Exploring the age-dependent burden of periodontal disease in women across different socio-demographic levels

Abstract Background Periodontal disease substantially affects women’s quality of life and shows sex-specific patterns due to physiological characteristics such as hormonal fluctuations, pregnancy, and menopause. However, most global assessments have focused on the general population and have not systematically characterized age specific burdens among women across different socio-demographic settings. This study addresses this gap by providing a life course analysis of the global, regional, and national incidence of periodontal disease in females from 1990 to 2021. Methods Within the Global Burden of Disease (GBD) framework, we estimated female incidence and age-standardized rates (ASR) of periodontal disease across the life course in 204 countries and territories. Socio-Demographic Index (SDI)—incorporating per-capita income, years of schooling, and fertility in women under 25—was used to stratify locations into five levels (low, low-middle, middle, high-middle, high). We examined incidence trends and burden in eight specific physiological stages (childhood, adolescent, reproductive-age, prime reproductive-age, adult, perimenopausal, menopausal and older-age), and assessed the effects of oral health resources, diagnostic rates, and hormonal fluctuations. Our study presented point estimates with 95% confidence intervals (CIs). It evaluated the changing trends in the burden of Periodontal Disease using the estimated annual percentage change (EAPC) and percentage change. Results Globally, the ASR differed across stages and was generally higher from the optimal reproductive age through older age. From 1990 to 2021, ASR rose steadily in childhood and adolescence, with a notable increase during the reproductive age in 2010–2014 (APC = 2.14). The optimal reproductive age showed increases in 1998–2005 and 2010–2014, adulthood and perimenopause exhibited fluctuating upward trends, while menopause and older age displayed divergent patterns. ASR–SDI associations were stage-dependent: negative correlations in childhood and adolescence, no significant association in adulthood and reproductive age, positive correlations in mid- to late-life, and SDI threshold effects (around SDI = 0.5, ASR tends to decrease; around SDI = 0.8, decelerated ASR growth). Conclusions Policymakers should tailor public health strategies to high-burden regions and key life stages (e.g., reproductive and mid-to-late life), expand oral-health investment for children and adolescents in low-SDI areas, and strengthen screening/interventions for mid-older women in high-SDI regions.