Pancreatitis, a prevalent digestive system disorder with diverse etiologies and complex clinical manifestations, continues to impose a growing global disease burden (1). For instance, acute pancreatitis represents a leading cause of hospitalization for acute abdominal conditions, with mortality rates exceeding 20% in severe cases. Chronic pancreatitis, meanwhile, severely compromises patient quality of life due to recurrent complications such as pancreatic pseudocysts and diabetes (2).

In recent decades, shifting global demographics—including population aging, lifestyle modifications, and dietary pattern transitions—have contributed to heterogeneous trends in pancreatitis incidence and burden across regions (3, 4). Particularly in China, the challenges posed by an aging population demand adaptive public health strategies. As highlighted by Chen et al. (5), integrating chronic disease management within the framework of healthy aging is critical to mitigating the health burden of conditions such as pancreatitis. Nevertheless, marked disparities persist in burden characteristics and their drivers among different geographic, sex, and age groups, highlighting the urgent need for more comprehensive and precise epidemiological investigations.

Existing evidence indicates substantial global disparities in pancreatitis incidence and mortality across nations, potentially attributable to inequitable distribution of health resources, diagnostic capacity limitations, and differential exposure to major risk factors such as biliary diseases, alcohol consumption, and hyperlipidemia (6, 7). In high-income countries, medical costs and socioeconomic burdens associated with pancreatitis are notably elevated, whereas management and prognosis remain critically constrained in resource-limited regions. Sex and age further shape pancreatitis burden, with males typically exhibiting higher acute pancreatitis incidence (8), while females in older populations demonstrate disproportionately elevated mortality rates and disability-adjusted life years (DALYs). These divergences underscore the heterogeneous nature of pancreatitis burden and the imperative for sex- and age-sensitive health policies. In China, the world’s most populous nation, pancreatitis has emerged as a pressing public health challenge. A study by Yu et al. revealed a marked increase in pancreatitis burden among Chinese older adults populations over the past three decades, particularly in those aged ≥65 years. Projections by Wen et al. suggest continued escalation of pancreatitis burden both globally and in China over the next decade, with widening health inequities anticipated (3, 4). Collectively, these findings highlight the necessity for in-depth epidemiological analyses of disease trends and driving mechanisms through multidisciplinary collaboration and global data integration (7).

This study leverages data from the Global Burden of Disease (GBD) Study (1990–2021) to systematically assess temporal trends in pancreatitis burden in China, with comparative evaluations against global benchmarks. By analyzing variation patterns across sex, age groups, and temporal dimensions, we delineate the evolving burden of pancreatitis in China over the past three decades. These findings aim to inform evidence-based decision-making for policymakers and clinicians, support optimization of prevention and management strategies, and guide targeted efforts to mitigate future disease burden.

Although the temporal trends of pancreatitis have been described in various settings, a systematic and quantitative analysis that directly benchmarks China’s trajectory against the global average—using uniform GBD metrics and analytical frameworks—has been lacking. This study fills this critical gap by providing a direct, head-to-head comparative analysis, which is essential to delineate China’s unique epidemiological trajectory and to derive actionable insights for global health equity.

Extensive literature has documented the declining trends of pancreatitis burden globally and in China. However, many studies present these trajectories in isolation. Our study moves beyond this siloed approach by establishing a direct, head-to-head comparative framework. This framework allows us not only to confirm the declining trends but, more importantly, to quantitatively benchmark China’s progress against the global average, revealing that the pace of reduction in China has been substantially steeper. To comprehensively assess the pancreatitis burden, this study employed the Global Burden of Disease (GBD) methodology, integrating mortality, disability-adjusted life years (DALYs), age-standardized incidence rate (ASIR), and prevalence for systematic analysis across China and globally. Crucially, aging emerges as a key driver of pancreatic disease burden. The aging pancreas undergoes structural and functional degeneration (e.g., reduced exocrine capacity, fibrotic remodeling), heightening susceptibility to chronic pathologies such as pancreatitis (14). These biological correlates necessitate the development of age-specific management frameworks to mitigate disease progression and socioeconomic impacts. Furthermore, Joinpoint regression analysis was applied to scrutinize temporal trends in pancreatitis, which provided temporal granularity beyond linear trends by identifying significant inflection points. This enabled the evaluation of annual percentage changes (AAPC) between consecutive years and their statistical significance, offering potential anchors for correlating burden transitions with specific healthcare reforms over the 32-year study period.

