Department of Immunology and Microbiology, College of Life Science and Technology, Jinan University, Guangzhou 510632, China.
Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510275, China.
Nutrients. 2024 Sep 23;16(18):3217. doi: 10.3390/nu16183217.
Diarrheal disease remains a significant public health issue, particularly affecting young children and older adults. Despite efforts to control and prevent these diseases, their incidence continues to be a global concern. Understanding the trends in diarrhea incidence and the factors influencing these trends is crucial for developing effective public health strategies.
This study aimed to explore the temporal trends in diarrhea incidence and associated factors from 1990 to 2019 and to project the incidence for the period 2020-2040 at global, regional, and national levels. We aimed to identify key factors influencing these trends to inform future prevention and control strategies.
The eXtreme Gradient Boosting (XGBoost) model was used to predict the incidence from 2020 to 2040 based on demographic, meteorological, water sanitation, and sanitation and hygiene indicators. SHapley Additive exPlanations (SHAP) value was performed to explain the impact of variables in the model on the incidence. Estimated annual percentage change (EAPC) was calculated to assess the temporal trends of age-standardized incidence rates (ASIRs) from 1990 to 2019 and from 2020 to 2040.
Globally, both incident cases and ASIRs of diarrhea increased between 2010 and 2019. The incident cases are expected to rise from 2020 to 2040, while the ASIRs and incidence rates are predicted to slightly decrease. During the observed (1990-2019) and predicted (2020-2040) periods, adults aged 60 years and above exhibited an upward trend in incidence rate as age increased, while children aged < 5 years consistently had the highest incident cases. The SHAP framework was applied to explain the model predictions. We identified several risk factors associated with an increased incidence of diarrhea, including age over 60 years, yearly precipitation exceeding 3000 mm, temperature above 20 °C for both maximum and minimum values, and vapor pressure deficit over 1500 Pa. A decreased incidence rate was associated with relative humidity over 60%, wind speed over 4 m/s, and populations with above 80% using safely managed drinking water services and over 40% using safely managed sanitation services.
Diarrheal diseases are still serious public health concerns, with predicted increases in the incident cases despite decreasing ASIRs globally. Children aged < 5 years remain highly susceptible to diarrheal diseases, yet the incidence rate in the older adults aged 60 plus years still warrants additional attention. Additionally, more targeted efforts to improve access to safe drinking water and sanitation services are crucial for reducing the incidence of diarrheal diseases globally.
腹泻病仍然是一个重大的公共卫生问题，尤其影响着儿童和老年人。尽管为控制和预防这些疾病做出了努力，但它们的发病率仍然是全球关注的问题。了解腹泻发病率的趋势以及影响这些趋势的因素对于制定有效的公共卫生策略至关重要。
本研究旨在探讨 1990 年至 2019 年期间腹泻发病率的时间趋势及相关因素，并预测 2020 年至 2040 年期间全球、区域和国家层面的发病率。我们旨在确定影响这些趋势的关键因素，以为未来的预防和控制策略提供信息。
使用极端梯度提升（XGBoost）模型根据人口统计学、气象学、水卫生、环境卫生和卫生习惯指标来预测 2020 年至 2040 年的发病率。采用 Shapley 加法解释（SHAP）值来解释模型中变量对发病率的影响。计算估计年变化百分比（EAPC），以评估 1990 年至 2019 年和 2020 年至 2040 年期间年龄标准化发病率（ASIR）的时间趋势。
全球范围内，2010 年至 2019 年期间腹泻的发病例数和 ASIR 均有所增加。预计 2020 年至 2040 年期间发病例数将上升，而 ASIR 和发病率预计将略有下降。在观察期（1990-2019 年）和预测期（2020-2040 年），60 岁及以上年龄组的发病率呈上升趋势，而年龄在 5 岁以下的儿童的发病例数始终最高。应用 SHAP 框架解释模型预测。我们确定了与腹泻发病率增加相关的几个风险因素，包括 60 岁以上、每年降水量超过 3000 毫米、最高和最低温度超过 20°C、蒸气压亏缺超过 1500 Pa。发病率降低与相对湿度超过 60%、风速超过 4 m/s 以及 80%以上的人口使用安全管理饮用水服务和 40%以上的人口使用安全管理卫生服务有关。
腹泻病仍然是严重的公共卫生问题，尽管全球的 ASIR 有所下降，但发病例数仍呈上升趋势。年龄在 5 岁以下的儿童仍然极易感染腹泻病，但 60 岁以上老年人的发病率仍需引起关注。此外，更有针对性地努力改善获得安全饮用水和卫生服务的机会，对于减少全球腹泻病的发病率至关重要。
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