Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990–2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021 - 19/12/24

Doi : 10.1016/S1473-3099(24)00691-1

GBD 2021 Diarrhoeal Diseases Collaborators^{^†}
Collaborators listed at the end of the Article

Hmwe Hmwe Kyu ⁎ , Avina Vongpradith, Regina-Mae Villanueva Dominguez, Jianing Ma, Samuel B Albertson, Amanda Novotney, Ibrahim A Khalil, Christopher E Troeger, Matthew C Doxey, Jorge R Ledesma, Sarah Brooke Sirota, Rose Grace Bender, Lucien R Swetschinski, Matthew Cunningham, Sandra Spearman, Yohannes Habtegiorgis Abate, Abdallah H A Abd Al Magied, Samar Abd ElHafeez, Meriem Abdoun, Bayeh Abera, Hassan Abidi, Richard Gyan Aboagye, Yonas Derso Abtew, Hasan Abualruz, Eman Abu-Gharbieh, Hana J Abukhadijah, Salahdein Aburuz, Isaac Yeboah Addo, Victor Adekanmbi, Charles Oluwaseun Oluwaseun Adetunji, Temitayo Esther Adeyeoluwa, Ripon Kumar Adhikary, Qorinah Estiningtyas Sakilah Adnani, Saryia Adra, Leticia Akua Adzigbli, Aanuoluwapo Adeyimika Afolabi, Muhammad Sohail Afzal, Saira Afzal, Suneth Buddhika Agampodi, Feleke Doyore Agide, Bright Opoku Ahinkorah, Aqeel Ahmad, Sajjad Ahmad, Ali Ahmed, Ayman Ahmed, Haroon Ahmed, Saeed Ahmed, Karolina Akinosoglou, Ema Akter, Salah Al Awaidy, Muaaz M Alajlani, Khurshid Alam, Almaza Albakri, Mohammed Albashtawy, Wafa A Aldhaleei, Abdelazeem M Algammal, Adel Ali Saeed Al-Gheethi, Abid Ali, Syed Shujait Ali, Waad Ali, Sheikh Mohammad Alif, Syed Mohamed Aljunid, Sabah Al-Marwani, Joseph Uy Almazan, Hesham M Al-Mekhlafi, Sami Almustanyir, Saleh A Alqahatni, Ahmad Alrawashdeh, Rami H Al-Rifai, Mohammed A Alsabri, Awais Altaf, Khalid A Altirkawi, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Mohammad Sharif Ibrahim Alyahya, Walid A Al-Zyoud, Dickson A Amugsi, Catalina Liliana Andrei, Sebastien Antoni, Boluwatife Stephen Anuoluwa, Iyadunni Adesola Anuoluwa, Saleha Anwar, Palwasha Anwari, Geminn Louis Carace Apostol, Jalal Arabloo, Mosab Arafat, Aleksandr Y Aravkin, Demelash Areda, Brhane Berhe Aregawi, Abdulfatai Aremu, Michael Benjamin Arndt, Akeza Awealom Asgedom, Tahira Ashraf, Seyyed Shamsadin Athari, Alok Atreya, Firayad Ayele, Davood Azadi, Gulrez Shah Azhar, Shahkaar Aziz, Ahmed Y. Azzam, Giridhara Rathnaiah Babu, Pegah Bahrami Taghanaki, Saeed Bahramian, Senthilkumar Balakrishnan, Biswajit Banik, Simachew Animen Bante, Mainak Bardhan, Till Winfried Bärnighausen, Hiba Jawdat Barqawi, Amadou Barrow, Zarrin Basharat, Quique Bassat, Mohammad-Mahdi Bastan, Saurav Basu, Prapthi Persis Bathini, Payam Behzadi, Maryam Beiranvand, Muhammad Bashir Bello, Olorunjuwon Omolaja Bello, Apostolos Beloukas, Azizullah Beran, Dinesh Bhandari, Pankaj Bhardwaj, Zulfiqar A Bhutta, Hamed Borhany, Souad Bouaoud, Michael Brauer, Danilo Buonsenso, Zahid A Butt, Mehtap Çakmak Barsbay, Luis Alberto Cámera, Angelo Capodici, Carlos A Castañeda-Orjuela, Muthia Cenderadewi, Chiranjib Chakraborty, Sandip Chakraborty, Vijay Kumar Chattu, Anis Ahmad Chaudhary, Fatemeh Chichagi, Patrick R Ching, Jesus Lorenzo Chirinos-Caceres, Hitesh