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Global, regional, and national burden of disease analysis on paralytic ileus and intestinal obstruction in adults aged 65 and over from 1990 to 2021, with projections for 2030: a Global Burden of Disease Study 2021 analysis

BMC Gastroenterology volume 25, Article number: 299 (2025) Cite this article

Abstract

Objective

This study aimed to evaluate the burden and trends of paralytic ileus and bowel obstruction in individuals aged ≥ 65 years, offering insights into prevention, treatment, and healthcare policy.

Methods

Data from the Global Burden of Disease Study 2021 were used to analyze paralytic ileus and intestinal obstruction by demographics, year, country/region, and Socio-Demographic Index (SDI). The statistical methods included Joinpoint regression, decomposition analysis, and Bayesian Age-Period-Cohort modeling.

Results

In 2021, the global age-standardized incidence of paralytic ileus and intestinal obstruction among the elderly was 643.45 cases per 100,000 individuals. The corresponding prevalence was 24.05 per 100,000 individuals, with disability-adjusted life years (DALYs) of 294.01 per 100,000 person-years and a mortality rate of 20.55 per 100,000 individuals. Between 1990 and 2021, the age-standardized incidence and prevalence of paralytic ileus and intestinal obstruction in the elderly gradually increased, while age-standardized DALYs and mortality consistently declined. Despite similar trends observed across both genders, the disease burden increased with age and was more pronounced in males than in females. Furthermore, the age-standardized incidence and prevalence of these conditions increased with SDI, whereas mortality and DALYs decreased. By 2030, the incidence and prevalence are expected to continue increasing, whereas mortality and DALYs are expected to decrease.

Conclusions

Despite the consistent decrease in mortality and DALYs associated with paralytic ileus and bowel obstruction in the elderly population aged ≥ 65 years, their incidence and prevalence continue to increase annually. This underscores the importance of improving preventive measures, early screening, and treatment efforts to address this pressing public health challenge.

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Introduction

Intestinal obstruction, a common surgical emergency, is primarily characterized by abdominal pain, vomiting, bloating, and constipation [1]. Paralytic ileus, a type of intestinal obstruction, is primarily caused by disturbances in the autonomic nervous system of the intestine, impairment of local neural conduction, and reduced smooth muscle contraction, leading to bowel distension and impaired peristalsis [2]. Both paralytic ileus and mechanical bowel obstruction are common complications of abdominal surgery, with small bowel obstruction occurring more commonly [3]. In the United States, the burden of gastrointestinal diseases is significant, with annual healthcare costs reaching $136.9 billion and up to 242,000 deaths occurring each year due to gastrointestinal conditions [4, 5]. Intestinal obstruction and paralytic ileus are among the most severe gastrointestinal disorders, significantly increasing mortality [6, 7]. Despite medical advancements, disparities in healthcare access and policies still influence disease burden trends. Timely access to medical care, surgery, and rehabilitation reduces disability and mortality, thereby improving quality of life. However, limited access to treatment exacerbates the disease burden. Therefore, developing targeted health policies and interventions is crucial for reducing patient risk and healthcare costs. Previous research has demonstrated that, compared to 1990, the age-standardized incidence and prevalence of paralytic ileus and intestinal obstruction increased by 86.67% and 56.91%, respectively, in 2019, particularly among the elderly, who are at higher risks of morbidity and mortality [8]. However, due to the timeliness of disease burden research, the 2019 data may have limited applicability in directing current health policy development. Moreover, the study did not thoroughly analyze or specifically address disease burden and its trends in the elderly population. Another analysis based on the 2021 Global Burden of Disease (GBD) Study data demonstrated that mortality was decreasing in approximately half of the European Union countries while the incidence was increasing [9]. This study was primarily descriptive and geographically limited, lacking an in-depth exploration of the factors influencing disease burden and future trends, especially among the elderly population.

As the global population ages, the healthcare burden of paralytic ileus and bowel obstruction in older adults becomes more complex. Older individuals often exhibit reduced physiological responsiveness, leading to atypical symptoms and rapid disease progression. Notably, colonic obstruction is prone to developing into a closed-loop obstruction, which may lead to severe complications, including bowel strangulation, necrosis, and perforation [10]. However, research on the disease burden of paralytic ileus and bowel obstruction in the elderly remains limited. Based on the latest data from GBD 2021, multiple analytical methods were used in this study, including descriptive analysis, correlation analysis, decomposition analysis, and predictive modeling, to comprehensively analyze the evolving trends in the disease burden of paralytic ileus and bowel obstruction among older adults. By combining disease burden estimates and GBD 2021 data, we provide a nuanced understanding of how healthcare accessibility, surgical capacity, and preventive strategies influence the disease trajectory. The results provide policymakers with actionable insights to reduce the incidence and mortality associated with aging populations. Furthermore, this study helps elucidate the specific drivers of disease burden in this population, providing more precise guidance for future disease prevention and policy development.

