A Systematic Analysis of Urticaria Disease Burden, Risk Factors in Adolescents and Middle-aged Adults (1990 - 2021) and 2050 Trend Forecast: Based on the 2021 Global Disease Study

Background: Urticaria, one of the most prevalent skin conditions worldwide, has a substantial impact on patients' quality of life The middle - aged and young population (15 - 49 years old) constitutes the backbone of society and families Analyzing their urticaria disease burden is crucial for public health policymaking. However, existing research on the global urticaria disease burden and its trends among middle - aged and young individuals is still relatively scarce. Objective: This study aims to analyze the incidence, prevalence, and disease burden (measured by disability - adjusted life - years, DALYs) of urticaria among middle - aged and young individuals globally, regionally, and nationally from 1990 to 2021, based on data from the Global Burden of Disease (GBD) database and explore its changing trends and associated factors and project the DALYs trend up to 2050 to inform healthcare policymaking. Methods: This study utilized data from the GBD database, filtering relevant data on urticaria among middle - aged and young individuals (15 - 49 years old). We calculated the incidence (ASIR), prevalence (ASPR), and DALYs rate (ASDR) using age - standardized methods and generated a world map. Using a linear regression model, we computed the annual average percentage change (EAPC) and 95% confidence interval (CI) to analyze disease burden trends across regions and countries. Additionally, we grouped patients by age (15 - 19 to 45 - 49 years old) to compare disease burden distribution across age groups and projected the DALYs trend up to 2050. All statistical analyses were performed using R software. Results: From 1990 to 2021, global urticaria cases new prevalent and DALYs in middle - aged and young individuals rose, whereas ASIR and ASPR fell. The disease burden was markedly higher in females than in males.Regionally, East Asia saw the largest drop in ASIR and ASPR, while Europe Western rose. The disease burden was higher in low - and middle - SDI countries, while high - SDI countries saw the least ASIR decline and ASPR increase. Nationally, India and China reported the highest urticaria burden. Age - specific data showed the highest incidence in the 15 - 19 age group, declining with age. By 2050, global urticaria DALYs in middle - aged and young individuals are expected to rise, but the DALYs rate may gradually decline. Conclusion: Despite declining ASIR and ASPR of urticaria among middle - aged and young individuals globally, the disease burden remains unevenly distributed. Females and younger age groups bear a heavier burden. The disease burden is especially pronounced in low - and middle - SDI countries. Future - oriented targeted interventions and policies are needed to address this emerging public health issue.