Adolescents and women: shared high-risk populations for the burden of anxiety disorders and eating disorders in China and the United States—a 30-year trend and predictive analysis based on GBD 2023

Anxiety disorders(AD) and eating disorders(ED) are two closely related mental disorders that significantly impact global human health, with increasing global disability burden and significant cross-national variations. However, few studies have compared their long-term trends and drivers across countries, especially between China and the US with distinct social contexts. This study aims to systematically evaluate the long-term disease burden and temporal trends of AD and ED in China and the US from 1990 to 2023, and analyze population characteristics, thereby providing evidence for developing targeted prevention and control strategies.

Data on the prevalence, incidence, and disability-adjusted life years(DALYs) for AD and ED in China and the US from 1990 to 2023 were extracted from the 2023 global burden of disease(GBD) database to evaluate the changes in age-standardized rates of these indicators. The study population was stratified by the 15－49 years age group and sex. Joinpoint regression analysis was used to identify trend turning points and calculate the average annual percentage change(AAPC). Simultaneously, decomposition analysis was employed to quantify the drivers behind the changes in disease burden. Furthermore, the autoregressive integrated moving average(ARIMA) model was applied to forecast the prevalence and DALYs rates for AD and ED in China and the US from 2023 to 2050.

From 1990 to 2023, the age-standardized prevalence rate(ASPR), age-standardized incidence rate(ASIR), and age-standardized DALYs rate(ASDR) for both AD and ED among the population aged 15－49 years in China showed increasing trends, whereas, the ASIR for AD in the US decreased, and the ASPR and ASDR for ED also exhibited declining trends. The temporal trends of AD and ED also differed between China and the US. Joinpoint regression analysis revealed a “V-shaped” pattern in the prevalence and DALYs rates of AD and a continuous significant increase in ED burden in China (P<0.05); in the US, the prevalence and DALYs rates of AD showed an “N-shaped” pattern, while the prevalence and DALYs rates for ED initially rose, then fell, followed by a slow rise again. Sex- and age-stratified analyses revealed that the disease burden of AD and ED was higher in females than in males in both countries, with the peak burden occurring in the 15－24 years age group. The 45－49 years age group in China also warranted attention for AD incidence. Decomposition analysis indicated that the increase in the prevalence and DALYs rates of AD in China was primarily driven by population growth, while the increase in AD incidence and the increase in ED burden were mainly driven by epidemiological changes. Changes in AD and ED burden in the US were more influenced by population growth, with epidemiological changes playing roles in different directions across indicators. Forecasting results showed that from 2023 to 2050, the ASPR and ASDR for both AD and ED in China and the US are projected to continue rising, with a more pronounced upward trend in China.

Significant differences exist in the burden trends and driving factors for AD and ED between China and the US. The rapid growth of the disease burden in China highlights the challenges faced by its prevention and control system. Adolescents, middle-aged adults, and females are high-risk groups. Future efforts should focus on developing early intervention strategies for these vulnerable populations and optimizing resource allocation to address this increasingly serious public health issue.

Health policymakers should implement targeted prevention and control policies stratified by age and sex. Specifically, for the 15－19 years age group, a combination of universal and targeted mental health promotion programs should be implemented in school settings; For the 45－49 years age group, mental health services should be integrated into their daily work and routine physical examinations; For the female population, targeted psychological screening and support services should be provided at different life stages. In addition, improving the accessibility and effectiveness of healthcare services, fostering a supportive social environment, and formulating healthy public policies are also of critical importance.