Methods

Data source

The data for this analysis were extracted from the GBD 2021 database, encompassing 371 diseases and 88 risk factors across 204 countries and territories globally [11, 12]. This study aimed to investigate the current status and emerging trends in the disease burden among the elderly population. To this end, data from individuals aged ≥ 65 years, spanning 1990 to 2021, were analyzed.

Key indicators

In this study, key metrics, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs), were used to assess the disease burden in individuals aged ≥ 65 years. To adjust for variations in population age structure, age-standardized incidence, prevalence, DALYs, and mortality were calculated using the GBD 2021 standard population’s age distribution. The trend in age-standardized data was assessed using the estimated annual percentage change (EAPC), while the 95% confidence interval (95% CI) was used to determine the statistical significance of these trends. An EAPC > 0 and a lower 95% CI indicated an upward trend, whereas a value < 0 indicated a downward trend.

Data analysis

Microsoft Excel (2021) and R software (version 4.3.3) were used for data management and statistical analysis. Microsoft Excel, with its user-friendly interface and efficiency in handling large-scale datasets, was primarily used for preliminary data organization, cleaning, and basic calculations. R, a powerful open-source statistical programming language, was selected for advanced statistical modeling, data visualization, and result reproducibility. The dplyr package was used for efficient data manipulation, including filtering, aggregation, and transformation, ensuring a smooth workflow for stratified and decomposition analyses. The ggplot2 package was used to generate high-resolution publication-ready figures. Additionally, the Microsoft Office package facilitated the automated generation of standardized reports and tables, thereby improving output formatting consistency. Collectively, these tools significantly improved the rigor, reproducibility, and scalability of the analysis, particularly in handling the multidimensional GBD dataset, which included 204 countries and territories over a 32-year timeframe.

Joinpoint regression analysis was conducted using the Joinpoint Trend Analysis Software (version 5.0.2), developed by the National Cancer Institute of the United States. Joinpoint regression analysis is a statistical method used to identify points in a dataset where a significant change in trend occurs. It fits a series of connected linear segments to the data and determines the location and number of these “joinpoints” based on statistical criteria. This method is useful for analyzing time trends in epidemiological and public health research. To determine the optimal number of joinpoints, we used permutation tests (default setting: 4,499 permutations) and selected the model with the smallest Bayesian Information Criterion. Assuming a log-linear trend, the annual percentage change (APC) for each segment was calculated, and its statistical significance was assessed using the Monte Carlo method [13, 14]. A trend was considered statistically significant if the 95% CI did not include 0; a CI entirely above or below 0 indicated a positive or negative trend, respectively. Additionally, Pearson correlation analysis was performed to evaluate the association between the Socio-Demographic Index (SDI) and disease burden metrics. This method quantifies the linear relationship between variables, revealing the correlation between SDI and changes in incidence, prevalence, DALYs, and mortality, with p < 0.05 considered statistically significant [15].

Advanced analytical methods

Decomposition analysis was used to attribute changes in disease burden to three major factors: population aging, population size changes, and epidemiological shifts. Population aging significantly impacts the disease burden by altering the age structure, particularly through an increasing proportion of elderly individuals. To disentangle this effect, we applied the standardized rate method, which involves determining the disease burden across different age groups using a fixed standard to eliminate the confounding influence of population structure differences. Changes in population size reflect variations in the total population, and the multiplicative decomposition method was used to quantify the interaction effect between population growth and disease rate changes, thereby determining how population size changes influence the absolute burden of disease. Conversely, epidemiological changes represent variations in the disease burden within each age group. These were analyzed using the fixed-baseline method, which compares the disease burden of different age groups to a reference year to elucidate the contribution of disease rate changes to the overall burden variation. Furthermore, an interaction decomposition method was used to analyze the interrelationships among these factors, with particular emphasis on the interplay between population aging and disease burden changes.

The Bayesian Age-Period-Cohort (BAPC) model was used to predict future disease burden. The BAPC model is an improved version of the traditional APC model, which incorporates Bayesian prior distributions and uses the Integrated Nested Laplace Approximation (INLA) algorithm to address parameter estimation issues caused by the linear dependence among age, period, and cohort effects. The mathematical expression for the model is as follows:

$$\:[\text{log}\left(\text{i}\text{j}\right)=\alpha\:+\mu\:i+\beta\:j+\gamma\:k]$$

where λij represents disease incidence, αis the intercept term, µi denotes the age effect, βj represents the period effect, and γk represents the cohort effect. By introducing a second-order random walk model to capture temporal dependencies, the BAPC model enables more flexible and efficient handling of complex, multi-factor interactions. BAPC and INLA packages in R were used to implement and forecast the model [16, 17].

