Azizmohammad Looha Mehdi, Saberi Shahrbabaki Ali, Mohammadpoor Azin, Zamani Mahmoud, Sadeghloo Zahra, Jameie Melika, Mousavi Hanieh, Pooresmaeil Niaki Seyede Roxane, Mohebbi Hossein, Asadimanesh Naghmeh, Norouzi Fatemeh, Banar Sepideh, Jalalinejad Matin, Yousefi Maedeh, Shahreki Mojahed Sofia, Masheghati Forough, Ghalandarlaki Mehrnoosh, Bahadorimonfared Alireza
Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Gastroenterol Hepatol Bed Bench. 2025;18(2):177-195. doi: 10.22037/ghfbb.v18i2.3158.
In this study, global and regional trends between 1990 and 2021 were examined by sex, level of development, and geography, and projected to 2025.
Diarrheal disease continues to be a leading cause of morbidity and mortality in children under the age of five (U5).
We assessed GBD 2021 data for U5 children in 204 countries, 21 regions, and 7 super-regions with joinpoint regression to analyze time trends, a hybrid ARIMA-ETS-ANN model to project prevalence and mortality until 2025, and longitudinal multilevel modeling to determine the effect of development level. Spatial clustering in 1990 and 2021 was assessed with Local Moran's I.
In 2021, the global prevalence and mortality rates of diarrheal disease among children under five were 885.07 and 51.72 per 100,000 population, respectively. Between 1990 and 2021, global U5 mortality decreased by 80.4%, and prevalence by 71.8%. The heaviest burden remained in Sub-Saharan Africa (SSA) and South Asia (SA), though all super-regions experienced statistically significant decreases. Joinpoint regression across the entire interval (1990-2021) revealed significant overall reductions in mortality (AAPC -5.15; 95% CI: -5.19, -5.10) and prevalence (AAPC -3.98; 95% CI: -4.03, -3.94). Hybrid forecasts predict ongoing decreases through 2025, with prevalence reaching 631.3 and mortality 36.6 per 100,000 population worldwide. Multilevel models revealed steeper annual reductions in low- and medium-Human Development Index (HDI) nations, corroborated by significant time-HDI interaction terms (β=79.76 for prevalence; β=7.50 for mortality; both p<0.001), although such countries had a persisting higher absolute burden. Spatial analysis revealed enduring hotspots in SSA and SA in both 1990 and 2021, and the formation of new clusters in several high-income countries. Coldspots occurred primarily in high-income and island nations.
Significant global advancements have lessened the burden of diarrheal disease in U5 children; yet, ongoing disparities attributed to unsafe water, poor sanitation and hygiene, undernutrition, and low maternal education underscore the necessity for combined water, sanitation, and hygiene interventions, rotavirus immunization, and community-based health education in high-risk areas.
本研究按性别、发展水平和地理位置，考察了1990年至2021年期间全球和区域的腹泻病趋势，并预测至2025年。
腹泻病仍然是五岁以下儿童发病和死亡的主要原因。
我们评估了204个国家、21个地区和7个超级区域五岁以下儿童的全球疾病负担研究（GBD）2021数据，采用连接点回归分析时间趋势，采用混合自回归积分滑动平均（ARIMA）-指数平滑法（ETS）-人工神经网络（ANN）模型预测至2025年的患病率和死亡率，并采用纵向多水平模型确定发展水平的影响。用局部莫兰指数评估1990年和2021年的空间聚集情况。
2021年，全球五岁以下儿童腹泻病的患病率和死亡率分别为每10万人口885.07例和51.72例。1990年至2021年期间，全球五岁以下儿童死亡率下降了80.4%，患病率下降了71.8%。负担最重的地区仍然是撒哈拉以南非洲（SSA）和南亚（SA），不过所有超级区域的腹泻病负担均有统计学意义的下降。对整个时间段（1990 - 2021年）进行连接点回归分析显示，死亡率（平均年度百分比变化[AAPC] -5.15；95%置信区间[CI]：-5.19，-5.10）和患病率（AAPC -3.98；95% CI：-4.03，-3.94）总体显著下降。混合预测显示，到2025年腹泻病负担将持续下降，全球每10万人口的患病率将降至631.3例，死亡率降至36.6例。多水平模型显示，在低人类发展指数（HDI）和中等HDI国家，腹泻病负担的年度降幅更大，时间-HDI交互项具有显著意义（患病率β = 79.76；死亡率β = 7.50；p均<0.001），尽管这些国家的绝对负担仍然较高。空间分析显示，1990年和2021年，SSA和SA地区一直是腹泻病负担的热点地区，并且在一些高收入国家形成了新的聚集区。冷点地区主要出现在高收入国家和岛国。
全球在腹泻病防治方面取得了显著进展，减轻了五岁以下儿童的腹泻病负担；然而，由于不安全饮用水、卫生条件差、个人卫生习惯不良、营养不良以及母亲教育程度低等因素导致的持续差异，凸显了在高风险地区开展水、环境卫生和个人卫生综合干预措施、轮状病毒免疫接种以及社区健康教育的必要性。
