Global burden of anorexia nervosa from 1990 to 2021 and future trends: pronounced disparities by sex, age, and socioeconomic development

Anorexia nervosa is a severe eating disorder with one of the highest mortality rates among psychiatric conditions and disproportionately affects adolescents and young women. However, comprehensive assessments of its long-term global burden and future trajectory remain limited. Methods Data on anorexia nervosa from the Global Burden of Disease (GBD) 2021 study were analyzed from 1990 to 2021. Age-standardized prevalence (ASPR), incidence (ASIR), death rates (ASDR), and disability-adjusted life years (DALYs) were estimated at global, regional, and national levels. Temporal trends were assessed using estimated annual percentage change (EAPC). Analyses were stratified by sex, age group, and Socio-demographic Index (SDI). Future trends from 2022 to 2041 were projected using autoregressive integrated moving average (ARIMA) models. Results Globally, ASPR and ASIR increased modestly from 1990 to 2021, whereas ASDR remained low and showed a slight decline. The burden of anorexia nervosa was substantially higher in high-SDI regions than in low-SDI regions. Females consistently exhibited a markedly higher burden than males, particularly among adolescents and young adults aged 15–24 years. Considerable regional and national heterogeneity was observed. Projections suggest a slight global decline in prevalence over the next two decades; however, the burden among females is expected to remain persistently high. Conclusions Anorexia nervosa continues to pose a significant global health challenge with pronounced disparities by sex, age, and socioeconomic development. These findings underscore the need for disorder-specific prevention strategies and improved surveillance of anorexia nervosa, particularly among adolescent girls and young women.