Epidemiological Transition in Health Risks and Disease Burden Among Women of Childbearing Age in East Asia and the Pacific, 1990–2023
Background Women of childbearing age (WCBA) in East Asia and Pacific (EAP) have experienced rapid epidemiological change, yet research focus and policy priorities often remain concentrated on maternal survival. We aimed to characterize three-decade comprehensive transitions in causes and risk factors, and quantify cross-country gaps. Methods We analyzed modelled GBD 2023 estimates for women aged 15–49 in the EAP region from 1990 to 2023, quantifying the disease burden by disability-adjusted life years (DALYs). Long-term trends were summarized using estimated annual percentage changes (EAPC), and investigated changes before and after the COVID-19 pandemic. Frontier analysis quantifies the disparities in preventable disease burden across countries. Results From 1990 to 2023, the age-standardized DALY rate among WCBA in EAP declined from 35,218 to 27,534 per 100,000, yet non-communicable diseases expanded their share from 62.3% to 75.7%. By 2023, gynecological disorders, depression, and headache disorders constituted the leading causes of burden. Among risk factors, high body-mass index risk increased significantly since 1990, and became the top risk factor (ASDR = 583.5 per 100,000) in 2023. During the acute pandemic phase, DALYs rose in 33 of 35 EAP regions. Frontier analysis revealed a 2.8-fold disparity in avoidable burden across countries at comparable development levels, with distance-to-frontier in ASDR ranging from 0.35 (Nauru) to 0.98 (China) in 2023. Conclusion The WCBA disease burden in EAP has transitioned from maternal and infectious conditions toward chronic, metabolic, and disability-related disorders, with significant persistent intra-regional disparities. Health systems should pivot from isolated reproductive care toward integrated life-course surveillance, embedding NCD and mental health services within routine women’s health platforms to address this evolving burden.