Xiong Xinyi, Yao Yuming, Li Ying, Jiang Ying, Peng Wenting, Wang Qianbin, Ma Xingchao, Fu Lei, Peng Shifang
Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
J Med Virol. 2025 Sep;97(9):e70599. doi: 10.1002/jmv.70599.
Sexually transmitted infections (STIs), including HIV/AIDS, remain a major global public health issue for women of childbearing age (WCBA). However, comprehensive data on their epidemiological and economic burden and long-term trends in this population are limited. This study aims to systematically assess the global, regional, and national burden and temporal trends of HIV/AIDS and other significant STIs among WCBA from 1990 to 2021, and to evaluate the associated economic burden in 2021. Data were obtained from the Global Burden of Disease Study 2021 to estimate the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for HIV/AIDS and other STIs across 204 countries or territories. Temporal trends were assessed using estimated annual percentage change (EAPC). An age-period-cohort model was applied to estimate relative risks, and frontier analysis was used to determine efficiency in resource utilization. The economic burden in 2021 was estimated using an indirect cost approach. In 2021, an estimated 287 million incident cases of HIV/AIDS and other STIs occurred globally. Since 1990, new HIV/AIDS cases have declined by 25.1%, and the age-standardized incidence rate (ASIR) decreased by 46.5%, while the age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) increased. In contrast, other STIs saw a 54.3% rise in incident cases, with slight increases in ASIR and ASPR, and decreases in ASMR and ASDR. The burden was highest in low sociodemographic index (SDI) regions and declined with increasing SDI. Sub-Saharan Africa remained the most affected region. Global direct healthcare spending on HIV/AIDS and other STIs among WCBA reached $2.46 billion in 2021, with high-SDI countries accounting for the majority. Low-SDI countries, despite high disease burdens, contributed minimally to global spending. From 1990 to 2021, the burden of HIV/AIDS and other STIs among WCBA increased significantly, with notable regional disparities. Sub-Saharan Africa carries a disproportionately high burden of HIV/AIDS and other STIs yet receives insufficient global attention. Low-SDI populations face greater disease burdens but benefit from less healthcare investment, underscoring the urgent need to strengthen STIs-specific prevention, treatment, and health education in these regions.
包括艾滋病毒/艾滋病在内的性传播感染（STIs）仍然是全球育龄妇女面临的一个重大公共卫生问题。然而，关于这一人群的流行病学和经济负担以及长期趋势的全面数据有限。本研究旨在系统评估1990年至2021年全球、区域和国家层面育龄妇女中艾滋病毒/艾滋病及其他主要性传播感染的负担和时间趋势，并评估2021年相关的经济负担。数据来自《2021年全球疾病负担研究》，以估计204个国家或地区艾滋病毒/艾滋病及其他性传播感染的发病率、患病率、死亡率和伤残调整生命年（DALYs）。使用估计年度百分比变化（EAPC）评估时间趋势。应用年龄-时期-队列模型估计相对风险，并使用前沿分析确定资源利用效率。采用间接成本法估计2021年的经济负担。2021年，全球估计有2.87亿例艾滋病毒/艾滋病及其他性传播感染新发病例。自1990年以来，艾滋病毒/艾滋病新发病例减少了25.1%，年龄标准化发病率（ASIR）下降了46.5%，而年龄标准化患病率（ASPR）、年龄标准化死亡率（ASMR）和年龄标准化伤残调整生命年率（ASDR）有所上升。相比之下，其他性传播感染的新发病例增加了54.3%，ASIR和ASPR略有上升，ASMR和ASDR下降。负担在社会人口指数（SDI）较低的地区最高，并随着SDI的增加而下降。撒哈拉以南非洲仍然是受影响最严重的地区。2021年，全球用于育龄妇女艾滋病毒/艾滋病及其他性传播感染的直接医疗支出达到24.6亿美元，高SDI国家占大部分。低SDI国家尽管疾病负担很高，但对全球支出的贡献最小。从1990年到2021年，育龄妇女中艾滋病毒/艾滋病及其他性传播感染的负担显著增加，存在明显的地区差异。撒哈拉以南非洲承担着过高的艾滋病毒/艾滋病及其他性传播感染负担，但在全球层面却未得到足够关注。低SDI人群面临更大的疾病负担，但获得的医疗投资较少，这凸显了在这些地区加强针对性传播感染的预防、治疗和健康教育的迫切需求。
