National and state-level trends in digestive diseases in the United States, 1990 to 2021

BACKGROUND: Digestive diseases are a major cause of morbidity and mortality in the United States, placing a substantial burden on healthcare. METHODS: Data from the 2021 Global Burden of Disease study were analyzed for all 50 US states and the District of Columbia. Temporal trends were quantified using estimated annual percentage changes, and correlations with the Socio-Demographic Index were assessed using Pearson's correlation. RESULTS: From 1990 to 2021, total incident digestive diseases cases rose from 20.1 to 26.2 million, a 30.5% increase, while age-standardized incidence rates declined by 9.8%. Age-standardized disability-adjusted life year (DALY) rates decreased by 7.7%, and death rates fell by 5.9%. Most digestive diseases showed declining DALY rates; however, cirrhosis and other chronic liver diseases increased by 4.5% and remained the highest contributor to DALYs, with a 9% rise in mortality. Inflammatory bowel disease also increased, with DALYs rising by 12% in males and 23% in females; mortality rose by 64% in females versus 44% in males. CONCLUSION: These findings reveal both progress and persistent disparities, with higher burdens among women and states with a lower Socio-Demographic Index. Targeted interventions and resource allocation are warranted to address these inequities.