Global, regional, and national disease burden of paralytic ileus and intestinal obstruction among individuals younger than 20 years, 1990 to 2021: Findings from the Global Burden of Disease Study 2021.

Using Global Burden of Disease Study 2021 data, this study assessed the global, regional, and national burden of paralytic ileus and intestinal obstruction among individuals younger than 20 years from 1990 to 2021 and explored its temporal patterns, inequalities, drivers, and future trends. We extracted global, regional, and national estimates of incidence, mortality, prevalence, and disability-adjusted life years (DALYs), together with age-standardized rates (ASR). Analytical methods included Joinpoint regression, age-period-cohort analysis, inequality and frontier analysis, decomposition analysis, and Bayesian age-period-cohort modeling to project burden to 2050. From 1990 to 2021, global ASR for incidence, mortality, prevalence, and DALYs declined, whereas absolute case numbers increased due to population growth. The burden was highest among children under 5 years and in lower socio-demographic index (SDI) regions. While inequalities in incidence and prevalence were relatively small, mortality and DALYs were disproportionately concentrated in lower-SDI regions, indicating pro-poor inequality. Frontier analysis revealed efficiency gaps in incidence and prevalence management in high-SDI areas, whereas several low-SDI countries approached their potential minimum for mortality and DALYs. Decomposition analysis attributed declining mortality and DALYs to epidemiological improvement and rising case numbers to population growth. All ASRs are projected to decline or stabilize by 2050. While fatal outcomes have improved, rising case numbers and persistent inequalities define the burden. Mortality reduction is driven by care improvements, while demographic growth fuels case increases. Public health strategies must be targeted: high-SDI regions should enhance prevention, low-SDI regions must strengthen acute care, and all efforts should prioritize children under 5.