Results

Global burden of paralytic ileus and intestinal obstruction in the elderly

In 2021, the age-standardized incidence of paralytic ileus and intestinal obstruction in the elderly was 643.45 per 100,000 people, the prevalence was 24.05 per 100,000 people, the DALYs were 294.01 per 100,000 person-years, and the mortality was 20.55 per 100,000 people. This implies that in 2021, there were 4,859,003.86 new cases of paralytic ileus and intestinal obstruction, with 181,820.34 existing cases, resulting in 2,173,409.47 DALYs per 100,000 person-years and 146,888.53 deaths per 100,000 people. The age-standardized incidence and prevalence of paralytic ileus and intestinal obstruction increased gradually from 1990 to 2021, whereas DALYs and mortality decreased. This suggests that the incidence and prevalence of the disease have deteriorated while DALYs and mortality have gradually decreased. The details are presented in Table 1.

Table 1 Age standardized disease burden of paralytic ileus and intestinal obstruction in elderly people worldwide, five SDI regions, and 21 GBD regions
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Regional burden of paralytic ileus and intestinal obstruction in the elderly

Among the five SDI regions, the high-SDI region demonstrated the highest age-standardized incidence (904.40 per 100,000 individuals) and prevalence (34.04 per 100,000 individuals) of paralytic ileus and intestinal obstruction in 2021. Conversely, the low-middle SDI region exhibited the lowest age-standardized incidence (478.18 per 100,000 individuals) and prevalence (17.45 per 100,000 individuals). The low-SDI region exhibited the highest age-standardized mortality (45.90 per 100,000 individuals) and DALYs (727.71 per 100,000 person-years), whereas the high-middle SDI region exhibited the lowest mortality (15.40 per 100,000 individuals) and DALYs (207.86 per 100,000 person-years).

In terms of temporal trends, the incidence and prevalence of paralytic ileus and intestinal obstruction increased across all SDI regions while the number of DALYs and mortality gradually declined. The high-SDI region exhibited the least pronounced increase in incidence (EAPC = 0.19) and prevalence (EAPC = 0.18), while the low-middle SDI region exhibited the most significant increases in incidence (EAPC = 0.63) and prevalence (EAPC = 0.70). The middle-SDI region demonstrated the most significant reductions in DALYs (EAPC = − 1.43) and mortality (EAPC = − 1.42), while the high-SDI region exhibited the least decline in both DALYs (EAPC = − 0.33) and mortality (EAPC = − 0.24). The incidence, prevalence, mortality, and DALY values for the five SDI regions are detailed in Table 1 as percentages of the global total.

In the 21 GBD regions, high-income North America had the highest age-standardized incidence (1204.93 per 100,000 individuals) and prevalence (45.54 per 100,000 individuals) in 2021. Eastern Sub-Saharan Africa had the highest age-standardized mortality (64.06 per 100,000 individuals) and DALYs (1079.68 per 100,000 person-years). Conversely, Central Asia had the lowest age-standardized incidence (269.32 per 100,000 individuals), Oceania had the lowest age-standardized prevalence (9.78 per 100,000 individuals), Central Asia had the lowest age-standardized mortality (7.76 per 100,000 individuals), and East Asia had the lowest age-standardized DALYs (117.63 per 100,000 person-years). The burden of disease across different GBD regions has changed over time, with increasing incidence and prevalence, while DALYs and mortality have generally decreased. The most significant increases in incidence (EAPC = 1.55) and prevalence (EAPC = 1.64) occurred in North Africa and the Middle East. However, some regions, such as Tropical Latin America and Central Europe, have demonstrated decreasing trends in incidence and prevalence. Specifically, Tropical Latin America saw the most notable declines in incidence (EAPC = − 0.95) and prevalence (EAPC = − 0.98). East Asia exhibited the largest reductions in DALYs (EAPC = − 2.63) and mortality (EAPC = − 2.58). However, some regions, such as Australasia, demonstrated an increase in DALYs (EAPC = 0.59), and Eastern Europe exhibited an increase in mortality (EAPC = 0.79), deviating from the overall trend. The incidence, prevalence, mortality, and DALY values of the 21 GBD regions, expressed as percentages of the global total, are detailed in Table 1.

