Rising burden and future projections of multiple sclerosis in East Asia: Findings from the global burden of disease study 2021.

Multiple sclerosis (MS) is a chronic central nervous system disorder characterized by immune-mediated inflammation and demyelination. Although East Asia was historically regarded as a low-prevalence region, recent evidence suggests a rising MS burden, yet region-wide analyses of long-term trends and future projections remain limited. Using data from the Global Burden of Disease (GBD) 2021 study, we assessed MS burden in China, Japan, South Korea, North Korea, and Mongolia from 1990 to 2021. Age-standardized prevalence (ASPR), incidence (ASIR), mortality (ASMR), and disability-adjusted life years (DALYs) were analyzed, with temporal trends quantified using estimated annual percentage change (EAPC) and future burdens projected to 2041 through autoregressive integrated moving average (ARIMA) models. Between 1990 and 2021, ASPR in East Asia steadily increased, while ASDR declined. Mongolia consistently carried the highest burden, whereas China experienced the fastest growth, with ASPR projected to rise by more than 80% by 2041. Japan and South Korea showed relatively stable patterns, while North Korea exhibited moderate increases. Across all countries, females consistently bore higher burdens than men, and MS indicators were positively correlated with the Sociodemographic Index (SDI). Overall, the burden of MS in East Asia is increasing, with China projected to experience the steepest rise by 2041 and Mongolia continuing to carry a disproportionately high load. This study integrates long-term trends, cross-country comparisons, and gender-specific analyses to evaluate the burden of MS in East Asia, providing relevant evidence for formulating region-specific and gender-sensitive policies, enhancing preparedness, and strengthening health systems in East Asia to respond to the increasing burden of multiple sclerosis.