The evolution of the global disease burden of polycystic ovary syndrome and the role of regional heterogeneity in high body mass index exposure: a spatiotemporal analysis based on the global burden of disease 2021.

Introduction: This study utilized data from the Global Burden of Disease (GBD) 2021 study to conduct a comprehensive analysis of the global burden of polycystic ovary syndrome (PCOS) from 1990 to 2021. Methods: We reported the trends of prevalence, incidence, years lived with disability (YLDs), and disability-adjusted life years (DALYs) in 204 countries and regions, stratified by age and sociodemographic index (SDI). All estimates were presented as absolute numbers and age-standardized rates (ASR) per 100,000 population, with 95% uncertainty intervals [95% UI] and estimated annual percentage changes (EAPCs) with 95% confidence intervals [95% CI]. In addition, we examined the association between high body mass index (BMI) exposure and PCOS, including its comorbidity burden across different age groups, taking into account regional variations in high BMI exposure. Results: In 2021, the global age-standardized prevalence rate (ASPR) of PCOS was 867.7 per 100,000 [95% UI: 618.7-1,195.3], representing a significant increase of 0.75 compared with 1990 [95% CI: 0.71-0.78]. The total number of PCOS cases reached 69.5 million [95% UI: 49.5-95.7 million]. The highest incidence was observed in adolescent females aged 15-19 years and in women of childbearing age aged 30-34 years. Low- and middle-SDI regions exhibited faster increases in incidence (EAPC: 1.76 [95% CI: 1.71-1.81]) compared with high-SDI regions, where incidence remained relatively stable (EAPC: 0.03 [95% CI: -0.14-0.2]). Among countries, the United States had the highest ASPR (1,958.7 per 100,000 [95% UI: 1,463.5-2,556.9]), while Central Europe had the lowest (111.7 per 100,000 [95% UI: 77-159.2]). Southeast Asia showed the fastest-growing PCOS burden (EAPC: 2.22 [95% CI: 2.11-2.32]). Among women exposed to high BMI, the PCOS burden demonstrated age- and region-specific heterogeneity. The overall disease burden decreased with age, particularly when high BMI exposure was below the 40th percentile (P40). Endometrial cancer burden increased with high BMI exposure in women aged 20-44 years, peaking during childbearing age, while the burden plateaued or declined in women aged 44-54 years and those over 55. Ovarian cancer showed an inverted U-shaped association across most age groups, peaking at BMI P40-60 in perimenopausal women. Mental disease burden was positively and synergistically associated with PCOS, with the highest impact at BMI P30-60. In contrast, metabolic disease burden was significantly elevated in postmenopausal women, exhibiting a pattern distinct from that of PCOS. Conclusion: These findings highlight the urgent need for stratified interventions targeting high-risk populations. Personalized screening and preventive measures can effectively mitigate long-term reproductive and metabolic complications associated with PCOS.