends through 2035.

## Key findings

- Age-standardized incidence, mortality, and DALY rates for PUD in China decreased by 54.9%, 73.7%, and 77.1% respectively from 1990 to 2021.
- Epidemiological changes were the main driver of the decline, while population ageing partially offset these reductions.
- Smoking was the only quantified risk factor for PUD in the GBD attribution framework.

## Abstract

Peptic ulcer disease (PUD) remains a significant digestive health concern in China, influenced by factors such as Helicobacter pylori infection, non-steroidal anti-inflammatory drugs use and demographic changes. A comprehensive assessment of its long-term burden is crucial for public health planning.

Using data from the Global Burden of Disease (GBD) 2021 study, we analysed incidence, mortality and disability-adjusted life years (DALYs) of PUD in China from 1990 to 2021. Estimated annual percentage changes (EAPCs) were calculated to assess temporal trends. Decomposition analysis was applied to quantify the contributions of population ageing, population growth and epidemiological changes to changes in absolute burden. In addition, a Bayesian age–period–cohort model was used to project trends from 2022 to 2035.

From 1990 to 2021, the age-standardized incidence rate of PUD in China decreased by 54.9% (EAPC = −2.85), the age-standardized mortality rate (ASMR) decreased by 73.7% (EAPC = −4.17) and the age-standardized DALY rate decreased by 77.1% (EAPC = −4.68). Despite these declines, the absolute burden remained substantial among adults aged ≥55 years. Males consistently experienced a higher burden than females. Smoking was identified as the only risk factor quantified in the GBD attribution framework for PUD. Decomposition analysis indicated that epidemiological changes accounted for the largest relative share of the observed decline, whereas population ageing partially offset these reductions. Model-based projections suggest that age-standardized rates may continue to decline through 2035, assuming recent trends persist.

Although the age-standardized burden of PUD in China has declined markedly over the past three decades, the absolute burden remains considerable, particularly among older adults and males. Continued reductions in PUD burden may benefit from sustained tobacco control and targeted prevention strategies for high-risk populations, while accounting for the challenges posed by population ageing.