Despite a global increase in the absolute number of pancreatitis cases from 1990 to 2021, our analysis reveals a consistent downward trend in age-standardized rates (ASRs) for incidence, mortality, and DALYs—a pattern more pronounced in China than globally. This divergence between crude and age-standardized metrics underscores the complex interplay of medical progress, demographic change, and health policy. The steeper decline in China’s age-standardized rates likely stems from synergistic advancements in clinical management and health system reforms, contextualized within its demographic transition. This accelerated decline is corroborated by an independent national burden analysis (15), and is plausibly linked to public health efforts. The effectiveness of such population-level measures is supported by global evidence, which confirms that alcohol control policies can reduce consumption and the burden of related diseases (16). In China, this is reflected in a documented reduction in the rate of frequent alcohol consumption (17). Refinements in evidence-based protocols for acute pancreatitis—including early goal-directed fluid resuscitation and step-up nutritional support—as outlined in updated national guidelines (18), have significantly improved outcomes for severe cases (19). Concurrently, enhancements in the management of chronic pancreatitis, guided by updated clinical guidelines, have reduced long-term disability (20). At the health system level, China’s healthcare reforms and the strengthening of its tiered medical care system have facilitated earlier detection and timely referral (5). This epidemiological shift is framed by demographic transition theory: while medical advancements reduce age-specific risks (captured by declining ASRs), population aging inflates the absolute number of at-risk individuals, explaining the paradox of rising crude case counts (2). However, global health inequities and disparities in regional healthcare capacity may constrain the translation of such advancements into practice. Differential access to diagnostics and therapeutics remains a critical barrier, potentially amplifying geographical divergences in disease burden trends.

Furthermore, this study highlights the significant impact of age-specific disparities on pancreatitis burden, particularly in older adults and pediatric populations. Emerging data indicate a progressive increase in pancreatitis-related burden among older adults, while pediatric cases present distinct clinical profiles and heterogeneous epidemiological patterns (21). These findings provide critical insights for developing targeted interventions tailored to specific population subgroups. Collectively, our research not only delineates temporal trends in pancreatitis burden but also offers comprehensive epidemiological evidence to inform future investigations into regional variations, risk factor prioritization, and health policy formulation. Subsequent studies should prioritize the optimization of global prevention frameworks and precision management strategies to mitigate pancreatitis burden. Emerging technologies may play a pivotal role in advancing these goals. For example, nanotechnology-based approaches—particularly those enabling targeted drug delivery and high-resolution diagnostic imaging—could refine risk stratification, enhance therapeutic specificity, and ultimately support personalized interventions tailored to disease stages or subphenotypes (22). Such innovations align with the broader objective of translating precision medicine into routine clinical practice.

The findings of this study demonstrate that although the absolute number of pancreatitis incident cases and prevalent cases has continued to rise globally and in China, age-standardized incidence rate (ASIR) and mortality rate (ASMR) exhibit a downward trend. This disparity suggests substantial advancements in global healthcare interventions and disease management over recent decades, particularly in critical care for acute pancreatitis and early diagnostic capabilities. Enhanced medical resources and the implementation of early interventions have effectively reduced pancreatitis-related lethality and disability rates, with notable progress in critical patient care significantly mitigating mortality risks (23).

Furthermore, while our national-level analysis delineates China’s overall progress against the global backdrop, it inevitably masks significant subnational heterogeneities. This study is limited by its national-level perspective, which precludes a direct examination of urban–rural and regional disparities within China. However, compelling evidence from national studies on healthcare resource allocation strongly suggests that such gradients are highly probable. Empirical research has consistently documented a pronounced ‘high-in-the-east and low-in-the-west’ geographical pattern in the distribution of healthcare resources across China, with spatial Gini coefficients for key indicators exceeding 0.5, indicating substantial inequality (24). This east–west gradient is evident at both hospital and primary care levels. For instance, the fairness of hospital resource allocation follows a pattern of western < eastern < central regions, while for primary institutions, it is western < central < eastern (25). Crucially, the distribution of highly specialized human resources—such as physicians and nurses, which are critical for managing complex conditions like severe acute pancreatitis—is particularly skewed. Studies on primary healthcare resources reveal that the ratio of medical personnel to population size is adequate in the east but falls short in the central and western regions (26). The clinical course of pancreatitis, particularly severe acute pancreatitis, is critically dependent on timely access to specialized diagnostics (e.g., endoscopic retrograde cholangiopancreatography) and advanced critical care facilities—resources that are known to be concentrated in eastern urban centers (27). Therefore, it is a logical and empirically supported inference that disparities in the availability of these specialized resources would translate into disparities in pancreatitis outcomes, such as mortality and disability rates. Consequently, our reported national averages likely represent a composite of markedly divergent local realities, underscoring an urgent need for region-specific health policies and targeted resource allocation to under-resourced regions to ensure equitable pancreatitis care outcomes nationwide.

