Table 6_Global trends, inequalities, and pathogen shifts in infectious diarrhea among children under five: a comprehensive analysis of the global burden of disease study 1990–2021.docx

BackgroundInfectious diarrhea is a major cause of morbidity and mortality among children under five, particularly in low- and middle-income countries. Despite notable improvements in public health, substantial regional, national, and socioeconomic disparities persist, while the evolving pathogen spectrum presents new challenges for prevention and control.
MethodsWe conducted a comprehensive analysis using data from the Global Burden of Disease (GBD) 2021 cycles, covering 204 countries and territories from 1990 to 2021. We assessed incidence, prevalence, mortality, and disability-adjusted life years (DALYs) at global, regional, national, and SDI quintile levels. Analytical methods included calculation of age-standardized rates (ASR), estimation of annual percentage changes (EAPC), joinpoint regression, inequality indices (SII and concentration index), frontier analysis, and pathogen-specific DALY trends.
ResultsGlobally, incident cases and DALYs increased while ASRs for all burden indicators declined substantially from 1990 to 2021. The heaviest burdens persisted in South Asia and Western Sub-Saharan Africa. Although absolute global inequalities lessened, relative disparities in mortality and DALYs widened. Temporal and geographic heterogeneity was evident, with high-income countries increasingly affected by viral etiologies. Frontier analysis revealed notable inefficiency gaps for several countries. Major pathogen-related DALY reductions were observed for rotavirus and Shigella, yet viral causes gained relative prominence in high-SDI settings.
ConclusionWhile marked global progress has been achieved in reducing childhood infectious diarrhea burden, persistent, and sometimes widening inequities remain. Enhanced investment in equitable health systems, renewed pathogen surveillance, and adaptive, targeted interventions are needed to sustain and accelerate progress, particularly in the most affected regions.

研究背景：
感染性腹泻（Infectious diarrhea）是5岁以下儿童发病与死亡的主要病因之一，尤其在中低收入国家表现突出。尽管公共卫生领域已取得显著进展，但地区间、国家间及社会经济层面的显著差异仍持续存在，且不断演变的病原体谱也为感染性腹泻的预防与控制工作带来了新挑战。

研究方法：
本研究基于全球疾病负担（Global Burden of Disease, GBD）2021年循环数据，纳入1990年至2021年间204个国家及地区的相关数据。我们分别在全球、区域、国家层面以及社会人口发展指数（Socio-demographic Index, SDI）五分位层级，评估了感染性腹泻的发病率、患病率、死亡率与伤残调整生命年（disability-adjusted life years, DALYs）。分析方法涵盖年龄标化率（age-standardized rates, ASR）计算、年度百分比变化（estimation of annual percentage changes, EAPC）估算、连接点回归、不平等指数（包括SII与集中指数）、前沿分析以及病原体特异性DALY趋势分析。

研究结果：
1990年至2021年，全球感染性腹泻的发病例数与DALYs总量有所上升，但各类疾病负担指标的年龄标化率均出现显著下降。疾病负担最重的地区仍为南亚与撒哈拉以南非洲西部。尽管全球范围内的绝对不平等程度有所缓解，但死亡率与DALYs的相对差异却有所扩大。研究观察到显著的时间与地理异质性：高收入国家受病毒性病原体感染的比例日益升高。前沿分析结果显示，多个国家存在显著的卫生系统效率缺口。轮状病毒（rotavirus）与志贺菌（Shigella）相关的DALY降幅最为显著，但在高SDI层级的地区，病毒性病原体导致的疾病负担占比相对提升。

结论：
尽管全球在降低儿童感染性腹泻疾病负担方面已取得显著进展，但持续存在、有时甚至不断扩大的健康不平等问题依然存在。为维持并加快防控进展，尤其是在疾病负担最重的地区，需加大对公平卫生体系的投入、强化病原体监测工作，并制定适应性的靶向干预措施。