Sex-specific and socioeconomic disparities in the global burden of inflammatory bowel disease in 204 countries, 1990–2021: projections to 2050

Background: Inflammatory bowel disease (IBD) represents a growing global health challenge, necessitating a systematic evaluation of its epidemiological trends and sociodemographic disparities. Methods: Using Global Burden of Disease 2021 data, we quantified IBD burden (incidence, mortality, prevalence, disability-adjusted life years [DALYs], years lived with disability [YLDs], and years of life lost [YLLs]) across 204 countries and territories from 1990 to 2021, and projected trends to 2050, evaluating associations with Sociodemographic Index (SDI) and sex disparities. Results: Between 1990 and 2021, global crude counts of incident cases, deaths, prevalence, DALYs, YLDs, YLLs increased by 88.3%, 98.1%, 76.5%, 59.2%, 75.1%, and 50.8%, respectively. However, age-standardized rates (ASRs) of mortality, prevalence, DALYs, YLDs, and YLLs declined by 13.0%, 6.5%, 16.1%, 6.6%, and 21.0%, respectively, contrasting with a modest rise in age-standardized incidence rates (ASIR, 5.5%). The average annual percentage changes (AAPCs) of Incidence, Mortality, Prevalence, DALYs, YLDs, and YLLs were 0.1582, -0.4885, -0.2223, -0.5704, -0.2237, -0.7686, respectively. Projections to 2050 indicate continued reductions in ASRs across all metrics. High and middle-high SDI regions retained the highest absolute burdens, yet low to middle-SDI regions exhibited the steepest escalation in crude incidence and prevalence, correlating strongly with rising SDI (Spearman's ρ=0.599 for incidence). Females showed a bimodal pattern, with higher disability and prevalence in both mid-life and very old age groups. Conclusions: High-SDI regions remain IBD epicenters, but accelerating burdens in low- and middle-SDI areas demand context-specific interventions. Persistent sex/age disparities necessitate tailored healthcare strategies to address the evolving global burden.