Paralytic ileus and intestinal obstruction in the elderly: a global burden analysis

In the 2021 GBD study encompassing 204 countries, Canada exhibited the highest age-standardized incidence (1,431.59 per 100,000 individuals) and prevalence (54.21 per 100,000 individuals) of intestinal obstruction. Conversely, Mozambique exhibited the highest age-standardized DALYs (1,461.92 per 100,000 person-years) and mortality rate (82.02 per 100,000 population). Afghanistan reported the lowest age-standardized incidence (193.37 per 100,000 individuals) and prevalence (6.73 per 100,000 individuals). Ukraine exhibited the lowest age-standardized rates of DALYs (43.88 per 100,000 person-years) and mortality (2.48 per 100,000 individuals). Turkey exhibited the most significant rise in age-standardized incidence (EAPC = 2.35), while Equatorial Guinea experienced the greatest increase in age-standardized prevalence (EAPC = 2.65). Georgia exhibited the greatest increases in age-standardized DALYs (EAPC = 3.98) and mortality (EAPC = 4.39). Conversely, Poland recorded the most significant reductions in age-standardized incidence (EAPC = − 1.41) and prevalence (EAPC = − 1.43), while Cyprus experienced the most substantial declines in age-standardized DALYs (EAPC = − 3.90) and mortality (EAPC = − 4.03). Globally, an upward trend in incidence (EAPC > 0) was observed in 187 countries, while 17 countries exhibited a downward trend (EAPC < 0). The prevalence increased in 186 countries (EAPC > 0) and decreased in 18 countries (EAPC < 0). The number of DALYs increased in 61 countries (EAPC > 0) and decreased in 143 countries (EAPC < 0). Mortality increased in 62 countries (EAPC > 0) and decreased in 142 countries (EAPC < 0) (Fig. 1). Comprehensive data on the disease burden across 204 countries and regions are illustrated in Supplementary Materials 1 and 2.

Fig. 1
figure 1

Disease burden of paralytic ileus and intestinal obstruction in 204 countries and regions globally in 2021 (A. age-standardized incidence; B. Age-standardized prevalence; C. Age-standardized DALYs; D. Age-standardized mortality; E. EAPC of age-standardized incidence; F. EAPC of age-standardized prevalence; G. EAPC of age-standardized DALYs; H. EAPC of age-standardized mortality)

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Paralytic ileus and intestinal obstruction in the elderly: an analysis of age-sex-time associations

The age- and gender-specific analysis of 2021 revealed that in elderly males, the age-standardized incidence and prevalence of paralytic ileus and intestinal obstruction initially increased and then declined, with a turning point around the age of 90. Conversely, the age-standardized mortality and DALYs continued to increase. Although the overall disease burden trends were similar in males and females, the age-standardized incidence and prevalence in females exhibited a continuous upward trend (Figs. 2A–D).

Fig. 2
figure 2

Age-sex trends and Joinpoint regression analysis results of the disease burden of paralytic ileus and intestinal obstruction (A. Incidence; B. Prevalence; C. DALYs; D. Deaths; E. Joinpoint analysis of Incidence; F. Joinpoint analysis of Prevalence; G. Joinpoint analysis of DALYs; H. Joinpoint analysis of Deaths)

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The age-time association analysis revealed that the disease burden of paralytic ileus and intestinal obstruction among elderly populations remained generally stable from 1990 to 2021 worldwide and within the five SDI regions without significant changes over time. The disease burden increased with age. However, in high- and high-middle SDI regions, the age-standardized incidence and prevalence were higher in the 85–90 age group compared to those aged over 90 years (Supplementary Figs. 1–4). The gender-time association analysis revealed that the age-standardized incidence and prevalence of paralytic ileus and intestinal obstruction among the elderly exhibited an increasing trend over time for both males and females globally and in the five SDI regions. These rates were higher in males than in females. Conversely, the age-standardized DALYs and mortality decreased over time; however, the disease burden remained higher in males compared to females (Supplementary Figs. 5–8).

Time trends in paralytic ileus and intestinal obstruction disease burden among the elderly

Joinpoint regression analysis revealed that from 1990 to 2021, the incidence and prevalence of paralytic ileus and intestinal obstruction in the elderly population increased continuously, whereas mortality and DALYs decreased. The average annual percentage change (AAPC) for incidence was 1.432, while it was 0.055 for prevalence. Contrarily, the AAPCs for DALYs and mortality were − 2.987 and − 0.186, respectively. Significant changes in incidence and prevalence were observed in 1999, 2010, and 2016, while DALYs demonstrated significant shifts in 1999, 2008, and 2016. Mortality exhibited joinpoints in 1999, 2003, and 2016 (Figs. 2E–H). The overall disease burden associated with the incidence and prevalence of paralytic ileus and intestinal obstruction has increased since 1990; however, it decreased around 2010 and stabilized after 2016. Meanwhile, the burden of mortality and DALYs has been steadily decreasing since 2003 (Figs. 2E–H and Supplementary Material 3).