Chopra, Sonali Gajanan Choudhari, Enayet Karim Chowdhury, Dinh-Toi Chu, Isaac Sunday Chukwu, Muhammad Chutiyami, Natalia Cruz-Martins, Omid Dadras, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Samuel Demissie Darcho, Jai K Das, Nihar Ranjan Dash, Ivan Delgado-Enciso, Belay Desye, Vinoth Gnana Chellaiyan Devanbu, Kuldeep Dhama, Meghnath Dhimal, Michael J Diaz, Thanh Chi Do, Sushil Dohare, Fariba Dorostkar, Ojas Prakashbhai Doshi, Leila Doshmangir, Haneil Larson Dsouza, Senbagam Duraisamy, Oyewole Christopher Durojaiye, Abdel Rahman E’mar, Abdelaziz Ed-Dra, Hisham Atan Edinur, Defi Efendi, Ferry Efendi, Foolad Eghbali, Temitope Cyrus Ekundayo, Iman El Sayed, Muhammed Elhadi, Ashraf A El-Metwally, Mohammed Elshaer, Ibrahim Elsohaby, Chadi Eltaha, Babak Eshrati, Majid Eslami, Ayesha Fahim, Ildar Ravisovich Fakhradiyev, Aliasghar Fakhri-Demeshghieh, Mohammad Farahmand, Folorunso Oludayo Fasina, Modupe Margaret Fasina, Alireza Feizkhah, Ginenus Fekadu, Nuno Ferreira, Getahun Fetensa, Florian Fischer, Takeshi Fukumoto, Blima Fux, Muktar A Gadanya, Santosh Gaihre, Márió Gajdács, Yaseen Galali, Aravind P Gandhi, Rupesh K Gautam, Miglas Welay Gebregergis, Mesfin Gebrehiwot, Teferi Gebru Gebremeskel, Motuma Erena Getachew, Genanew K Getahun, Molla Getie, Afsaneh Ghasemzadeh, Ramy Mohamed Ghazy, Sherief Ghozy, Artyom Urievich Gil, Alem Abera Girmay, Abraham Tamirat T Gizaw, Mahaveer Golechha, Pouya Goleij, Philimon N Gona, Ayman Grada, Giovanni Guarducci, Mesay Dechasa Gudeta, Vivek Kumar Gupta, Awoke Derbie Habteyohannes, Najah R Hadi, Samer Hamidi, Erin B Hamilton, Harapan Harapan, Md. Kamrul Hasan, S.M. Mahmudul Hasan, Hamidreza Hasani, Md Saquib Hasnain, Ikrama Ibrahim Hassan, Jiawei He, Mehdi Hemmati, Kamal Hezam, Mehdi Hosseinzadeh, Junjie Huang, Hong-Han Huynh, Segun Emmanuel Ibitoye, Kevin S Ikuta, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Sumant Inamdar, Mustafa Alhaji Isa, Md. Rabiul Islam, Sheikh Mohammed Shariful Islam, Nahlah Elkudssiah Ismail, Chidozie Declan Iwu, Kathryn H Jacobsen, Haitham Jahrami, Akhil Jain, Nityanand Jain, Ammar Abdulrahman Jairoun, Mihajlo Jakovljevic, Reza Jalilzadeh Yengejeh, Javad Javidnia, Shubha Jayaram, Mohammad Jokar, Jost B Jonas, Abel Joseph, Nitin Joseph, Jacek Jerzy Jozwiak, Hannaneh Kabir, Dler H. Hussein Kadir, Md Moustafa Kamal, Vineet Kumar Kamal, Arun Kamireddy, Tanuj Kanchan, Kehinde Kazeem Kanmodi, Suthanthira Kannan S, Rami S Kantar, Jafar Karami, Prabin Karki, Hengameh Kasraei, Harkiran Kaur, Mohammad Keykhaei, Yousef Saleh Khader, Alireza Khalilian, Faham Khamesipour, Gulfaraz Khan, Mohammad Jobair Khan, Zeeshan Ali Khan, Vishnu Khanal, Khaled Khatab, Moawiah Mohammad Khatatbeh, Amir M Khater, Khalid A Kheirallah, Feriha Fatima Khidri, Atulya Aman Khosla, Kwanghyun Kim, Yun Jin Kim, Adnan Kisa, Niranjan Kissoon, Desmond Klu, Sonali Kochhar, Ali-Asghar Kolahi, Farzad Kompani, Soewarta Kosen, Kewal Krishan, Barthelemy Kuate Defo, Md Abdul Kuddus, Mohammed Kuddus, Mukhtar Kulimbet, G Anil Kumar, Rakesh Kumar, Frank