While these trends align with reports from the Global Burden of Disease (GBD) and other studies, discrepancies may arise from variations in regional healthcare infrastructure, data sources, and technological advancements. The observed increase in pancreatitis burden across China and globally corresponds with findings from the GBD 2021 study. Similarly, Li et al. (28) and Yu et al. (3) identified rising global pancreatitis incidence, yet noted persistently escalating burdens in low-income regions due to inadequate medical resources. Our research further highlights that the growing burden of pancreatitis is closely linked to population aging, increased prevalence of chronic comorbidities, and lifestyle changes (e.g., dietary habits, rising obesity rates), a conclusion corroborated by Petrov et al. (2) and Li et al. (28).

Improvements in severe acute pancreatitis management—such as advances in endoscopic therapies, early nutritional support protocols, and critical care strategies—have markedly enhanced survival rates and reduced both mortality and disability-adjusted life years (DALYs). Additionally, advancements in healthcare systems, particularly in developed nations, have alleviated long-term sequelae through timely diagnosis and intervention (28). In China, the significant decline in ASMR is likely attributable to optimized critical-care management strategies, including early goal-directed fluid resuscitation and stepwise nutritional support, which mitigate complication risks in acute pancreatitis patients (19). However, this progress remains uneven across low- and middle-income countries (LMICs), where limited access to advanced diagnostics and therapies perpetuates high mortality rates, especially in severe acute cases. Han et al. (29) emphasize that persistent health inequities and resource scarcity in LMICs constitute major barriers to reducing pancreatitis-related mortality.

Nevertheless, despite continuous advancements in therapeutic approaches, the burden of pancreatitis remains substantial, particularly against the backdrop of a globally aging population, where the burden among older adults individuals is progressively escalating (30). This underscores that despite improved treatment protocols, significant challenges persist in managing pancreatitis within the geriatric patient population. Older adults patients frequently exhibit multimorbidity profiles—including hypertension, diabetes mellitus, and cardiovascular diseases—a complex clinical context that complicates both diagnosis and therapeutic management while heightening treatment resistance (31).

Petrov and Yadav (2) have also highlighted that insulin resistance in older adults patients may exacerbate pancreatic microcirculatory disturbances, thereby delaying inflammatory resolution. This evidence underscores the critical role of comorbidity management—such as stringent glycemic control in diabetes—as a cornerstone of comprehensive geriatric care for pancreatitis. Furthermore, aging populations face heightened burdens of pancreatitis due to age-related immune senescence and metabolic dysregulation, both of which contribute to the aggravated disease burden. These factors collectively undermine therapeutic efficacy in older adults patients, resulting in poorer clinical outcomes and increased disease severity. Notably, pancreatitis manifests distinct clinical features across age groups. In contrast to adults, the primary etiological drivers of pancreatitis in pediatric populations include infections (e.g., mumps virus), adverse drug reactions (e.g., valproic acid), and genetic predisposition (e.g., PRSS1 gene mutations) (21).

For instance, certain genetic variants may heighten pediatric susceptibility to pancreatitis, and therapeutic regimens for this population often necessitate personalized adjustments aligned with developmental physiology (32). Therefore, early identification and targeted therapeutic interventions—such as minimizing invasive procedures and prioritizing nutritional support—are critical for mitigating the burden of pancreatitis in children (33). While geriatric populations face escalating pancreatitis burdens, pediatric cases demonstrate greater etiological complexity. This observation aligns with findings by Yu et al. (3) and Liu et al. (21), who also reported heightened pancreatitis risks in older adults patients amid advancing global aging. In older adults patients, comorbid chronic diseases and age-related immune dysfunction pose greater therapeutic challenges and increase susceptibility to complications (34). For pediatric populations, although pancreatitis incidence is relatively low, its pathogenesis is primarily mediated by infectious agents (e.g., viral infections), drug hypersensitivity (e.g., anticonvulsant reactions), and genetic predisposition—a pattern corroborated by Liu et al. (21).

