Zheng Yang, Yu Qi, Lin Yushi, Zhou Yuqing, Lan Lei, Yang Shigui, Wu Jie
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Department of General Practice, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Department of Cardiology and Endodontics, The Stomatology Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Lancet Infect Dis. 2022 Apr;22(4):541-551. doi: 10.1016/S1473-3099(21)00448-5. Epub 2021 Dec 20.
Sexually transmitted infections (STIs) are a major public health issue worldwide, but there is a paucity of literature on their burden and trends globally. We aimed to assess the global disease burden and trends of STIs from 1990 to 2019.
In this observational trend study, we collected data on incident cases, age-standardised incidence rate, and disability-adjusted life-years (DALYs), and calculated age-standardised DALY rates, for five STIs (syphilis, chlamydia, gonorrhoea, trichomonas, and genital herpes) between 1990 and 2019, by sex, geographical region, and cause using data exclusively from the Global Burden of Disease study 2019. The estimated annual percentage changes in the age-standardised incidence rate and age-standardised DALY rate were calculated to quantify the changing trend.
Globally, the age-standardised incidence rate of STIs showed a decreasing trend with an estimated annual percentage change of -0·04 (95% uncertainty interval [UI] -0·08 to 0·00) from 1990 to 2019, reaching 9535·71 per 100 000 person-years (8169·73 to 11 054·76) in 2019. The age-standardised DALY rate showed a decreasing trend with an estimated annual percentage change of -0·92 (-1·01 to -0·84) and reached 22·74 per 100 000 person-years (14·37 to 37·11) in 2019. The sub-Saharan African region had the highest age-standardised incidence rate (19 973·12 per 100 000 person-years, 17 382·69 to 23 001·57) and age-standardised DALY rate (389·32 per 100 000 person-years, 154·27 to 769·74). Adolescents had the highest incidence rate (18 377·82 per 100 000 person-years, 14 040·38 to 23 443·31) and showed stable total STI trends, except for an upward trend of syphilis between 2010 (347·65 per 100 000 person-years, 203·58 to 590·69) and 2019 (423·16 per 100 000 person-years, 235·70 to 659·01). Male individuals had a higher age-standardised incidence rate (10 471·63 per 100 000 person-years, 8892·20 to 12 176·10) than female individuals (8602·40 per 100 000 person-years, 7358·00 to 10001·18), whereas female individuals had a higher age-standardised DALY rate (33·31 per 100 000 person-years, 21·05 to 55·25) than male individuals (12·11 per 100 000 person-years, 7·63 to 18·93).
Although most countries showed a decrease in age-standardised rates of incidence and DALYs for STIs, the absolute incident cases and DALYs increased from 1990 to 2019. Therefore, STIs still represent a global public health challenge, especially in sub-Saharan Africa and Latin America, which warrants more attention and health prevention service.
Mega-Project of National Science and Technology for the 13th Five-Year Plan of China and the National Natural Science Foundation of China.
性传播感染（STIs）是全球主要的公共卫生问题，但全球范围内关于其负担和趋势的文献较少。我们旨在评估1990年至2019年期间性传播感染的全球疾病负担和趋势。
在这项观察性趋势研究中，我们收集了1990年至2019年期间5种性传播感染（梅毒、衣原体、淋病、滴虫病和生殖器疱疹）的发病病例、年龄标准化发病率和伤残调整生命年（DALYs）数据，并按性别、地理区域和病因计算年龄标准化DALY率，数据仅来自2019年全球疾病负担研究。计算年龄标准化发病率和年龄标准化DALY率的估计年百分比变化以量化变化趋势。
全球范围内，性传播感染的年龄标准化发病率呈下降趋势，1990年至2019年期间估计年百分比变化为-0.04（95%不确定区间[UI]-0.08至0.00），2019年达到每10万人年9535.71例（8169.73至11054.76例）。年龄标准化DALY率呈下降趋势，估计年百分比变化为-0.92（-1.01至-0.84），2019年达到每10万人年22.74例（14.37至37.11例）。撒哈拉以南非洲地区年龄标准化发病率最高（每10万人年19973.12例，17382.69至23001.57例），年龄标准化DALY率最高（每10万人年389.32例，154.27至769.74例）。青少年发病率最高（每10万人年18377.82例，14040.38至23443.31例），除2010年（每10万人年347.65例，203.58至590.69例）至2019年（每10万人年423.16例，235.70至659.01例）梅毒呈上升趋势外，性传播感染总体趋势稳定。男性年龄标准化发病率（每10万人年10471.63例，8892.20至12176.10例）高于女性（每10万人年8602.40例，7358.00至10001.18例），而女性年龄标准化DALY率（每10万人年33.31例，21.05至55.25例）高于男性（每10万人年12.11例，7.63至18.93例）。
尽管大多数国家性传播感染的年龄标准化发病率和DALYs呈下降趋势，但1990年至2019年期间发病病例和DALYs的绝对数量有所增加。因此，性传播感染仍然是全球公共卫生挑战，特别是在撒哈拉以南非洲和拉丁美洲，这需要更多关注和健康预防服务。
中国国家科技十三五重大项目和中国国家自然科学基金。
