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Trends and cross-country inequalities in schizophrenia from 1990 to 2021, with prediction to 2035: a systematic analysis of the global burden of disease study 2021

Wei Luo,Jie Gao,Zihan Guo,Xiao Han,Jiayu Song,Xue Su,Xuzu Da,Xingrong Liu

Published 2025 in BMC Psychiatry

ABSTRACT

Schizophrenia is one of the most severe mental illnesses, but there have been few studies on trends in the epidemiological burden and cross-national inequalities. Using data from the Global Burden of Disease Study 2021 (GBD 2021), the study aimed to evaluate the trends and cross-country inequalities of global schizophrenia burden over the past 32 years and predict its changes to 2035. The estimates and 95% uncertainty intervals (UI) for incidence, prevalence, and disability-adjusted life-years (DALYs) of schizophrenia were extracted from GBD 2021. The study calculated the estimated annual percentage change (EAPC) of schizophrenia’s incidence, prevalence, and DALYs from 1990 to 2021. Trends in the schizophrenia burden were analysed globally, regionally, and across multiple dimensions (including age-period-cohort effects), followed by decomposition according to population size, age structure, and epidemiological changes. The study quantified cross-country inequalities in the schizophrenia burden using standard health equity methods and predicted its changes by 2035. In 2021, there were 1.22 million incident cases, 23.18 million prevalent cases, and 14.82 million DALYs. From 1990 to 2021, the cases of incidence, prevalence, and DALYs of schizophrenia worldwide continued to increase, and the age-standardised rate (ASR) of prevalence and DALYs showed an upward trend. The risk of onset was highest at 20–24, and the risk of illness was highest at 35–39. The increase in DALYs of schizophrenia is driven by population growth. The burden of DALYs from schizophrenia is concentrated in wealthier countries, and the inequality in the burden has increased. It is worth noting that the ASR of DALYs will remain stable, while the ASR of incidence and prevalence shows an upward trend, and the number of cases of these indexes will continue to increase. The global schizophrenia burden generally increased between 1990 and 2021, with the burden concentrated in young adults. Trends in the schizophrenia burden show regional and national differences and vary by age, sex, period, cohort, and socio-demographic index. This study highlights the challenges, including increasing global burdens and inequalities, which may be instructive for better public health policy development and allocation of healthcare resources. Comprehensive strategies to promote mental health among young adults need to be continually prioritised.

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