关键词: 疟疾, 疾病负担, 发病率, 患病率, 死亡率, 伤残调整寿命年

Abstract:

Objective To analyze the trends in global burden of malaria from 1990 to 2021 and to predict the trends in malaria burden from 2022 to 2035, so as to provide a scientific basis for the global malaria control programm. Methods Demographic data, and the incidence, prevalence, mortality, and disability-adjusted life years (DALY) rates of malaria were extracted from the Global Burden of Disease 2021 Database, and the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), age-standardized DALY rate (ASDR) of malaria with their 95% uncertainty intervals (UI), and socio-demographic index (SDI) were extracted. The trends in ASIR, ASPR, ASMR and ASDR of malaria from 1990 to 2021 were examined using average annual percent change (AAPC) with 95% confidence interval (CI). The global burden due to malaria was projected from 2022 to 2035 with a Bayesian age-period-cohort (BAPC) model, and the trends in ASIR, ASPR, ASMR and ASDR of malaria from 2022 to 2035 were analyzed with AAPC and 95%CI. Results Significant declines were observed globally in ASIR [AAPC = -7.25%, 95%CI: (-11.68%, -2.81%)], ASPR [AAPC = -14.42%, 95%CI: (-15.99%, -12.84%)], ASMR [AAPC = -0.06%, 95%CI: (-0.08%, -0.05%), and ASDR [AAPC = -4.86%, 95%CI: (-5.81%, -3.91%)] of malaria from 1990 to 2021. Across different SDI regions, the lowest SDI region demonstrated the most substantial decline in all standardized indicators, with AAPCs of -184.95% [95%CI: (-193.26%, -176.64%)], -253.13% [95%CI: (-256.83%, -249.43%)], -0.75% [95%CI: (-0.82%, -0.68%)], and -65.59% [95%CI: (-69.07%, -62.11%)], respectively. In 2021, the Central sub-Saharan Africa region had the highest malaria ASIR [21 152.56 per 100 000, 95%UI: (16 857.61, 26 956.39) per 100 000] and ASPR [21 328.79 per 100 000, 95%UI: (16 092.29, 28 557.44) per 100 000], whereas Western sub-Saharan Africa had the highest ASMR [106.48 per 100 000, 95%UI: (38.23, 222.04) per 100 000] and ASDR [5 668.41 per 100 000, 95%UI: (2 216.18, 11 127.48) per 100 000]. At the national level, Liberia reported the highest ASIR [27 702.66 per 100 000, 95%UI: (14 565.45, 38 887.49) per 100 000] and ASPR [29 248.89 per 100 000, 95%UI: (13 845.02, 47 808.36) per 100 000]; Burkina Faso had the highest ASMR [173.13 per 100 000, 95%UI: (75.38, 318.49) per 100 000]; and Sierra Leone recorded the highest ASDR [8 940.31 per 100 000, 95%UI: (3 029.75, 17 358.47) per 100 000]. Among different age groups, children under 5 years had the highest number of incident cases (96.303 4 million) and prevalent cases (31.749 million), as well as the highest incidence [14 631.95 per 100 000, 95%UI: (10 175.30, 21 120.91) per 100 000] and prevalence [4 823.86 per 100 000, 95%UI: (4 362.74, 5 361.59) per 100 000]. Globally, malaria ASIR, ASPR, ASMR, and ASDR showed strong inverse correlations with SDI (r = -0.89, -0.89, -0.87, -0.87, respectively; all P < 0.01). It was projected with the BAPC model that declining trends were seen in ASIR [AAPC = -17.12%, 95%CI: (-17.24%, -16.99%)], ASPR [AAPC = -5.93%, 95%CI: (-6.07%, -5.80%)], ASMR [AAPC = -0.10%, 95%CI: (-0.10%, -0.11%)], and ASDR [AAPC = -9.63%, 95%CI: (-9.65%, -9.62%)] of malaria from 2022 to 2035. Conclusion The global burden of malaria declined continuously from 1990 to 2021, with children under five years of age identified as high-risk populations. Forecasts suggest an overall tendency towards a continued decline in the global burden of malaria from 2022 to 2035.

Key words: Malaria, Burden of disease, Incidence, Prevalence, Mortality, Disability-adjusted life year