Li Tianyun, Qiang Ne, Bao Yujia, Li Yongxuan, Zhao Shi, Chong Ka Chun, Deng Xiaobei, Zhang Xiaoxi, Ran Jinjun, Han Lefei
School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai 200025, China.
Sci One Health. 2024 Aug 10;3:100075. doi: 10.1016/j.soh.2024.100075. eCollection 2024.
Understanding the global burden of enteric infections is crucial for prioritizing control strategies for foodborne and waterborne diseases. This study aimed to assess the global burden of enteric infections in 2021 and identify risk factors from One Health aspects.
Leveraging the Global Burden of Disease (GBD) 2021 database, the incidence, disability-adjusted life years (DALYs), and deaths of enteric infections and the subtypes were estimated, including diarrheal diseases, typhoid and paratyphoid fever, invasive non-typhoidal (iNTS) infections, and other intestinal infectious diseases. The estimates were quantified by absolute number, age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR) and age-standardized DALY rate with 95% uncertainty intervals (s). Thirteen pathogens and three risk factors associated with diarrheal diseases were analyzed.
In 2021, the global age-standardized DALY rate of enteric infections was 1020.15 per 100,000 popultion (95% : 822.70-1259.39 per 100,000 population) with an estimated annual percentage change (EAPC) of -4.11% (95% confidence interval: -4.31% to -3.90%) in 1990-2021. A larger burden was observed in regions with lower Socio-demographic index (SDI) levels. Diarrheal disease was the most serious subtype with Western Sub-Saharan Africa exhibiting the highest age-standardized DALY rate (2769.81 per 100,000 population, 95% : 1976.80-3674.41 per 100,000 population). Children under 5 and adults over 65 years suffered more from diarrheal diseases with the former experiencing the highest global age-standardized DALY rate (9382.46 per 100,000 population, 95% : 6771.76-13,075.12 per 100,000 population). Rotavirus remained the leading cause of diarrheal diseases despite a cross-year decline in the observed age-standardized DALY rate. Unsafe water, sanitation, and handwashing contributed most to the disease burden.
The reduced burden of enteric infections suggested the effectiveness of previous control strategies; however, more efforts should be made in vulnerable regions and populations through a One Health approach.
了解肠道感染的全球负担对于确定食源性和水源性疾病的控制策略优先级至关重要。本研究旨在评估2021年肠道感染的全球负担，并从“同一健康”角度确定风险因素。
利用全球疾病负担（GBD）2021数据库，估计了肠道感染及其亚型的发病率、伤残调整生命年（DALYs）和死亡人数，包括腹泻病、伤寒和副伤寒热、侵袭性非伤寒（iNTS）感染以及其他肠道传染病。通过绝对数、年龄标准化发病率（ASIR）、年龄标准化死亡率（ASMR）和年龄标准化DALY率以及95%不确定性区间（s）对估计值进行量化。分析了与腹泻病相关的13种病原体和3种风险因素。
2021年，全球肠道感染的年龄标准化DALY率为每10万人1020.15（95%：每10万人822.70 - 1259.39），1990 - 2021年估计年变化百分比（EAPC）为 - 4.11%（95%置信区间： - 4.31%至 - 3.90%）。在社会人口指数（SDI）水平较低的地区观察到更大的负担。腹泻病是最严重的亚型，撒哈拉以南非洲西部地区的年龄标准化DALY率最高（每10万人2769.81，95%：每10万人1976.80 - 3674.41）。5岁以下儿童和65岁以上成年人受腹泻病影响更大，前者的全球年龄标准化DALY率最高（每10万人9382.46，95%：每10万人6771.76 - 13075.12）。尽管观察到的年龄标准化DALY率逐年下降，但轮状病毒仍然是腹泻病的主要病因。不安全的水、卫生设施和洗手对疾病负担的贡献最大。
肠道感染负担的减轻表明先前控制策略的有效性；然而，应通过“同一健康”方法在脆弱地区和人群中做出更多努力。
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