Trends in burden of pelvic fractures from 1990 to 2023 and long short-term memory-based insights into future projections_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FAN Wenbin ^1,2,3,4 , YIN Yueheng ^1,2,3,4 ^{共同第一作者} , TIAN Chuwei ^1,2,3,4 ^{△共同第一作者} , ZHOU Jun ^1,2,3,4 , XIE Tian ^1,2,3,4 , SHI Liu ^1,2,3,4 ,  LIU Guodong ⁵ ,  RUI Yunfeng ^1,2,3,4

1. Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P. R. China;
2. Trauma Center, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P. R. China;
3. Orthopaedic Trauma Institute, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P. R. China;
4. School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P. R. China;
5. Department of Wound Care Support, National Key Laboratory of Trauma and Chemical Injury, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, P. R. China;

Corresponding author：

LIU Guodong, Email: frankliugd@163.com; RUI Yunfeng, Email: ruiyunfeng@126.com

Keywords：

Pelvic fractures; Global Burden of Disease Study; sociodemographic index; long short-term memory model

DOI：

10.7507/1002-1892.202509022

Video：

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Objective To analyze the disease burden of pelvic fractures at the global, regional, and national levels from 1990 to 2023 using data from the 2023 Global Burden of Disease Study (GBD), and to predict the disease burden through 2050. Methods Leveraging data from the GBD 2023, this study investigated the disease burden of pelvic fractures across 204 countries and regions. Assessment indicators included incidence rate, prevalence rate, and years lived with disability (YLDs). The Joinpoint regression model was employed to analyze trends in pelvic fracture burden from 1990 to 2023, while the average annual percentage change (AAPC) was used to quantify this temporal trend. The relationship between the socio-demographic index and pelvic fracture burden was evaluated. Furthermore, the long short-term memory (LSTM) model was applied to predict trends in pelvic fracture burden through 2050. Results In 2023, the estimated number of new pelvic fracture cases globally was 7 479 884 [95% uncertainty interval (UI): 5 293 401-10 611 876], representing a 42.74% increase from 1990. In the same year, the number of prevalent pelvic fracture cases and YLDs were 23 007 508 (95%UI: 21 021 518-25 327 165) and 3 909 228 person-years (95%UI: 2 725 498-5 194 385), respectively. Additionally, age-standardized rates exhibited an opposing downward trend. Significant disparities in the disease burden of pelvic fractures were identified across different age groups, genders, and social contexts. According to predictions from the LSTM model, the global age-standardized incidence rate (ASIR) of pelvic fractures will be approximately 88.44 per 100 000 persons by 2050, while the total number of incident cases will rise to 8 547 095. Conclusion Although the overall incidence rate, prevalence rate, and YLDs of pelvic fractures have exhibited an upward trend over the past three decades, the ASIR, age-standardized prevalence rate (ASPR), and age-standardized years of life lost rate (ASYR) have shown a downward trend. It is predicted that over the upcoming 26-year period, the age-standardized rate of disease burden due to pelvic fractures will further decrease, while the number of incident cases and prevalent cases will continue to exhibit an upward trend. Formulating more targeted disease prevention strategies is critical to addressing disparities across genders, regions, and other dimensions, and to mitigating the burden of pelvic fractures.