The study further underscores the profound impact of geographical disparities on pancreatitis outcomes. Heterogeneity in healthcare resources, socioeconomic conditions, and health policy frameworks across nations and regions may significantly influence the pancreatitis burden. In high-income countries, robust healthcare infrastructure and integrated early diagnostic systems typically correlate with reduced morbidity and mortality rates. Conversely, low- and middle-income countries (LMICs) face persistently elevated mortality rates due to resource-constrained settings and suboptimal disease management protocols, particularly in managing severe acute pancreatitis (9, 19). These disparities are notably evident in China, where urban–rural healthcare gaps and geographical imbalances in medical resource allocation remain key drivers of differential pancreatitis-related mortality (35).

These findings collectively indicate that disparities in pancreatitis burden are primarily driven by inequitable healthcare resource allocation. In high-income countries, proactive early diagnosis and specialized critical care infrastructure have achieved significant reductions in mortality, whereas resource-limited settings face delayed clinical management due to systemic constraints (36). For example, studies by Wen et al. (4) and Jiang et al. (36) demonstrate that comprehensive healthcare systems and targeted public health interventions in affluent nations correlate with markedly lower pancreatitis-related mortality and complication rates, in stark contrast to the escalating disease burden observed in developing economies. Our study further reveals a gradually rising pancreatitis burden in China, where despite recent improvements in healthcare capacity, persistent urban–rural care disparities and regionally fragmented resource distribution remain a key contributing factor to unequal mortality outcomes (29). This evidence underscores the urgent need for globally coordinated strategies prioritizing equitable resource distribution and evidence-based health policy reform. While this study provides a comprehensive historical benchmark, the future trajectory of the pancreatitis burden remains a critical concern for healthcare planning. Building directly upon the trends quantified herein—particularly the accelerated decline in China against a slowly improving global backdrop—future research must prioritize the development of robust forecasting models. Utilizing statistical approaches such as age-period-cohort modeling or time-series analysis to project incidence, mortality, and DALYs would offer invaluable insights for anticipating healthcare needs and optimizing resource allocation. The historical patterns established in this analysis serve as the essential foundation for validating and refining such predictive efforts.

Collectively, the findings of this study align with previous research, particularly regarding the upward trajectory of pancreatitis burden observed globally and in China. Despite the persistent rise in global pancreatitis burden, evidence confirms that timely therapeutic interventions, early diagnostic protocols, and optimized healthcare resource utilization are pivotal to reducing pancreatitis-related mortality and disability. With advancements in global healthcare standards, especially in high-income nations, age-standardized mortality and disability rates associated with pancreatitis have shown significant reductions (19, 23). However, structural inequities in healthcare resource allocation persist worldwide, with acute shortages in low- and middle-income countries (LMICs) critically undermining mortality reduction efforts (37). To address this gap, context-adaptable strategies that couple cost-effective innovation with equity-driven design are urgently needed. Emerging approaches such as Just-in-Time Adaptive Interventions (JITAI)—leveraging mobile health monitoring and dynamic resource prioritization to optimize pancreatitis care in real-time (e.g., early detection of exacerbations, tailored patient triaging)—may offer a scalable model for LMICs (38). By aligning technological advancements with locally feasible infrastructure, JITAI frameworks could mitigate disparities in pancreatitis outcomes, provided systemic biases in resource distribution are concurrently addressed.

The study’s pivotal contribution resides in establishing a direct, quantitative benchmark of China’s pancreatitis burden against the world, moving beyond siloed descriptions. This comparative approach enabled a granular analysis of geographical and population-level disparities, coupled with mechanistic insights into their socioeconomic and systemic drivers that are contextualized within China’s unique trajectory. By contextualizing these findings within China’s ongoing healthcare reforms and public health initiatives, the study elucidates the multi-layered determinants of observed epidemiological shifts. Nevertheless, despite global progress in pancreatitis management, persistent challenges—including spatial resource mismatch, aging populations, and escalating comorbid chronic disease burdens—demand urgent attention. Thus, future research must prioritize three axes: (1) targeted mitigation of health inequities; (2) personalized therapeutic approaches for geriatric patients; and (3) equity-driven globalization of healthcare resource frameworks. Strategic efforts in these domains are imperative to achieving sustainable reductions in the global pancreatitis burden.