Association between paralytic ileus and intestinal obstruction disease burden and SDI in the elderly

In the 21 GBD regions, there was a positive association between the age-standardized incidence and prevalence of paralytic ileus and intestinal obstruction and increasing SDI. These rates significantly increased once SDI exceeded approximately 0.7. Conversely, age-standardized mortality and DALYs gradually declined as SDI increased, stabilizing once the SDI reached approximately 0.4. The most pronounced increase in incidence and prevalence was observed in high-income North America (Figs. 3A–D).

Fig. 3
figure 3

SDI analysis results (A. Incidence in 21 regions; B. Prevalence in 21 regions; C. DALYs in 21 regions; D. Mortality in 21 regions; E. Incidence in 204 countries; F. Prevalence in 204 countries; G. DALYs in 204 countries; H. Mortality in 204 countries; I. EAPC of incidence; J. EAPC of prevalence; K. EAPC of DALYs; L. EAPC of mortality)

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The nonlinear relationship between SDI and disease burden across 204 countries is illustrated in Figs. 3E–H. Driven by factors such as population aging and lifestyle changes, the incidence and prevalence increased sharply when SDI exceeded 0.7 (for instance, Canada: SDI = 0.92, incidence = 1431.59/100,000 individuals). Conversely, mortality and DALYs tended to stabilize once the SDI surpassed 0.6, reflecting diminishing returns in healthcare advancements for managing severe cases (Figs. 3G-H). These patterns underscore the dual role of socioeconomic development in both exacerbating and alleviating the disease burden.

With increasing SDI, the overall EAPC for incidence and prevalence exhibited no significant variation but remained positive, indicating a further increase in incidence and prevalence. Similarly, the overall EAPC for DALYs and mortality exhibited no significant change but remained negative, suggesting a declining trend in disease burden. Detailed trends are presented in Figs. 3I–L.

Decomposition analysis results of paralytic ileus and intestinal obstruction disease burden in the elderly

Decomposition analysis revealed that the synergistic effects of population growth, population aging, and the evolution of epidemiological patterns significantly exacerbated the global burden of paralytic ileus and bowel obstruction, with population growth being the most influential factor (Fig. 4). Population growth has increased the disease burden across all geographic regions. Population aging has led to an overall 21.3% increase in incidence and an 18.7% cumulative increase in prevalence. Aging accounted for only 9.2% of the increase in incidence in regions with higher SDI and relatively stable age structures. Conversely, in lower- and middle-SDI regions undergoing rapid demographic transitions, aging induced a 34.8% increase in incidence. This disparity is particularly pronounced in East Asia, where the rapid aging process accounts for 41.5% of the increase in incidence, highlighting a significant feature of the region’s demographic trends.

Fig. 4
figure 4

Decomposition analysis results (A. Incidence for global and five SDI regions; B. Prevalence for global and five SDI regions; C. DALYs for global and five SDI regions; D. Death for global and five SDI regions; E. Incidence for 21 GBD regions; F. Prevalence for 21 GBD regions; G. DALYs for 21 GBD regions; H. Death for 21 GBD regions)

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While epidemiological trends predominantly elevate the incidence and prevalence in most countries, certain regions exhibit paradoxical declines. Tropical Latin America and the high-income Asia-Pacific region demonstrated epidemiologically driven reductions in incidence and prevalence, underscoring regional heterogeneities in healthcare infrastructure and preventive strategies. Furthermore, although epidemiological transitions are associated with diminished DALYs and mortality in most regions, countervailing trends were observed in specific regions. For instance, high-income North America exhibited epidemiologically mediated increases in DALYs and mortality, indicating complex interactions between therapeutic advancements and comorbid disease profiles (Fig. 4).

Predictive analysis of the disease burden of paralytic ileus and intestinal obstruction in the elderly

Projection analyses predicted a persistent increase in the age-standardized incidence and prevalence of paralytic and mechanical intestinal obstruction among the global geriatric population (≥ 65 years) from 2022 to 2030, whereas the corresponding DALYs and mortality are expected to decline. By 2030, the age-standardized incidence, prevalence, DALYs, and mortality rates for this demographic are projected to reach 652.36, 24.22, 261.75 per 100,000 person-years, and 18.47 (16.12–21.05) per 100,000 population, respectively (Supplementary Material 4).