Kyei-Arthur, Chandrakant Lahariya, Dharmesh Kumar Lal, Nhi Huu Hanh Le, Seung Won Lee, Wei-Chen Lee, Yeong Yeh Lee, Ming-Chieh Li, Virendra S Ligade, Gang Liu, Shuke Liu, Xiaofeng Liu, Xuefeng Liu, Chun-Han Lo, Giancarlo Lucchetti, Lei Lv, Kashish Malhotra, Ahmad Azam Malik, Bishnu P Marasini, Miquel Martorell, Roy Rillera Marzo, Hossein Masoumi-Asl, Medha Mathur, Navgeet Mathur, Rishi P Mediratta, Elahe Meftah, Tesfahun Mekene Meto, Hadush Negash Meles, Endalkachew Belayneh Melese, Walter Mendoza, Mohsen Merati, Tuomo J Meretoja, Tomislav Mestrovic, Sachith Mettananda, Le Huu Nhat Minh, Vinaytosh Mishra, Prasanna Mithra, Ashraf Mohamadkhani, Ahmed Ismail Mohamed, Mouhand F H Mohamed, Nouh Saad Mohamed, Mustapha Mohammed, Shafiu Mohammed, Lorenzo Monasta, Mohammad Ali Moni, Rohith Motappa, Vincent Mougin, Sumaira Mubarik, Francesk Mulita, Kavita Munjal, Yanjinlkham Munkhsaikhan, Pirouz Naghavi, Gurudatta Naik, Tapas Sadasivan Nair, Hastyar Hama Rashid Najmuldeen, Shumaila Nargus, Delaram Narimani Davani, Abdulqadir J Nashwan, Zuhair S Natto, Athare Nazri-Panjaki, G Takop Nchanji, Pacifique Ndishimye, Josephine W Ngunjiri, Duc Hoang Nguyen, Nhien Ngoc Y Nguyen, Van Thanh Nguyen, Yeshambel T Nigatu, Ali Nikoobar, Vikram Niranjan, Chukwudi A Nnaji, Efaq Ali Noman, Nurulamin M Noor, Syed Toukir Ahmed Noor, Mehran Nouri, Majid Nozari, Chisom Adaobi Nri-Ezedi, Fred Nugen, Ismail A Odetokun, Adesola Adenike Ogunfowokan, Tolulope R Ojo-Akosile, Iruka N Okeke, Akinkunmi Paul Okekunle, Abdulhakeem Abayomi Olorukooba, Isaac Iyinoluwa Olufadewa, Gideon Olamilekan Oluwatunase, Verner N Orish, Doris V Ortega-Altamirano, Esteban Ortiz-Prado, Uchechukwu Levi Osuagwu, Olayinka Osuolale, Amel Ouyahia, Jagadish Rao Padubidri, Anamika Pandey, Ashok Pandey, Victoria Pando-Robles, Shahina Pardhan, Romil R Parikh, Jay Patel, Shankargouda Patil, Shrikant Pawar, Prince Peprah, Arokiasamy Perianayagam, Simone Perna, Ionela-Roxana Petcu, Anil K Philip, Roman V Polibin, Maarten J Postma, Naeimeh Pourtaheri, Jalandhar Pradhan, Elton Junio Sady Prates, Dimas Ria Angga Pribadi, Nameer Hashim Qasim, Asma Saleem Qazi, Deepthi R, Venkatraman Radhakrishnan, Fakher Rahim, Mosiur Rahman, Muhammad Aziz Rahman, Shayan Rahmani, Mohammad Rahmanian, Nazanin Rahmanian, Mahmoud Mohammed Ramadan, Shakthi Kumaran Ramasamy, Sheena Ramazanu, Muhammed Ahmed Ahmed Rameto, Pramod W Ramteke, Kritika Rana, Chhabi Lal Ranabhat, Davide Rasella, Mohammad-Mahdi Rashidi, Ashkan Rasouli-Saravani, Devarajan Rathish, Santosh Kumar Rauniyar, Salman Rawaf, Elrashdy Moustafa Mohamed Redwan, Aavishkar Raj Regmi, Kannan RR Rengasamy, Nazila Rezaei, Nima Rezaei, Mohsen Rezaeian, Abanoub Riad, Monica Rodrigues, Jefferson Antonio Buendia Rodriguez, Leonardo Roever, Ravi Rohilla, Luca Ronfani, Moustaq Karim Khan Rony, Allen Guy Ross, Shekoufeh Roudashti, Bedanta Roy, Tilleye Runghien, Mamta Sachdeva Dhingra, Basema Ahmad Saddik, Erfan Sadeghi, Mehdi Safari, Soumya Swaroop Sahoo, S. Mohammad Sajadi, Afeez Abolarinwa Salami, Mohamed A Saleh, Hossein Samadi