This study reveals significant shifts in the global and Chinese pancreatitis burden between 1990 and 2021, particularly in trends of incidence and mortality rates. These findings carry critically important theoretical and practical implications for optimizing public health policies and healthcare resource allocation. The data demonstrate that while the global burden of pancreatitis has increased, improvements in early diagnosis and evidence-based critical care management have driven marked reductions in mortality (2). Furthermore, personalized therapeutic strategies tailored to specific demographic groups—particularly geriatric and pediatric populations—are proven to mitigate disease burden effectively (3). By quantifying geospatial and socioeconomic disparities, this research provides robust empirical support for addressing global health inequalities and underscores the urgency of scaling up context-specific healthcare resources in low-income nations (28).

Notwithstanding these contributions, our findings must be interpreted in the context of several limitations. First, as the GBD estimates rely on modeled data and predictive algorithms, they are subject to inherent uncertainty, particularly in regions with limited primary surveillance (e.g., low-income countries), which may introduce indirect estimation biases. Second, the scope of our analysis was constrained by the available GBD metrics; clinically relevant long-term outcomes such as pancreatitis recurrence rates were not included, which limits a more comprehensive assessment of the disease’s clinical progression and burden. Third, this study is a retrospective analysis focused on historical trends and does not include forecasting models to predict the future burden of pancreatitis. Fourth, and specific to the Chinese context, our national-level analysis inevitably masks subnational heterogeneity. The GBD 2021 public database does not provide subnational data for China (e.g., provincial-level estimates), which precluded a direct analysis of urban–rural and regional (east-central-west) disparities in pancreatitis burden. Although we have cited independent studies confirming significant geographical inequalities in healthcare resources across China, future studies with access to granular, subnational data are warranted to explore this critical dimension. Despite these constraints, the GBD framework remains the gold standard for comparative epidemiological studies, and our analysis provides valuable population-level insights that lay the groundwork for future research incorporating primary, longitudinal data to elucidate finer-grained clinical dynamics.

Employing the Global Burden of Disease (GBD) methodology, this study systematically evaluated the pancreatitis burden across global and Chinese populations from 1990 to 2021, integrating metrics such as incidence, mortality, and disability-adjusted life years (DALYs). The analysis captures spatiotemporal patterns and highlights age- and sex-specific disparities critical for tailoring public health interventions. Key findings reveal that, despite an increase in global pancreatitis case counts (both incident and prevalent), there has been a concurrent decline in age-standardized incidence and mortality rates. These trends suggest that advancements in therapeutic protocols and healthcare infrastructure have contributed to improved outcomes. However, persistent inequities in healthcare access—particularly in low- and middle-income countries (LMICs)—and geographic disparities in disease burden among older adults populations remain significant challenges. The theoretical and practical contributions of this study provide an empirical basis for evidence-based public health strategies that integrate precision medicine with equitable resource allocation. This underscores the need for targeted therapeutic approaches for high-risk groups, including older adults individuals and populations in resource-limited settings. Emerging technologies, such as nanotechnology for targeted diagnostics and Just-in-Time Adaptive Interventions (JITAI) for real-time resource optimization, present promising opportunities to address these disparities. To translate these findings into actionable policies, a staged approach is recommended. In the short term, priorities implementable within existing healthcare frameworks include: (1) launching region-specific epidemiological studies to identify and prioritize local risk factors (e.g., biliary diseases, alcohol consumption, hyperlipidemia) for targeted primary prevention; and (2) developing and validating forecasting models using the historical benchmarks from this study to anticipate future healthcare needs and optimize resource allocation. For long-term, transformative impact, exploratory efforts should focus on: advancing the development of robust forecasting models for pancreatitis burden, building upon the historical trends established herein and evaluating the real-world effectiveness and scalability of emerging technologies, such as nanotechnology for targeted drug delivery and diagnostics, and Just-in-Time Adaptive Interventions (JITAI) for dynamic, personalized disease management in both community and clinical settings.