This epidemiological trajectory implies that by 2030, there will be 6,646,806 incident cases and 2,467,618 prevalent cases of intestinal obstruction among older adults globally, culminating in 26,669,218 DALYs lost and 1,882,258 attributable deaths (Fig. 5; Supplementary Material 5). Moreover, age-stratified analyses revealed a monotonic increase in both incidence and prevalence across advancing age cohorts, with nonagenarians and centenarians demonstrating a disproportionately higher disease burden. Although population-level reductions in DALYs and mortality are expected, the absolute burden remains significantly elevated in extreme age groups (Supplementary Figs. 9–12).

Fig. 5
figure 5

Predictive analysis results (A. age-standardized incidence; B. Age-standardized prevalence; C. Age-standardized DALYs; D. Age-standardized mortality; E. Actual values of incidence; F. Actual values of prevalence; G. Actual values of DALYs; H. Actual values of mortality)

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Discussion

The global incidence and prevalence of paralytic ileus and intestinal obstruction gradually increased among individuals aged ≥ 65 years between 1990 and 2021. This trend may be attributed to population growth, improved living standards, and dietary changes, all of which impose a greater metabolic burden on the gastrointestinal system [18]. Our decomposition analysis identified population expansion as the primary driver of the increasing disease burden, which is closely linked to global demographic shifts. Additionally, population aging exacerbates the disease burden, as age-related physiological decline, chronic comorbidities, and reduced intestinal motility increase susceptibility to bowel obstruction [19, 20]. Moreover, chronic diseases and their treatments increase the strain on the gastrointestinal system, while the risk of postoperative complications is also elevated [21]. Additionally, aging is associated with the deterioration of digestive function and the prevalence of constipation, further increasing the risk of bowel obstruction. As global aging intensifies, the incidence and mortality of bowel obstruction are increasing, particularly in developing regions.

In contrast, age-standardized DALYs and mortality exhibited a downward trend, likely attributed to innovations in medical technologies and improvements in treatment methods, which have significantly reduced the severity of bowel obstruction and its complications. For example, enhanced recovery after surgery (ERAS) protocols, which emphasize early postoperative feeding, have substantially reduced the risk of postoperative bowel obstruction [22]. Similarly, the risk of postoperative bowel obstruction is significantly reduced by early ileostomy closure after colorectal surgery [23]. Furthermore, the application of sodium hyaluronate and carboxymethylcellulose membranes has demonstrated efficacy in preventing postoperative small bowel obstruction in patients [24].

Our findings demonstrate that regions with rapid economic development exhibit the highest incidence and prevalence of intestinal obstruction. Decomposition analysis revealed that population growth plays a vital role in increasing disease burden in these regions than in lower-SDI areas. The increased burden of bowel obstruction in high-SDI regions is closely associated with the synergistic effects of obesity, malignancy, and comorbidities. Obesity exacerbates the risk of both mechanical and paralytic bowel obstruction through multiple mechanisms, including increased intra-abdominal pressure, chronic low-grade inflammation, and disruption of enteric nervous system signaling [25]. Malignancies, particularly colorectal and ovarian cancers, cause obstruction by compressing the lumen and spreading peritoneally. Chemotherapy and radiotherapy increase the risk of adhesive bowel obstruction further [26, 27]. Furthermore, surgical interventions in cancer survivors exacerbate adhesion formation, which remains a major cause of bowel obstruction [28, 29]. Meanwhile, comorbidities such as diabetes induce autonomic neuropathy that impairs gut motility, while polypharmacy, including opioids and calcium channel blockers, significantly increases the risk of motility disorders [26, 30]. Opioids, which are widely used for pain management in North America, Australia, and Central Europe, have been extensively investigated and proven to inhibit gastrointestinal motility and increase the incidence of paralytic ileus [31, 32]. However, the lower DALYs and mortality rates in these regions are primarily attributed to advanced medical infrastructure and the implementation of established therapeutic strategies.

Contrarily, the higher DALYs and mortality in economically underdeveloped regions are closely associated with lower levels of healthcare facilities. The lower incidence and prevalence in these regions may be related to slower population growth and insufficient statistical data due to limited medical resources and inadequate disease diagnosis and record keeping. For instance, sub-Saharan Africa has experienced the fastest increase in incidence and prevalence, likely due to poor healthcare infrastructure, rapid population growth, and high prevalence of parasitic infections, such as ascariasis [33, 34]. Ascariasis not only leads to peritonitis but also significantly increases the risk of intestinal obstruction. The regions with the most significant declines in DALYs and mortality included those with a medium SDI and East Asia. Significant reductions in disease burden have been observed in these areas due to improvements in education, increased awareness of disease prevention, and rapid advancements in healthcare [35, 36].

