Trends and Burden of Inguinal, Femoral, and Abdominal Hernia From 1990 to 2023 in the Gulf Cooperation Council.

BACKGROUND Abdominal wall hernias are common, largely non-fatal surgical conditions that impose substantial disability when untreated. Contemporary guidelines emphasize standardized evaluation and repair to reduce recurrence and chronic pain and to optimize population health impact. This study aims to assess the burden and trends of hernia in Arabian Gulf Region from 1990 to 2023. METHODS A comparative, multi-country analysis was conducted for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates using Global Burden of Disease (GBD) 2023 estimates. Outcomes included age-standardized incidence (ASIR), prevalence (ASPR), years lived with disability (YLDs), and disability-adjusted life years (DALYs), reported per 100,000 by year (1990-2023), sex, and age. Temporal trends were evaluated with Joinpoint regression to derive average annual percent change (AAPC). Forecasts to 2033 applied linear regression, Exponential Smoothing (ETS), ARIMA, and Neural Network Autoregression (NNAR) models; the best model for each indicator-country-sex combination was selected using root mean square error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE), with 95% prediction intervals. Analyses were performed in R (forecast package) and the NCI Joinpoint program. RESULTS In 2023, the Gulf Cooperation Council (GCC) recorded approximately 1.1 million prevalent hernia cases. While absolute counts rose 12.4% since 1990, attributable to population aging, age-standardized metrics declined across countries and sexes. YLDs comprised 75%-80% of DALYs, confirming a predominantly non-fatal burden. Male prevalence exceeded female prevalence in all states; Qatar and Bahrain formed a higher-burden cluster, whereas the United Arab Emirates and Saudi Arabia exhibited lower rates. Age-specific analyses showed marked improvements at 60-79 years but persistent or paradoxical increases in ≥ 85 years. Forecasts indicated continued declines in ASIR/ASPR to 2033, with vigilance warranted for very-elderly cohorts. CONCLUSION The GCC experienced sustained reductions in age-standardized hernia burden since 1990 despite rising absolute numbers from demographic change. Findings support guideline-concordant expansion of elective repair, registry-based quality measurement, and targeted capacity for the oldest adults to further compress disability.