1.	Hu S, Guo J, Zhu B, et al. Epidemiology and burden of pelvic fractures: Results from the Global Burden of Disease Study 2019. Injury, 2023, 54(2): 589-597.
2.	Ooi CK, Goh HK, Tay SY, et al. Patients with pelvic fracture: what factors are associated with mortality? Int J Emerg Med, 2010, 3(4): 299-304.
3.	Buller LT, Best MJ, Quinnan SM. A nationwide analysis of pelvic ring fractures: Incidence and trends in treatment, length of stay, and mortality. Geriatr Orthop Surg Rehabil, 2016, 7(1): 9-17.
4.	Qiu X, Zhu T, Deng H, et al. Multicenter epidemiological analysis of related factors in 10, 808 hospitalized children with lower limb and pelvic fractures in China. Sci Rep, 2024, 14(1): 27860. doi: 10.1038/s41598-024-77970-x.
5.	Abdelrahman H, El-Menyar A, Keil H, et al. Patterns, management, and outcomes of traumatic pelvic fracture: insights from a multicenter study. J Orthop Surg Res, 2020, 15(1): 249. doi: 10.1186/s13018-020-01772-w.
6.	Andrich S, Haastert B, Neuhaus E, et al. Excess mortality after pelvic fractures among older people. J Bone Miner Res, 2017, 32(9): 1789-1801.
7.	Mi M, Kanakaris NK, Wu X, et al. Management and outcomes of open pelvic fractures: An update. Injury, 2021, 52(10): 2738-2745.
8.	Yoshihara H, Yoneoka D. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality. J Trauma Acute Care Surg, 2014, 76(2): 380-385.
9.	Huang F, Li X, Yuan C, et al. Attention-emotion-enhanced convolutional LSTM for sentiment analysis. IEEE Trans Neural Netw Learn Syst, 2022, 33(9): 4332-4345.
10.	Zhou L, Zhao C, Liu N, et al. Improved LSTM-based deep learning model for COVID-19 prediction using optimized approach. Eng Appl Artif Intell, 2023, 122: 106157. doi: 10.1016/j.engappai.2023.106157.
11.	Hay SI, Ong KL, Santomauro DF, et al. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet, 2025, 406(10513): 1873-1922.
12.	Stevens GA, Alkema L, Black RE, et al. Guidelines for accurate and transparent health estimates reporting: the GATHER statement. PLoS Med, 2016, 13(6): e1002056. doi: 10.1371/journal.pmed.1002056.
13.	GBD 2023 Demographics Collaborators. Global age-sex-specific all-cause mortality and life expectancy estimates for 204 countries and territories and 660 subnational locations, 1950-2023: a demographic analysis for the Global Burden of Disease Study 2023. Lancet, 2025, 406(10513): 1731-1810.
14.	Devleesschauwer B, Havelaar AH, Maertens de Noordhout C, et al. DALY calculation in practice: a stepwise approach. Int J Public Health, 2014, 59(3): 571-574.
15.	Hudson DJ. Fitting segmented curves whose join points have to be estimated. Journal of the American Statistical Association, 1966, 61(316): 1097-1129.
16.	Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 2000, 19(3): 335-351.
17.	Kim HJ, Luo J, Chen HS, et al. Improved confidence interval for average annual percent change in trend analysis. Stat Med, 2017, 36(19): 3059-3074.
18.	Hua Z, Wang S, Yuan X. Trends in age-standardized incidence rates of depression in adolescents aged 10-24 in 204 countries and regions from 1990 to 2019. J Affect Disord, 2024, 350: 831-837.
19.	Ahmed LA, Schirmer H, Bjørnerem A, et al. The gender- and age-specific 10-year and lifetime absolute fracture risk in Tromsø, Norway. Eur J Epidemiol, 2009, 24(8): 441-448.
20.	Alvarez-Nebreda ML, Weaver MJ, Uribe-Leitz T, et al. Epidemiology of pelvic and acetabular fractures in the USA from 2007 to 2014. Osteoporos Int, 2023, 34(3): 527-537.
21.	Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet, 2019, 393(10169): 364-376.
22.	Eastell R, O’Neill TW, Hofbauer LC, et al. Postmenopausal osteoporosis. Nat Rev Dis Primers, 2016, 2: 16069. doi: 10.1038/nrdp.2016.69.
23.	Kiely KM, Brady B, Byles J. Gender, mental health and ageing. Maturitas, 2019, 129: 76-84.
24.	Auais M, Sousa TAC, Feng C, et al. Understanding the relationship between psychological factors and important health outcomes in older adults with hip fracture: A structured scoping review. Arch Gerontol Geriatr, 2022, 101: 104666. doi: 10.1016/j.archger.2022.104666.
25.	Guggenbuhl P, Meadeb J, Chalès G. Osteoporotic fractures of the proximal humerus, pelvis, and ankle: epidemiology and diagnosis. Joint Bone Spine, 2005, 72(5): 372-375.
26.	Krappinger D, Kammerlander C, Hak DJ, et al. Low-energy osteoporotic pelvic fractures. Arch Orthop Trauma Surg, 2010, 130(9): 1167-1175.
27.	Cawthon PM. Gender differences in osteoporosis and fractures. Clin Orthop Relat Res, 2011, 469(7): 1900-1905.
28.	Holm E, Cook J, Porter K, et al. A quantitative and qualitative literature analysis of the orthopedic surgeons’ experience: reflecting on 20 years in the global war on terror. Mil Med, 2023, 188(9-10): 2924-2931.
29.	Oh JS, Tubb CC, Poepping TP, et al. Dismounted blast injuries in patients treated at a role 3 military hospital in afghanistan: patterns of injury and mortality. Mil Med, 2016, 181(9): 1069-1074.
30.	Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet, 2020, 395(10219): 200-211.
31.	Hoveidaei AH, Nakhostin-Ansari A, Heckmann ND, et al. Increasing burden of lower-extremity fractures in the Middle East and North Africa (MENA): A 30-year epidemiological analysis. J Bone Joint Surg (Am), 2024, 106(5): 414-424.
32.	Marengoni A, Angleman S, Melis R, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev, 2011, 10(4): 430-439.
33.	Coccolini F, Stahel PF, Montori G, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg, 2017, 12: 5. doi: 10.1186/s13017-017-0117-6.
34.	Villiger K, Meier MK, Hasler RM, et al. Demographic changes in pelvic fracture patterns at a Swiss academic trauma center from 2007 to 2017. J Trauma Acute Care Surg, 2022, 92(5): 862-872.
35.	Spiteri J, von Brockdorff P. Economic development and health outcomes: Evidence from cardiovascular disease mortality in Europe. Soc Sci Med, 2019, 224: 37-44.
36.	Yu F, Xia W. The epidemiology of osteoporosis, associated fragility fractures, and management gap in China. Arch Osteoporos, 2019, 14(1): 32. doi: 10.1007/s11657-018-0549-y.
37.	Chen Q, Li T, Ding H, et al. Age-period-cohort analysis of epidemiological trends in pelvic fracture in China from 1992 to 2021 and forecasts for 2046. Front Public Health, 2024, 12: 1428068. doi: 10.3389/fpubh.2024.1428068.
38.	Smith CT, Barton DW, Piple AS, et al. Pelvic fragility fractures: an opportunity to improve the undertreatment of osteoporosis. J Bone Joint Surg (Am), 2021, 103(3): 213-218.
39.	Yu Y, Si X, Hu C, et al. A review of recurrent neural networks: LSTM cells and network architectures. Neural Comput, 2019, 31(7): 1235-1270.

