Population-Level Co-Distribution and Spatiotemporal Burden Trends of Endometriosis and Polycystic Ovary Syndrome Among Reproductive-Age Women in Europe, 1990–2023: An Analysis of the Global Burden of Disease 2023

Chanchan Ma,1– 3 Shibo Huang,4 Lihuan Song,5 Ying Luo,6 Honglan Zhu1,31Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China; 2Department of Obstetrics and Gynecology, North China Medical Health Group Fengfeng General Hospital, Handan, Hebei, People’s Republic of China; 3Obstetrics and Gynecology Teaching and Research Office, Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China; 4Department of Medical Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China; 5Independent Researcher, Fuzhou, Fujian, People’s Republic of China; 6Department of Pathology, Fujian Maternal and Child Health Hospital, Fuzhou, Fujian, People’s Republic of ChinaCorrespondence: Honglan Zhu, Email honglanzhu01@163.comBackground: Endometriosis (EM) and polycystic ovary syndrome (PCOS) are two prevalent endocrine-related gynecological conditions with shared pathophysiological pathways, yet their population-level burden patterns and socioeconomic correlates across Europe remain unclear. This study examines the geographic overlap in population-level disease burden patterns of EM and PCOS (hereafter referred to as ecological co-distribution), which does not represent individual-level comorbidity.Methods: Using the Global Burden of Disease (GBD) 2023 dataset, we retrieved incident cases and disability-adjusted life years (DALYs) data for EM and PCOS among women aged 15– 49 years covering 44 European countries (1990– 2023). Countries were classified into three population-level burden phenotypes (consistent pattern, EM-predominant pattern, PCOS-predominant pattern) by cross-tabulating quartiles of age-standardized incidence rates (ASIR). Temporal trajectories were quantified via the estimated annual percentage change (EAPC) method combined with Joinpoint regression modeling. Additional analyses included age-stratified burden distribution, correlation with the Socio-demographic Index (SDI), and decomposition analysis of burden drivers.Results: EM and PCOS exhibited diametrically opposite spatial gradients: EM burden concentrated in Central and Eastern Europe, while PCOS burden predominated in Western Europe. Only 7 countries showed consistent dual-disease burden levels, with 19 EM-dominant and 18 PCOS-dominant countries. From 1990 to 2023, ASIR of both diseases declined across most subregions. The age-standardized DALY rate (ASDR) of EM declined in Western Europe but showed a non-monotonic trajectory in Eastern Europe, whereas PCOS ASDR increased substantially across all regions. EM incidence was weakly but significantly negatively correlated with SDI, whereas both incidence and disability burden of PCOS showed significant positive associations with SDI. Decomposition analysis indicated that epidemiological shifts drove rising PCOS disability, while demographic changes mainly contributed to EM burden reduction.Conclusion: EM and PCOS exhibit geographically divergent burden patterns with differing socioeconomic gradients across Europe, underscoring the need for regionally differentiated reproductive health strategies.Keywords: Endometriosis, Polycystic ovary syndrome, GBD 2023, Geographic disparity, SDI