Lancet Infect Dis. 2025 May;25(5):519-536. doi: 10.1016/S1473-3099(24)00691-1. Epub 2024 Dec 18.
Diarrhoeal diseases claim more than 1 million lives annually and are a leading cause of death in children younger than 5 years. Comprehensive global estimates of the diarrhoeal disease burden for specific age groups of children younger than 5 years are scarce, and the burden in children older than 5 years and in adults is also understudied. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to assess the burden of, and trends in, diarrhoeal diseases overall and attributable to 13 pathogens, as well as the contributions of associated risk factors, in children and adults in 204 countries and territories from 1990 to 2021.
We used the Cause of Death Ensemble modelling strategy to analyse vital registration data, verbal autopsy data, mortality surveillance data, and minimally invasive tissue sampling data. We used DisMod-MR (version 2.1), a Bayesian meta-regression tool, to analyse incidence and prevalence data identified via systematic reviews, population-based surveys, and claims and inpatient data. We calculated diarrhoeal disability-adjusted life-years (DALYs) as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for each location, year, and age-sex group. For aetiology estimation, we used a counterfactual approach to quantify population-attributable fractions (PAFs). Additionally, we estimated the diarrhoeal disease burden attributable to the independent effects of risk factors using the comparative risk assessment framework.
In 2021, diarrhoeal diseases caused an estimated 1·17 million (95% uncertainty interval 0·793-1·62) deaths globally, representing a 60·3% (50·6-69·0) decrease since 1990 (2·93 million [2·31-3·73] deaths). The most pronounced decline was in children younger than 5 years, with a 79·2% (72·4-84·6) decrease in diarrhoeal deaths. Global YLLs also decreased substantially, from 186 million (147-221) in 1990 to 51·4 million (39·9-65·9) in 2021. In 2021, an estimated 59·0 million (47·2-73·2) DALYs were attributable to diarrhoeal diseases globally, with 30·9 million (23·1-42·0) of these affecting children younger than 5 years. Leading risk factors for diarrhoeal DALYs included low birthweight and short gestation in the neonatal age groups, child growth failure in children aged between 1-5 months and 2-4 years, and unsafe water and poor sanitation in older children and adults. We estimated that the removal of all evaluated diarrhoeal risk factors would reduce global DALYs from 59·0 million (47·2-73·2) to 4·99 million (1·99-10·0) among all ages combined. Globally in 2021, rotavirus was the predominant cause of diarrhoeal deaths across all ages, with a PAF of 15·2% (11·4-20·1), followed by norovirus at 10·6% (2·3-17·0) and Cryptosporidium spp at 10·2% (7·03-14·3). In children younger than 5 years, the fatal PAF of rotavirus was 35·2% (28·7-43·0), followed by Shigella spp at 24·0% (15·2-37·9) and adenovirus at 23·8% (14·8-36·3). Other pathogens with a fatal PAF greater than 10% in children younger than 5 years included Cryptosporidium spp, typical enteropathogenicEscherichia coli, and enterotoxigenic E coli producing heat-stable toxin.
The substantial decline in the global burden of diarrhoeal diseases since 1990, particularly in children younger than 5 years, supports the effectiveness of health interventions such as oral rehydration therapy, enhanced water, sanitation, and hygiene (WASH) infrastructure, and the introduction and scale-up of rotavirus vaccination. Targeted interventions and preventive measures against key risk factors and pathogens could further reduce this burden. Continued investment in the development and distribution of vaccines for leading pathogens remains crucial.
Bill & Melinda Gates Foundation.
腹泻病每年导致超过100万人死亡，是5岁以下儿童死亡的主要原因。目前全球缺乏针对5岁以下特定年龄组儿童腹泻病负担的全面估计，5岁以上儿童和成人的腹泻病负担也未得到充分研究。我们利用《2021年全球疾病、伤害和风险因素负担研究》的结果，评估了1990年至2021年期间204个国家和地区儿童及成人中腹泻病的总体负担、13种病原体所致腹泻病负担及其趋势，以及相关风险因素的影响。
我们采用死因综合建模策略分析生命登记数据、口头尸检数据、死亡率监测数据和微创组织采样数据。我们使用贝叶斯元回归工具DisMod-MR（版本2.1）分析通过系统评价、基于人群的调查以及索赔和住院数据确定的发病率和患病率数据。我们将腹泻病伤残调整生命年（DALYs）计算为每个地点、年份和年龄-性别组的生命损失年数（YLLs）和残疾生存年数（YLDs）之和。对于病因估计，我们采用反事实方法来量化人群归因分数（PAFs）。此外，我们使用比较风险评估框架估计了风险因素独立作用所致的腹泻病负担。
2021年，腹泻病在全球估计导致117万（95%不确定区间0.793 - 1.62）人死亡，较1990年（293万[2.31 - 3.73]人死亡）下降了60.3%（50.6 - 69.0）。下降最显著的是5岁以下儿童，腹泻病死亡人数下降了79.2%（72.4 - 84.6）。全球YLLs也大幅下降，从1990年的1.86亿（1.47 - 2.21）降至2021年的5140万（3990 - 6590）。2021年，全球估计有5900万（4720 - 7320）DALYs归因于腹泻病，其中3090万（2310 - 4200）影响5岁以下儿童。腹泻病DALYs的主要风险因素包括新生儿年龄组的低出生体重和早产、1 - 5个月及2 - 4岁儿童的生长发育不良，以及大龄儿童和成人的不安全饮水和卫生条件差。我们估计，消除所有评估的腹泻病风险因素将使所有年龄段的全球DALYs从5900万（4720 - 7320）降至499万（199 - 1000）。2021年在全球范围内，轮状病毒是各年龄段腹泻病死亡的主要原因，PAF为15.2%（11.4 - 20.1），其次是诺如病毒，为10.6%（2.3 - 17.0），隐孢子虫属为10.2%（7.03 - 14.3）。在5岁以下儿童中，轮状病毒的致死PAF为35.2%（28.7 - 43.0），其次是志贺菌属，为24.0%（15.2 - 37.9），腺病毒为23.8%（14.8 - 36.3）。在5岁以下儿童中，致死PAF大于10%的其他病原体包括隐孢子虫属、典型肠致病性大肠杆菌和产热稳定毒素的产肠毒素大肠杆菌。
自1990年以来，全球腹泻病负担大幅下降，尤其是5岁以下儿童，这支持了口服补液疗法、改善水、环境卫生和个人卫生（WASH）基础设施以及引入和扩大轮状病毒疫苗接种等卫生干预措施的有效性。针对关键风险因素和病原体的针对性干预措施和预防措施可进一步减轻这一负担。持续投资开发和分发针对主要病原体的疫苗仍然至关重要。
比尔及梅琳达·盖茨基金会。
