Age-Period-Cohort Analysis of the Disease Burden of Polycystic Ovary Syndrome in China from 1990 to 2021 and Prediction of the Trend

doi:10.12280/gjszjk.20250513

Abstract

Abstract:

Objective: To analyze the trends in the disease burden of polycystic ovary syndrome (PCOS) in China from 1990 to 2021, to evaluate the age-period-cohort effects, and to predict its prevalence trend from 2022 to 2035, thereby providing a reference for formulating targeted prevention and control strategies. Methods: Data on the incidence, prevalence, and disability adjusted life year (DALY) rate of PCOS in China were extracted from the 2021 study of Global Burden of Disease (GBD). Joinpoint regression analysis was used to assess temporal trends. The age-period-cohort model was employed to evaluate the effects of age, period, and birth cohort on the disease burden. The autoregressive integrated moving average (ARIMA) model was applied to predict the disease burden indicators from 2022 to 2035. Results: In 2021, the incident cases of PCOS in China were 130.4 thousand. The age-standardized incidence rate (ASIR) was 57.31 per 100 000, representing a 63.51% increase from 1990 (35.05 per 100 000). The number of prevalent cases was 9.481 5 million, with an age-standardized prevalence rate (ASPR) of 2 962.19 per 100 000, marking an 84.63% increase from 1990 (1 604.41 per 100 000). The DALY was 81.3 thousand person-years, and the age-standardized DALY rate (ASDR) was 25.57 per 100 000, showing a 86.23% increase from 1990 (13.73 per 100 000). Joinpoint regression indicated significant upward trends in ASIR, ASPR, and ASDR from 1990 to 2021, with average annual percent change (AAPC) of 1.61%, 2.02%, and 2.05%, respectively (all P<0.001). Age distribution showed that the peak age of incidence was 15-19 years. The prevalence peaked in the 25-29 years group, followed by the 30-34 years group. The DALY rate reached its peak at 20-24 years and remained at a high level at 25-39 years. Age-period-cohort model analysis showed that the DALY rate increased continuously with age. The period DALY rate ratio exhibited an upward trend over time; using the 2006 group as reference, the rate ratio of the 1991 group was 0.69, rising to 1.15 for the 2021 group. Compared with the 1975 birth cohort, the disease risk increased progressively for cohorts born in 1980 and later, with the DALY rate ratio peaking at 3.36 for the 2005 birth cohort. The ARIMA model demonstrated satisfactory goodness-of-fit (all R2≥0.999 8). It is predicted that by 2035, the ASIR, ASPR, and ASDR will reach 63.31 per 100 000, 3 615.43 per 100 000 and 31.16 per 100 000, corresponding to increases of 10.47%, 22.05% and 21.86% compared to 2021, respectively. Conclusions: The disease burden of PCOS in China increased continuously from 1990 to 2021, with the incidence peak concentrated in adolescents (15-19 years) and the increasing risk of birth cohort. Predictions indicate a continued significant rise in all disease burden indicators by 2035. Enhanced early prevention, control, and long-term management for women of reproductive age, particularly younger populations, are warranted.

Key words: Polycystic ovary syndrome, Global disease burden, China, Incidence, Prevalence, Disability adjusted life year, Forecasting

KANG Xu-li, LIU Bo-xin, HE Xiao, ZHAI Hui. Age-Period-Cohort Analysis of the Disease Burden of Polycystic Ovary Syndrome in China from 1990 to 2021 and Prediction of the Trend[J]. Journal of International Reproductive Health/Family Planning, 2026, 45(1): 11-17.

