Global burden of plastic-surgery-related conditions, 1990-2021: a composition-aware analysis with projections to 2050.

[BACKGROUND] Plastic surgery-related diseases impose a substantial and growing burden on global health systems, yet comprehensive estimates of their temporal trends and future projections remain scarce. This study aims to quantify the global, regional, and national burden of 12 plastic surgery-relevant conditions from 1990 to 2021 and to forecast their trajectories through 2050.

[METHOD] Data were extracted from the Global Burden of Disease Study 2021. We analyzed age-standardized incidence rate (ASIR), prevalence rate (ASPR), death rate (ASDR), and disability-adjusted life years (DALYs) across 204 countries and territories. Estimated annual percentage changes (EAPCs) were calculated to evaluate temporal trends, and a Bayesian age-period-cohort (BAPC) model was employed to project disease burden to 2050. Socio-demographic disparities were assessed using SDI-based stratification and Spearman correlation.

[FINDINGS] Globally, incidence was compositionally dominated by pyoderma (about 90% in 1990-2021). Incident cases increased from 508.18 million (95% UI 489.85-527.22) in 1990 to 902.35 million (95% UI 871.47-934.10) in 2021, with an ASIR increasing from 9,611.94 to 11,560.66 per 100,000 population. In contrast, the ASPR declined from 2,862.67 to 2,207.26 per 100,000, and age-standardized mortality and DALYs rates also fell. The burden rose steeply with age: adults aged ≥60 years consistently exhibited the highest age-specific rates, and the absolute burden progressively shifted toward older populations. High-SDI regions had lower age-standardized mortality and DALYs rates than low-SDI regions, despite occasionally higher prevalence consistent with improved survival. By 2050, the absolute burden is projected to grow with population aging, while most age-standardized rates continue to decline.

[INTERPRETATION] Aggregate incidence increases were driven mainly by pyoderma. Surgically relevant burdens concentrated in oncologic and burn/trauma cohorts; hence service implications should be anchored to these metrics rather than incidence. By 2050, incidence continues to rise largely from infections, while DALYs trajectories in surgically managed subgroups diverge by SDI-supporting targeted prevention, context-specific capacity strengthening, and integrated rehabilitation.