Table 5_The burden and etiologies of diarrhea in Asia and its countries from 1990 to 2021 and the forecast to 2040: analyses informed by the global burden of disease study 2021.docx

BackgroundThis study aimed to analyze the burden, temporal trends and etiologies of diarrhea from 1990 to 2021, and to forecast the burden from 2022 to 2040 in Asia and Asian countries.
MethodsData were sourced from the Global Burden of Diseases (GBD) 2021 study. Temporal trends from 1990 to 2021 were analyzed using estimated annual percentage change (EAPC) values. Spearman’s rank test was performed to evaluate the association between diarrhea burdens and socio-demographic index (SDI). Joinpoint analysis was applied to estimate the trends of age-standardized rates (ASRs) from 1990 to 2021. To forecast the burden for diarrhea from 2022 to 2040, we used Bayesian Age-Period-Cohort (BAPC) model. Furthermore, we generated heatmaps to visualize the 13 etiologies of diarrhea.
ResultsOverall burden showed that the ASRs in Asia decreased from 1990 to 2021, with EAPCs of −0.40, −0.55, −5.70, and −5.47, respectively. The ASRs demonstrated statistically significant negative correlations with SDI in 2021. The incidence and prevalence rates in 0–9 years old and 90+ years old and the DALY rates and mortality rates in all age groups in 2021 were decreased compared with 1990. Temporal joinpoint analysis revealed that after 2019, the age-standardized incidence rate (ASIR) of diarrhea exhibited a significant upward trend in Asia and some Asian countries. Based on the BAPC model analysis, the ASIR and the age-standardized prevalence rate of diarrhea in Asia are predicted to decrease initially and then increase. The age-standardized DALY rate (ASDR) and the age-standardized mortality rate (ASMR) of diarrhea in Asia are predicted to demonstrate a consistent declining trend. Rotavirus showed the highest ASDRs in both 1990 and 2021 among 13 diarrheal etiologies, while norovirus replaced rotavirus as the leading cause of ASMR by 2021.
ConclusionThe study demonstrates an overall declining trend in the burden of diarrhea in Asia due to urbanization, economic growth, and public health interventions. However, significant challenges persist in some countries and specific population groups. Socioeconomic status exerts a substantial influence on disease burden, highlighting the urgent need for enhanced healthcare resource allocation in some countries.

背景
本研究旨在分析1990年至2021年亚洲及亚洲各国腹泻的疾病负担、时间趋势及病因，并预测2022年至2040年的腹泻疾病负担。

方法
数据来源于2021年全球疾病负担（Global Burden of Diseases, GBD）研究。采用估计年度变化百分比（estimated annual percentage change, EAPC）分析1990年至2021年的时间趋势。通过斯皮尔曼秩相关检验（Spearman’s rank test）评估腹泻疾病负担与社会人口指数（socio-demographic index, SDI）之间的关联。采用连接点分析（Joinpoint analysis）估算1990年至2021年的年龄标化率（age-standardized rates, ASRs）变化趋势。为预测2022年至2040年的腹泻疾病负担，本研究采用贝叶斯年龄-时期-队列（Bayesian Age-Period-Cohort, BAPC）模型。此外，本研究绘制热图以可视化13种腹泻病因的分布情况。

结果
整体疾病负担数据显示，1990年至2021年亚洲的年龄标化率呈下降趋势，对应的估计年度变化百分比分别为-0.40、-0.55、-5.70和-5.47。2021年，年龄标化率与社会人口指数呈显著负相关。与1990年相比，2021年0~9岁及90岁以上人群的发病率与患病率，以及所有年龄组的伤残调整寿命年（disability-adjusted life years, DALY）率和死亡率均有所下降。时间序列连接点分析结果表明，2019年后亚洲及部分亚洲国家的腹泻年龄标化发病率（age-standardized incidence rate, ASIR）呈现显著上升趋势。基于贝叶斯年龄-时期-队列模型分析结果，预计亚洲地区腹泻的年龄标化发病率及年龄标化患病率将先下降后上升。而亚洲地区腹泻的年龄标化伤残调整寿命年率（age-standardized DALY rate, ASDR）与年龄标化死亡率（age-standardized mortality rate, ASMR）预计将持续呈下降趋势。在13种腹泻病因中，轮状病毒（Rotavirus）在1990年与2021年的年龄标化伤残调整寿命年率均位居首位；而到2021年，诺如病毒（norovirus）已取代轮状病毒成为年龄标化死亡率最高的致病原。

结论
本研究表明，受城市化进程、经济增长与公共卫生干预措施的影响，亚洲地区的腹泻疾病负担整体呈下降趋势。但部分国家及特定人群仍面临严峻挑战。社会经济状况对疾病负担影响显著，这凸显了部分国家亟需加强医疗资源配置的紧迫性。