Figures/Tables 6

References 25

[1]	Zhang J, Zhang H, Xin X, et al. Efficacy of Flavonoids on Animal Models of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis[J]. Nutrients, 2022, 14(19):4128. doi: 10.3390/nu14194128.
[2]	宋颖, 李蓉. 多囊卵巢综合征中国诊疗指南解读[J]. 实用妇产科杂志, 2018, 34(10):737-741.
[3]	Wu Q, Gao J, Bai D, et al. The prevalence of polycystic ovarian syndrome in Chinese women: a meta-analysis[J]. Ann Palliat Med, 2021, 10(1):74-87. doi: 10.21037/apm-20-1893. pmid: 33545750
[4]	武海飞, 郭雪桃, 刘睿欣, 等. 青春期与育龄期PCOS病人内分泌代谢特征分析[J]. 中西医结合心脑血管病杂志, 2022, 20(24):4577-4580. doi: 10.12102/j.issn.1672-1349.2022.24.032.
[5]	刘理凤, 常惠, 万天恩, 等. 不同饮食结构对多囊卵巢综合征的影响综述[J]. 中华中医药杂志, 2023, 38(7):3268-3272.
[6]	莫婷婷, 陈然, 潘雪, 等. 育龄期多囊卵巢综合征患者合并焦虑抑郁的相关因素分析[J]. 中国计划生育和妇产科, 2023, 15(12):54-59. doi: 10.3969/j.issn.1674-4020.2023.12.14.
[7]	Barber TM, Franks S. Obesity and polycystic ovary syndrome[J]. Clin Endocrinol(Oxf), 2021, 95(4):531-541. doi: 10.1111/cen.14421.
[8]	Safiri S, Noori M, Nejadghaderi SA, et al. Prevalence, incidence and years lived with disability due to polycystic ovary syndrome in 204 countries and territories, 1990-2019[J]. Hum Reprod, 2022, 37(8):1919-1931. doi: 10.1093/humrep/deac091.
[9]	Salari N, Nankali A, Ghanbari A, et al. Global prevalence of polycystic ovary syndrome in women worldwide: a comprehensive systematic review and meta-analysis[J]. Arch Gynecol Obstet, 2024, 310(3):1303-1314. doi: 10.1007/s00404-024-07607-x. pmid: 38922413
[10]	Jiang B. The Global Burden of Polycystic Ovary Syndrome in Women of Reproductive Age: Findings from the GBD 2019 Study[J]. Int J Womens Health, 2025, 17:153-165. doi: 10.2147/IJWH.S490836. pmid: 39882398
[11]	American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome[J]. Obstet Gynecol, 2018, 131(6):e157-e171. doi: 10.1097/AOG.0000000000002656.
[12]	李辉章, 杜灵彬. Joinpoint回归模型在肿瘤流行病学时间趋势分析中的应用[J]. 中华预防医学杂志, 2020, 54(8):908-912. doi: 10.3760/cma.j.cn112150-20200616-00889.
[13]	Clegg LX, Hankey BF, Tiwari R, et al. Estimating average annual per cent change in trend analysis[J]. Stat Med, 2009, 28(29):3670-3682. doi: 10.1002/sim.3733. pmid: 19856324
[14]	王瑾瑶, 张年萍, 白志强, 等. 1993—2017年中国宫颈癌发病率和死亡率长期趋势的年龄-时期-队列模型分析[J]. 中国全科医学, 2022, 25(13):1564-1568. doi: 10.12114/j.issn.1007-9572.2022.0074.
[15]	Rutherford MJ, Lambert PC, Thompson JR. Age-period-cohort modeling[J]. Stata J, 2010, 10(4):606-662. doi: 10.1177/1536867X11010004057.
[16]	Mary Victoria Florence M, Priyadarshini E. Aeroengine gas trajectory prediction using time-series analysis auto regressive integrated moving average[J]. Aircr Eng Aerosp Tec, 2024, 96(8):1074-1082. doi: 10.1108/AEAT-01-2023-0018.
[17]	邓芷晴, 周利华, 叶久红, 等. ARIMA模型在肺癌发病率预测中的应用[J]. 医学新知杂志, 2019, 29(4):414-417. doi: 10.3969/j.issn.1004-5511.2019.04.020.
[18]	Zhang J, Zhu Y, Wang J, et al. Global burden and epidemiological prediction of polycystic ovary syndrome from 1990 to 2019: A systematic analysis from the Global Burden of Disease Study 2019[J]. PLoS One, 2024, 19(7):e0306991. doi: 10.1371/journal.pone.0306991.
[19]	Liao WT, Huang JY, Lee MT, et al. Higher risk of type 2 diabetes in young women with polycystic ovary syndrome: A 10-year retrospective cohort study[J]. World J Diabetes, 2022, 13(3):240-250. doi: 10.4239/wjd.v13.i3.240.
[20]	陈晓惠, 丘芬芬, 黄利珊, 等. 超声在多囊卵巢综合征诊断及疗效评估中的应用进展[J]. 疑难病杂志, 2025, 24(6):765-768. doi: 10.3969/j.issn.1671-6450.2025.06.025.
[21]	王兴亮, 黄少敏, 王丹丹. 彩色多普勒超声诊断多囊卵巢综合征的影像学表现及临床价值分析[J]. 现代医用影像学, 2025, 34(9):1733-1736. doi: 10.3969/j.issn.1006-7035.2025.09.039.
[22]	邓敏英, 张勇, 龚月秋. 抗苗勒管激素及性激素指标联合卵巢超声指标对多囊卵巢综合征不孕的诊断价值[J]. 转化医学杂志, 2024, 13(5):677-680. doi: 10.3639/j.issn.2095-3097.2024.05.003.
[23]	柳慧. 环境内分泌干扰物双酚A与多囊卵巢综合征相关性研究[D]. 广州: 南方医科大学, 2023.
[24]	王景尚, 尹晓丹, 何军琴, 等. 来曲唑联合高糖高脂饮食构建多囊卵巢综合征伴胰岛素抵抗大鼠模型研究[J]. 首都医科大学学报, 2021, 42(3):436-442. doi:10.3969/j.issn.1006-7795.2021.03.016.
[25]	心洁, 壹图. 《中国居民营养与慢性病状况报告(2020年)》国务院新闻办公室2020年12月23日新闻发布会[J]. 中老年保健, 2021(2):14-21.

