关键词: 全球疾病负担, 人体寄生虫病, 年龄标准化死亡率, 伤残调整生命年, 空间分布, 趋势分析

Abstract:

Objective To investigate the trends in disease burden and distribution characteristics of major human parasitic diseases in the world from 1990 to 2021, so as to provide insights into parasitic disease control. Methods Age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of 12 major human parasitic diseases, including malaria, American trypanosomiasis, leishmaniasis, African trypanosomiasis, schistosomiasis, cysticercosis, cystic echinococcosis, lymphatic filariasis, onchocerciasis, intestinal nematode infections, food-borne trematodiases, and guinea worm disease, were extracted from the Global Burden of Disease database, and the temporal, population (gender) and regional [including socioeconomic index (SDI) stratification] distributions of and trends in disease burdens were analyzed. R software was used for data processing and visualization, and Monte Carlo simulation was employed to estimate uncertainty intervals (UI). Results The total global DALYs of parasitic diseases declined from 74.03 million to 64.24 million person-years from 1990 to 2021, with a reduction of 13.22%. The disease burdens due to most types of parasitic diseases declined, and the disease burdens due to onchocerciasis, cysticercosis, food-borne trematodiases and American trypanosomiasis increased by 1 to 5 folds. As to types of parasitic diseases, malaria always bore the highest disease burden (consisting of more than 3/4 of total burdens), and the disease burden due to leishmaniasis fell from the 2nd to the 8th place, while the burden of schistosomiasis rose to the 2nd place. The disease burden of malaria had remarkably reduced since 2005 and rebounded slightly in recent years, and the burdens due to intestinal nematode infections and lymphatic filariasis have declined by more than 50%. The highest burden of parasitic diseases was found in sub-Saharan Africa, with high clustering of disease burdens due to malaria and schistosomiasis, and the disease burden due to food-borne trematodiases was concentrated in east Asia and Southeast Asia, while cysticercosis was also highly prevalent in Europe and the United States. The disease burden due to lymphatic filariasis was higher among men (the second leading cause of death) than women (the seventh leading cause of death); malaria and schistosomiasis ranked 1st and 3rd respectively among the causes of death for males, and 1st and 2nd respectively among the causes of death for females. The disease burden due to parasitic diseases was significantly higher in low SDI regions than in high SDI areas. Conclusion The overall global burden of parasitic diseases has declined overall; however, regional disparities are prominent, and the risk of rebound for some parasitic diseases remains. It is necessary to adjust the parasitic disease control strategies, strengthen resources investment in low SDI regions, pay attention to gender differences, and be alert to emerging challenges such as climate change and globalization.

Key words: Global burden of disease, Human parasitic disease, Age-standardized mortality, Disability-adjusted life years, Spatial distribution, Trend analysis