The Heterogeneous Global Burden of Hemoglobinopathies Among Women of Childbearing Age, 1990-2021, with Projection to 2030

Huiqiang Wu,1,2,* Zhiyin Cai,1,2,* Wanyi Liu,1,2,* Zechuan Wang,1,2 Meiling Li,1,2 Weihuang Zhuang1,2 1Department of Hematology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, People’s Republic of China; 2The Second Clinical Medical College, Fujian Medical University, Quanzhou, Fujian, People’s Republic of China*These authors contributed equally to this workCorrespondence: Weihuang Zhuang, Department of Hematology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 36200, People’s Republic of China, Tel +86 13808521170, Email zhuangweihuang@vip.163.comObjective: To systematically assess the global, regional, and national disease burden of Hemoglobinopathies among women of childbearing age (WCBA) from 1990 to 2021, whilst projecting trends to 2030.Methods: Data were sourced from the Global Burden of Disease 2021 database, covering 204 countries and five socio-demographic index strata. Analyses focused on thalassemia and SCD among WCBA aged 15– 49 years, with indicators including prevalence, deaths, and disability-adjusted life years (DALYs). Joinpoint regression, age–period–cohort model, decomposition analysis, frontier analysis, and Bayesian Age-Period-Cohort models explored the changes, drivers, inequalities, and future trends in disease.Results: Between 1990 and 2021, the overall burden of thalassemia in the WCBA declined, with age-standardized prevalence rates (ASPR) decreasing from 12.75 to 9.90 per 100,000 population and age-standardized DALY rates falling from 9.69 to 6.56 per 100,000 population. Conversely, SCD showed a marked increase: ASPR rose from 42.99 to 67.17, age-standardized death rates (ASDR) increased from 0.35 to 0.54, and age-standardized DALY rates climbed from 25.88 to 40.76 per 100,000 population. Regional and national disparities were pronounced, with thalassemia bearing the highest burden in East Asia, while SCD predominantly concentrated in sub-Saharan Africa with low SDI. Decomposition analysis indicated that the decline in thalassemia primarily stemmed from epidemiological improvements, whereas the rise in SCD was mainly associated with population growth and inadequate healthcare accessibility. Projections suggest that by 2030, the burden of thalassemia will continue to decrease, while SCD will further intensify.Conclusion: Thalassemia and SCD exhibit divergent disease burden trends within the WCBA, posing significant challenges to maternal health. Future efforts should focus on expanding tailored premarital and prenatal screening, genetic counselling, and multidisciplinary antenatal management to reduce inequalities and achieve sustained reductions in haemoglobinopathy burden, particularly in low-SDI regions.Keywords: hemoglobinopathies, women of childbearing age, thalassemia, sickle cell disorders, projection