Despite significant advancements in healthcare, the DALYs and mortality rates in regions such as southern South America, Oceania, Central America, Eastern Europe, and Central Asia continue to increase. This trend may be attributed to insufficient healthcare infrastructure in these regions and inadequate implementation of public health policies in certain areas. Conversely, advancements in medical technology and the introduction of various treatment strategies have significantly improved the prognosis of patients with bowel obstruction and effectively reduced mortality. High-income countries have played a crucial role in reducing mortality through early diagnosis and timely surgical interventions. Low-SDI regions often face issues such as low income, inadequate healthcare systems, insufficient public awareness of diseases, and delayed medical services, significantly exacerbating the disease burden in these areas [37]. Furthermore, disparities in access to surgical treatment remain a significant challenge in low-income countries [34, 38]. Common issues, including delayed medical care, shortages of specialized personnel, and inadequate medical facilities, contribute to the increasing disease burden in these regions [39].

Local initiatives and international aid projects have provided effective strategies for addressing healthcare resource gaps in low- and middle-income countries. For instance, Rwanda’s collaboration with the “Strengthening Emergency and Essential Surgical Care Program” led to a 22% reduction in bowel obstruction-related mortality [37]. Besides, Ethiopia’s implementation of ERAS protocols has reduced recurrence rates by 18% [22]. Policymakers should prioritize promoting these models while also addressing potential causes of bowel obstruction, such as parasitic infections, through measures like deworming campaigns [33]. International aid can improve the accessibility of healthcare resources by providing technical support, financial assistance, and training, thereby improving early diagnosis and treatment outcomes for bowel obstruction and reducing the disease burden.

Further analysis of age, gender, and temporal trends revealed that older males bear a higher disease burden than older females. Research indicates that females exhibit certain protective physiological mechanisms, possibly due to the influence of estrogen and progesterone receptors on respiratory function [40]. Furthermore, studies indicate that the incidence of postoperative intestinal obstruction is higher in males [41]. The disease burden becomes more severe with increasing age, possibly due to declining physical fitness, reduced gastrointestinal function, and a rising prevalence of comorbidities among the elderly population [42,43,44].

Our analysis revealed a nonlinear correlation between SDI and bowel obstruction burden. When SDI reached 0.7, the incidence and prevalence were at their lowest levels across 21 regions and 204 countries before increasing sharply. This pattern may be explained by two key factors. First, in economically developed countries, advancements in medical technology have significantly improved diagnostic capabilities, leading to more accurate case identification. Moreover, these countries maintain standardized and comprehensive disease registries, including the Healthcare Cost and Utilization Project and the Medical Information Mart for Intensive Care database in the United States, as well as Eurostat’s health statistics for EU countries, all of which provide detailed records of bowel obstruction cases [45]. Second, high-SDI regions benefit from advanced healthcare systems, which have reduced mortality and DALYs. However, the increased incidence and prevalence in these regions may be attributed to improved diagnostic capabilities and lifestyle changes, including the adoption of high-calorie diets. For instance, studies have demonstrated that obesity is a major risk factor for gastrointestinal disorders [46]. Additionally, the incidence of neoplastic diseases is gradually increasing in the elderly population, and abdominal tumors are significant contributors to paralytic and mechanical bowel obstruction [32, 47]. When the SDI reached 0.4 in 21 regions and 0.6 in 204 countries, DALYs and mortality significantly decreased and gradually stabilized. This stabilization may be attributed to advancements in medical technology, which have significantly reduced mortality rates among patients in the early stages of the disease. However, since bowel obstruction remains a severe illness in the elderly, particularly when complicated by tumors, abdominal adhesions, systemic metabolic diseases, or obesity, treatment becomes significantly difficult. Therefore, the decline in mortality tends to plateau after reaching a certain threshold [33].

In conclusion, our results revealed that from 1990 to 2021, the age-standardized incidence and prevalence of paralytic ileus and bowel obstruction in the elderly worldwide exhibited an overall upward trend, while mortality and DALYs decreased. Projections for 2030 imply that these trends in the disease burden will continue. Moreover, the disease burden in the elderly population is expected to intensify with increasing age. The data from this study indicate that the incidence and prevalence of paralytic ileus and bowel obstruction in the elderly continue to increase, whereas mortality and DALYs are declining. These findings demonstrate that future research could elucidate the potential role of preventive measures, such as health education and nutritional interventions, in reducing the risk of such diseases.

Limitations

This study provides a comprehensive analysis of the current global disease burden, trends, and future projections of paralytic ileus and bowel obstruction in the elderly. However, there are several limitations.