Kafil, Yoseph Leonardo Samodra, Juan Sanabria, Rama Krishna Sanjeev, Tanmay Sarkar, Benn Sartorius, Brijesh Sathian, Maheswar Satpathy, Monika Sawhney, Austin E Schumacher, Mengistu Abayneh Sebsibe, Dragos Serban, Mahan Shafie, Samiah Shahid, Wajeehah Shahid, Masood Ali Shaikh, Sunder Sham, Muhammad Aaqib Shamim, Mehran Shams-Beyranvand, Mohammad Ali Shamshirgaran, Mohd Shanawaz, Mohammed Shannawaz, Amin Sharifan, Manoj Sharma, Vishal Sharma, Suchitra M Shenoy, Samendra P Sherchan, Mahabalesh Shetty, Pavanchand H Shetty, Desalegn Shiferaw, Aminu Shittu, Seyed Afshin Shorofi, Emmanuel Edwar Siddig, Luís Manuel Lopes Rodrigues Silva, Baljinder Singh, Jasvinder A Singh, Robert Sinto, Bogdan Socea, Heidi M Soeters, Anton Sokhan, Prashant Sood, Soroush Soraneh, Chandrashekhar T Sreeramareddy, Suresh Kumar Srinivasamurthy, Vijay Kumar Srivastava, Muhammad Haroon Stanikzai, Narayan Subedi, Vetriselvan Subramaniyan, Sahabi K Sulaiman, Muhammad Suleman, Chandan Kumar Swain, Lukasz Szarpak, Sree Sudha T Y, Seyyed Mohammad Tabatabaei, Celine Tabche, Zanan Mohammed-Ameen Taha, Ashis Talukder, Jacques Lukenze Tamuzi, Ker-Kan Tan, Sarmila Tandukar, Mohamad-Hani Temsah, Ocean Thakali, Ramna Thakur, Sathish Thirunavukkarasu, Joe Thomas, Nikhil Kenny Thomas, Jansje Henny Vera Ticoalu, Krishna Tiwari, Marcos Roberto Tovani-Palone, Khai Hoan Tram, An Thien Tran, Nghia Minh Tran, Thang Huu Tran, Samuel Joseph Tromans, Thien Tan Tri Tai Truyen, Munkhtuya Tumurkhuu, Aniefiok John Udoakang, Arit Udoh, Saeed Ullah, Muhammad Umair, Muhammad Umar, Brigid Unim, Bhaskaran Unnikrishnan, Sanaz Vahdati, Asokan Govindaraj Vaithinathan, Rohollah Valizadeh, Madhur Verma, Georgios-Ioannis Verras, Manish Vinayak, Yasir Waheed, Mandaras Tariku Walde, Yanzhong Wang, Muhammad Waqas, Kosala Gayan Weerakoon, Nuwan Darshana Wickramasinghe, Asrat Arja Wolde, Felicia Wu, Sajad Yaghoubi, Sanni Yaya, Saber Yezli, Vahit Yiğit, Dehui Yin, Dong Keon Yon, Naohiro Yonemoto, Hadiza Yusuf, Mondal Hasan Zahid, Fathiah Zakham, Leila Zaki, Iman Zare, Michael Zastrozhin, Mohammed G M Zeariya, Haijun Zhang, Zhi-Jiang Zhang, Abzal Zhumagaliuly, Hafsa Zia, Mohammad Zoladl, Ali H Mokdad, Stephen S Lim, Theo Vos, James A Platts-Mills, Jonathan F Mosser, Robert C Reiner, Simon I Hay, Mohsen Naghavi, Christopher J L Murray

^* Correspondence to: Dr Hmwe H Kyu, Department of Health Metrics Sciences, School of Medicine, and Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA Department of Health Metrics Sciences School of Medicine Institute for Health Metrics and Evaluation University of Washington Seattle WA 98195 USA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 19 December 2024

Summary

Background

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.

Methods

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.

Findings

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 enteropathogenic Escherichia coli, and enterotoxigenic E coli producing heat-stable toxin.

Interpretation

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.