1. Hu S, Guo J, Zhu B, et al. Epidemiology and burden of pelvic fractures: Results from the Global Burden of Disease Study 2019. Injury, 2023, 54(2): 589-597.
2. Ooi CK, Goh HK, Tay SY, et al. Patients with pelvic fracture: what factors are associated with mortality? Int J Emerg Med, 2010, 3(4): 299-304.
3. Buller LT, Best MJ, Quinnan SM. A nationwide analysis of pelvic ring fractures: Incidence and trends in treatment, length of stay, and mortality. Geriatr Orthop Surg Rehabil, 2016, 7(1): 9-17.
4. Qiu X, Zhu T, Deng H, et al. Multicenter epidemiological analysis of related factors in 10, 808 hospitalized children with lower limb and pelvic fractures in China. Sci Rep, 2024, 14(1): 27860. doi: 10.1038/s41598-024-77970-x.
5. Abdelrahman H, El-Menyar A, Keil H, et al. Patterns, management, and outcomes of traumatic pelvic fracture: insights from a multicenter study. J Orthop Surg Res, 2020, 15(1): 249. doi: 10.1186/s13018-020-01772-w.
6. Andrich S, Haastert B, Neuhaus E, et al. Excess mortality after pelvic fractures among older people. J Bone Miner Res, 2017, 32(9): 1789-1801.
7. Mi M, Kanakaris NK, Wu X, et al. Management and outcomes of open pelvic fractures: An update. Injury, 2021, 52(10): 2738-2745.
8. Yoshihara H, Yoneoka D. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality. J Trauma Acute Care Surg, 2014, 76(2): 380-385.
9. Huang F, Li X, Yuan C, et al. Attention-emotion-enhanced convolutional LSTM for sentiment analysis. IEEE Trans Neural Netw Learn Syst, 2022, 33(9): 4332-4345.
10. Zhou L, Zhao C, Liu N, et al. Improved LSTM-based deep learning model for COVID-19 prediction using optimized approach. Eng Appl Artif Intell, 2023, 122: 106157. doi: 10.1016/j.engappai.2023.106157.
11. Hay SI, Ong KL, Santomauro DF, et al. Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet, 2025, 406(10513): 1873-1922.
12. Stevens GA, Alkema L, Black RE, et al. Guidelines for accurate and transparent health estimates reporting: the GATHER statement. PLoS Med, 2016, 13(6): e1002056. doi: 10.1371/journal.pmed.1002056.
13. GBD 2023 Demographics Collaborators. Global age-sex-specific all-cause mortality and life expectancy estimates for 204 countries and territories and 660 subnational locations, 1950-2023: a demographic analysis for the Global Burden of Disease Study 2023. Lancet, 2025, 406(10513): 1731-1810.
14. Devleesschauwer B, Havelaar AH, Maertens de Noordhout C, et al. DALY calculation in practice: a stepwise approach. Int J Public Health, 2014, 59(3): 571-574.
15. Hudson DJ. Fitting segmented curves whose join points have to be estimated. Journal of the American Statistical Association, 1966, 61(316): 1097-1129.
16. Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 2000, 19(3): 335-351.
17. Kim HJ, Luo J, Chen HS, et al. Improved confidence interval for average annual percent change in trend analysis. Stat Med, 2017, 36(19): 3059-3074.
18. Hua Z, Wang S, Yuan X. Trends in age-standardized incidence rates of depression in adolescents aged 10-24 in 204 countries and regions from 1990 to 2019. J Affect Disord, 2024, 350: 831-837.
19. Ahmed LA, Schirmer H, Bjørnerem A, et al. The gender- and age-specific 10-year and lifetime absolute fracture risk in Tromsø, Norway. Eur J Epidemiol, 2009, 24(8): 441-448.
20. Alvarez-Nebreda ML, Weaver MJ, Uribe-Leitz T, et al. Epidemiology of pelvic and acetabular fractures in the USA from 2007 to 2014. Osteoporos Int, 2023, 34(3): 527-537.
21. Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet, 2019, 393(10169): 364-376.
22. Eastell R, O’Neill TW, Hofbauer LC, et al. Postmenopausal osteoporosis. Nat Rev Dis Primers, 2016, 2: 16069. doi: 10.1038/nrdp.2016.69.
23. Kiely KM, Brady B, Byles J. Gender, mental health and ageing. Maturitas, 2019, 129: 76-84.
24. Auais M, Sousa TAC, Feng C, et al. Understanding the relationship between psychological factors and important health outcomes in older adults with hip fracture: A structured scoping review. Arch Gerontol Geriatr, 2022, 101: 104666. doi: 10.1016/j.archger.2022.104666.
25. Guggenbuhl P, Meadeb J, Chalès G. Osteoporotic fractures of the proximal humerus, pelvis, and ankle: epidemiology and diagnosis. Joint Bone Spine, 2005, 72(5): 372-375.
26. Krappinger D, Kammerlander C, Hak DJ, et al. Low-energy osteoporotic pelvic fractures. Arch Orthop Trauma Surg, 2010, 130(9): 1167-1175.
27. Cawthon PM. Gender differences in osteoporosis and fractures. Clin Orthop Relat Res, 2011, 469(7): 1900-1905.
28. Holm E, Cook J, Porter K, et al. A quantitative and qualitative literature analysis of the orthopedic surgeons’ experience: reflecting on 20 years in the global war on terror. Mil Med, 2023, 188(9-10): 2924-2931.
29. Oh JS, Tubb CC, Poepping TP, et al. Dismounted blast injuries in patients treated at a role 3 military hospital in afghanistan: patterns of injury and mortality. Mil Med, 2016, 181(9): 1069-1074.
30. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet, 2020, 395(10219): 200-211.
31. Hoveidaei AH, Nakhostin-Ansari A, Heckmann ND, et al. Increasing burden of lower-extremity fractures in the Middle East and North Africa (MENA): A 30-year epidemiological analysis. J Bone Joint Surg (Am), 2024, 106(5): 414-424.
32. Marengoni A, Angleman S, Melis R, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev, 2011, 10(4): 430-439.
33. Coccolini F, Stahel PF, Montori G, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg, 2017, 12: 5. doi: 10.1186/s13017-017-0117-6.
34. Villiger K, Meier MK, Hasler RM, et al. Demographic changes in pelvic fracture patterns at a Swiss academic trauma center from 2007 to 2017. J Trauma Acute Care Surg, 2022, 92(5): 862-872.
35. Spiteri J, von Brockdorff P. Economic development and health outcomes: Evidence from cardiovascular disease mortality in Europe. Soc Sci Med, 2019, 224: 37-44.
36. Yu F, Xia W. The epidemiology of osteoporosis, associated fragility fractures, and management gap in China. Arch Osteoporos, 2019, 14(1): 32. doi: 10.1007/s11657-018-0549-y.
37. Chen Q, Li T, Ding H, et al. Age-period-cohort analysis of epidemiological trends in pelvic fracture in China from 1992 to 2021 and forecasts for 2046. Front Public Health, 2024, 12: 1428068. doi: 10.3389/fpubh.2024.1428068.
38. Smith CT, Barton DW, Piple AS, et al. Pelvic fragility fractures: an opportunity to improve the undertreatment of osteoporosis. J Bone Joint Surg (Am), 2021, 103(3): 213-218.
39. Yu Y, Si X, Hu C, et al. A review of recurrent neural networks: LSTM cells and network architectures. Neural Comput, 2019, 31(7): 1235-1270.

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Latest ArticlesTrends in burden of pelvic fractures from 1990 to 2023 and long short-term memory-based insights into future projections

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