年份	发病人数（万例，95%UI）	ASIR （1/10万，95%UI）	患病人数（万例，95%UI）	ASPR （1/10万，95%UI）	DALY （万人年，95%UI）	ASDR （1/10万，95%UI）
1990年	13.44（7.79~22.98）	35.05（20.25~59.70）	512.75（355.07~727.03）	1 604.41（1 114.17~2 269.41）	4.41（1.89~9.28）	13.73（5.92~28.91）
2021年	13.04（7.65~21.72）	57.31（33.95~95.23）	948.15（659.16~1 348.88）	2 962.19（2 052.80~4 216.89）	8.13（3.54~17.06）	25.57（11.12~53.70）
AAPC（%，95%CI）	-	1.61*（1.59~1.64）	-	2.02*（2.00~2.06）	-	2.05*（2.02~2.07）

年份	发病人数（万例，95%UI）	ASIR （1/10万，95%UI）	患病人数（万例，95%UI）	ASPR （1/10万，95%UI）	DALY （万人年，95%UI）	ASDR （1/10万，95%UI）
1990年	13.44（7.79~22.98）	35.05（20.25~59.70）	512.75（355.07~727.03）	1 604.41（1 114.17~2 269.41）	4.41（1.89~9.28）	13.73（5.92~28.91）
2021年	13.04（7.65~21.72）	57.31（33.95~95.23）	948.15（659.16~1 348.88）	2 962.19（2 052.80~4 216.89）	8.13（3.54~17.06）	25.57（11.12~53.70）
AAPC（%，95%CI）	-	1.61*（1.59~1.64）	-	2.02*（2.00~2.06）	-	2.05*（2.02~2.07）

指标	年份（年）	APC（%，95%CI）	P	AAPC（%，95%CI）	P
ASIR	总体（1990—2021）			1.61（1.59~1.64）	<0.001
	1990—1993	1.47（1.13~1.71）	<0.001
	1994—1999	3.20（3.06~3.43）	<0.001
	2000—2003	2.15（1.80~2.39）	<0.001
	2004—2012	0.66（0.55~0.75）	<0.001
	2013—2018	1.55（1.40~1.88）	<0.001
	2019—2021	0.63（0.18~1.19）	0.012
ASPR	总体（1990—2021）			2.02（2.00~2.06）	<0.001
	1990—1991	1.03（0.58~1.74）	<0.001
	1992—1994	1.97（1.76~4.43）	<0.001
	1995—1999	4.29（2.35~4.56）	<0.001
	2000—2003	2.42（1.05~2.71）	<0.001
	2004—2010	1.14（0.87~1.73）	<0.001
	2011—2021	1.58（1.41~1.74）	<0.001
ASDR	总体（1990—2021）			2.05（2.02~2.07）	<0.001
	1990—1994	1.81（1.65~1.98）	<0.001
	1995—1999	4.36（4.13~4.52）	<0.001
	2000—2003	2.41（2.16~3.04）	<0.001
	2004—2011	1.17（0.98~1.58）	<0.001
	2012—2017	1.72（1.19~2.09）	<0.001
	2018—2021	1.16（0.67~1.55）	<0.001

指标	年份（年）	APC（%，95%CI）	P	AAPC（%，95%CI）	P
ASIR	总体（1990—2021）			1.61（1.59~1.64）	<0.001
	1990—1993	1.47（1.13~1.71）	<0.001
	1994—1999	3.20（3.06~3.43）	<0.001
	2000—2003	2.15（1.80~2.39）	<0.001
	2004—2012	0.66（0.55~0.75）	<0.001
	2013—2018	1.55（1.40~1.88）	<0.001
	2019—2021	0.63（0.18~1.19）	0.012
ASPR	总体（1990—2021）			2.02（2.00~2.06）	<0.001
	1990—1991	1.03（0.58~1.74）	<0.001
	1992—1994	1.97（1.76~4.43）	<0.001
	1995—1999	4.29（2.35~4.56）	<0.001
	2000—2003	2.42（1.05~2.71）	<0.001
	2004—2010	1.14（0.87~1.73）	<0.001
	2011—2021	1.58（1.41~1.74）	<0.001
ASDR	总体（1990—2021）			2.05（2.02~2.07）	<0.001
	1990—1994	1.81（1.65~1.98）	<0.001
	1995—1999	4.36（4.13~4.52）	<0.001
	2000—2003	2.41（2.16~3.04）	<0.001
	2004—2011	1.17（0.98~1.58）	<0.001
	2012—2017	1.72（1.19~2.09）	<0.001
	2018—2021	1.16（0.67~1.55）	<0.001

指标	ASIR预测模型	ASPR预测模型	ASDR预测模型
拟合最优模型(p, d, q)	ARIMA(2, 1, 0)	ARIMA(2, 1, 1)	ARIMA(2, 1, 0)
AIC	215.16	-65.97	-81.07
BIC	220.89	-58.81	-75.33
RMSE	6.422 7	0.062 6	0.054 1
Ljung-Box检验	0.666 6	0.902 5	0.867 4
MAPE	0.20%	0.10%	0.21%
R²	0.999 8	0.999 9	0.999 8