Persistence of Mortality-Dominant Pancreatitis Burden Despite Declining Rates, 1990-2023: An Analysis of the Global Burden of Disease 2023 Study.

backgroundWhether the fatal and non-fatal composition of aggregate pancreatitis burden has changed over time remains unclear. We assessed long-term changes in the fatal-to-non-fatal composition of aggregate pancreatitis burden using Global Burden of Disease (GBD) 2023 estimates.

methodsWe conducted a systematic descriptive and trend analysis using publicly available estimates from the GBD 2023 Results Tool for incidence, prevalence, deaths, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) across 204 countries and territories from 1990 to 2023. Because GBD reports pancreatitis as an aggregate cause category, the analysis could not distinguish acute pancreatitis, recurrent acute pancreatitis, chronic pancreatitis, or acute exacerbations of chronic pancreatitis. Primary analyses used age-standardised rates per 100,000 population. Four burden-composition metrics were derived within each location-year stratum: the YLL:YLD ratio, YLD:DALY proportion, deaths-to-incidence ratio, and prevalence-to-incidence ratio. Temporal trends were modelled in R version 4.5, using segmented regression, with up to three joinpoints selected by a Bayesian information criterion.

resultsGlobally, all six age-standardised native GBD measures declined between 1990 and 2023. The age-standardised incidence rate decreased from 37.62 (95% UI 32.20-43.11) to 32.91 (28.84-37.17) per 100,000, prevalence from 93.78 (69.26-126.25) to 68.92 (52.53-90.32), deaths from 1.76 (1.49-2.16) to 1.40 (1.21-1.66), YLDs from 5.70 (2.75-9.45) to 4.34 (2.18-7.04), YLLs from 55.96 (46.50-69.72) to 43.60 (36.89-53.53), and DALYs from 61.66 (50.62-75.61) to 47.94 (40.57-58.16). However, the fatal-to-non-fatal composition changed little: the global YLL:YLD ratio was 9.82 in 1990 and 10.04 in 2023, while the YLD share of DALYs was 0.092 and 0.091, respectively. Joinpoint modelling showed fluctuation rather than a sustained shift toward disability-dominant burden: the global YLL:YLD ratio was stable until 1998, increased from 1998 to 2002 (annual percent change [APC] 1.38%, 95% CI 0.42 to 2.36), and then declined modestly thereafter (APC -0.13%, -0.20 to -0.06). Burden remained higher in males, whereas females had a greater non-fatal share of total burden (YLD:DALY in 2023: 0.134 vs. 0.073). All sociodemographic index strata remained mortality-dominant in both 1990 and 2023; low-SDI settings had the greatest fatal dominance (YLL:YLD 34.94 in 1990; 24.72 in 2023). Using a descriptive YLD:DALY ≥ 0.50 benchmark, 203 of 204 countries and territories remained below the disability-dominant threshold in both years, no country crossed from below to above this benchmark, and only Georgia moved from above to below the benchmark.

conclusionsDespite declines in global incidence, mortality, and DALY rates, the aggregate GBD pancreatitis burden remained overwhelmingly mortality-dominant from 1990 to 2023. Because GBD pancreatitis combines acute and chronic pancreatitis, this finding should be interpreted as describing the modelled aggregate pancreatitis cause category rather than proving subtype-specific mortality dominance. The intensity of fatal dominance varied by sex, SDI, region, age, and country, but a structural shift toward disability-dominant aggregate burden was not observed.