First, the GBD 2021 data were derived from aggregated health statistics across various countries and regions, which may lead to underestimation, particularly in low-SDI regions with limited healthcare infrastructure. For instance, in low- and middle-income countries, there is a lack of detailed data on surgical waiting times and postoperative complication rates, which limits the comprehensive assessment of the effects of resource constraints on mortality trends. Similarly, diagnostic capabilities in low-SDI regions may be inadequate, leading to incomplete case identification and, consequently, an underestimation of the incidence and prevalence in these areas [48]. The actual prevalence of the disease in low-SDI regions may be obscured by delayed diagnoses and incomplete reporting, leading to potential underestimation and distorted projections of disease burden.

Second, discrepancies in diagnostic standards and coding practices across countries (for instance, distinguishing between paralytic ileus and mechanical bowel obstruction) may introduce misclassification bias, which could affect the accuracy of disease burden estimations [49].

Third, some GBD data rely on modeling to fill data gaps in regions with limited original data, which may introduce uncertainties. The wide confidence intervals of some estimated values reflect this. Fourth, the BAPC prediction model used in this study cannot completely account for potential future events, including new public health crises, sudden changes in health policies, and shifting epidemiological patterns. The accuracy of its predictions is highly dependent on the precision of the input data and the validity of the assumptions. For the 2030 forecast, the prediction outcomes may be significantly influenced by unforeseen variables, including disease prevention strategies, changes in demographic structure, and the emergence of new treatment methods.

Finally, a more detailed analysis cannot be conducted because the GBD database does not provide information on the causes of the disease. To enhance the utility of epidemiological data, future iterations of the database should include more granular etiological information. This improvement would not only refine disease burden estimates but also support the development of more targeted prevention and intervention strategies. From a policy perspective, integrating these data could facilitate evidence-based decision-making and resource allocation, thereby improving patient outcomes and healthcare efficiency.

Conclusion

From 1990 to 2021, the age-standardized incidence and prevalence of paralytic ileus and bowel obstruction in the global population aged ≥ 65 years demonstrated a consistent upward trend. However, mortality and DALYs have continuously declined. The disease burden of bowel obstruction increases with age and is higher in males than in females, although the overall trend between genders remains similar. High-SDI regions exhibited higher incidence and prevalence but lower mortality and DALYs. Conversely, despite a lower incidence, low-SDI regions exhibited higher mortality. Predictive models indicate that this trend will persist globally until 2030. In response to these trends, policymakers should improve early detection and intervention for bowel obstruction to reduce its incidence and severe outcomes in a timely manner. Additionally, it is imperative to increase investments in healthcare infrastructure, particularly in low-SDI regions.

Data availability

Data is provided within the manuscript or supplementary information files.

Abbreviations

GBD:

Global Burden of Disease

DALYs:

Disability-adjusted life years

EAPC:

The estimated annual percentage change

95% CI:

The 95% Confidence Interval

APC:

Annual Percent Change

SDI:

Socio-Demographic Index

BAPC:

Bayesian Age-Period-Cohort

INLA:

The Integrated Nested Laplace Approximation

AAPC:

The Average Annual Percentage Change

ERAS:

Enhanced recovery after surgery

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Acknowledgements

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Funding

Liaoning Province’s “Xingliao Talent Plan” project(XLYC2002002); Key R&D Program Project of Liaoning Province(2023JH2/101300100); Basic Research Projects of Liaoning Provincial Department of Science and Technology for Universities(2024-JYTCB-071).

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Authors and Affiliations

  1. Liaoning University of Traditional Chinese Medicine, Shenyang, 110000, China

    Tao Zhang, Zhitong Yu, Ling Wang, Qi Si, Xinping Lu, Siyuan Bu, Sihong Shen & Qingyan Wang

  2. Third Affiliated Hospital, Liaoning University of Traditional Chinese Medicine, Shenyang, 110000, China

    Meng Chen

  3. Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100000, China

    Zhetan Ren

  4. Second Affiliated Hospital, Liaoning University of Traditional Chinese Medicine, Shenyang, 110000, China

    Yongduo Yu

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Contributions

TZ, MC, ZY, and ZR contributed to the conceptualization, design, and initial drafting of the manuscript. TZ, LW, and QS conducted the literature review, data gathering, analysis, and statistical evaluations. QW and YY were involved in data collection, oversight, and manuscript revision. SS, SB, and XL offered insightful feedback on data interpretation and figure presentation. XY and ZY provided critical reviews of the manuscript.

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Zhang, T., Chen, M., Yu, Z. et al. Global, regional, and national burden of disease analysis on paralytic ileus and intestinal obstruction in adults aged 65 and over from 1990 to 2021, with projections for 2030: a Global Burden of Disease Study 2021 analysis. BMC Gastroenterol 25, 299 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12876-025-03904-0

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BMC Gastroenterology

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