1990~2021年全球5岁以下腹泻患儿的疾病负担分析及趋势预测

doi:10.12122/j.issn.1673-4254.2025.10.13

摘要/Abstract

摘要：

目的系统分析全球5岁以下儿童腹泻疾病负担情况。方法本研究基于全球疾病负担（GBD 2021）研究数据，采用Joinpoint回归模型评估1990~2021年各国家（地区）和GBD区域5岁以下儿童腹泻的发病率与死亡率（/10万）及其年均变化百分比（AAPC）。同时，通过平滑曲线回归分析腹泻负担与社会人口指数（SDI）之间的相关性，并对特定腹泻病原体所致的疾病负担进行分析。利用斜率指数和集中指数衡量不同SDI水平人群间的差异，采用贝叶斯年龄-时期-队列模型（BAPC）预测未来趋势。结果 1990~2021年，全球腹泻发病率（AAPC=-3.65）和死亡率（AAPC=-5.15）持续下降。2021 年发病率和死亡率最高的年龄组为新生儿（<28 d），发病率为138 058.74/10万，死亡率为 251.14/10万。轮状病毒是腹泻相关死亡的首位病原体。相关性分析与斜率指数结果显示，SDI与发病率之间存在显著负相关关系。集中指数从1990年的-0.293下降至2021年的-0.314。性别差异无统计学意义。BAPC模型预测显示，2022~2050 年腹泻发病率将持续下降，至2050年男性和女性预计分别为23 448.04/10万和29 932.59/10万。结论尽管全球腹泻疾病负担持续下降，未来趋势亦显示将进一步下降，但其在新生儿及低 SDI 地区仍造成较大影响。轮状病毒仍为全球腹泻死亡的主要病原体，不同国家（地区）和GBD区域的主要病原体存在差异。应加强对易感人群的针对性干预措施，以进一步减轻腹泻相关疾病负担。

关键词: 5岁以下儿童, 腹泻病, 病因, 疾病负担, 全球比较, 趋势

Abstract:

Objective To conduct a comprehensive analysis of the global burden of diarrheal diseases in children under 5 years. Methods The data from the Global Burden of Disease (GBD) 2021 were analyzed to assess the incidence, mortality rates and average annual percentage changes (AAPC) of diarrhea among children under 5 years across nations(regions) and GBD regions from 1990 to 2021 using joinpoint regression. Smoothed curve regression was employed to explore the correlation of diarrheal disease burden with the Social Development Index (SDI) and for analyzing the burden of specific diarrheal pathogens. The Slope and Concentration Indices quantified disparities across SDI levels and the future trend were projected by the Bayesian Age-Period-Cohort (BAPC) model. Results From 1990 to 2021, the global incidence (AAPC: -3.65) and mortality (AAPC: -5.15) rates of diarrheal diseases declined steadily in children below 5 years. In 2021, neonates (<28 days) were the most affected, with an incidence rate of 138 058.74 per 100 000 and a mortality rate of 251.14 per 100 000. Rotavirus was the leading cause of death. The incidence rate of diarrheal diseases was negatively correlated with SDI, and the Concentration Index decreased from -0.293 in 1990 to -0.314 in 2021 without a significant gender difference. The BAPC model suggested that the global incidence rate of diarrheal diseases tends to decrease progressively from 2022 to 2050, with a predicted rate of 23 448.04 per 100 000 for male and 29 932.59 per 100 000 for female by 2050. Conclusions Despite the reduction in the global burden of diarrhea and the projection of its further decline, diarrheal diseases disproportionately affect neonates and low-SDI regions. While rotavirus remains the primary etiological agent worldwide, the predominant pathogens vary by nations (regions) and GBD regions, and strengthened interventions targeting vulnerable populations are needed.

Key words: children under five, diarrheal disease, etiology, disease burden, global comparison, trends

邓颖, 张敏怡, 汪诗奥, 范顺昌, 陈佳琪, 冼举贤, 陈清. 1990~2021年全球5岁以下腹泻患儿的疾病负担分析及趋势预测[J]. 南方医科大学学报, 2025, 45(10): 2171-2181.

Ying DENG, Minyi ZHANG, Shiao WANG, Shunchang FAN, Jiaqi CHEN, Juxian XIAN, Qing CHEN. Global burden and predicted trends of diarrheal disease in children under five from 1990 to 2021[J]. Journal of Southern Medical University, 2025, 45(10): 2171-2181.

图/表 9

图1 1990~2021年全球5岁以下儿童腹泻病的Joinpoint回归分析

Fig.1 Joinpoint regression analysis of the incidence (A) and mortality (B) rates of diarrheal diseases in Children under 5 globally from 1990 to 2021. AAPC： Average annual percentage change. The joinpoints are labeled, and the corresponding annual percent change (APC) and P values (P<0.001 indicates a statistically significant difference) are shown in the legend. Different colors represent different segments.

图2 1990~2021 年全球 5 岁以下儿童腹泻疾病负担的性别和年龄差异

Fig.2 Gender and age-specific burden of diarrheal diseases among children under 5 years globally in 1990-2021 (per 100 000). A, B: Bar charts showing the incidence rate and mortality rate of diarrheal diseases among children under 5 years stratified by sex from 1990 to 2021. C, D: Line charts showing the incidence rate and mortality rate of diarrheal diseases among children under 5 years stratified by age, from 1990 to 2021.

图3 2021年全球21个GBD区域5岁以下儿童腹泻疾病的发病率和死亡率及1990~2021年间其在全球GBD地区的变化趋势及与社会人口学指数（SDI）的相关性

Fig.3 Incidence and mortality rates (per 100 000) of diarrheal diseases among children under 5 in 21 GBD regions in 2021 and the trends and their correlation with the socio-demographic index (SDI) across GBD regions worldwide from 1990 to 2021. A: Trends of the incidence rates and SDI. B: Trends of the mortality rates and SDI by GBD regions. The black line represents the expected rate based solely on SDI.

图4 1990~2021年全球5岁以下儿童腹泻疾病的不同病原体致死率（每100 000人）差异

Fig.4 Mortality rates of diarrheal diseases caused by different pathogens among children under 5 years globally in 1990-2021 （per 100 000）. A: Trends in diarrhoeal mortality rate by pathogen in children under 5 regionally in 1990-2021. B: Pathogen attributed death proportion of diarrhea in children of different age groups in 1990 to 2021. C: Distribution of diarrhoeal mortality by pathogen in children under 5 globally from 1990 to 2021.

表2 按不同病原体分列的全球5岁以下儿童腹泻病死亡率和平均年度变化百分比（AAPC）

Tab.2 Mortality rate and average annual percentage changes (AAPC) of diarrheal disease in children under 5 years stratified by different pathogens worldwide

Global	Mortality rate, 1990 (per 100 000)	Mortality rate, 2021 (per 100 000)	AAPC, 1990-2021 (95% CI)
Adenovirus	56.78 (32.70 to 90.28)	12.32 (6.82 to 20.21)	-4.82 (-4.99 to -4.65)
Aeromonas	8.31 (3.62 to 15.15)	1.63 (0.73 to 3.07)	-5.17 (-5.27 to -5.07)
Campylobacter	22.98 (10.17 to 42.40)	3.84 (1.56 to 7.41)	-5.63 (-5.77 to -5.49)
Cholera	17.76 (14.75 to 21.43)	3.92 (2.81 to 5.31)	-4.83 (-5.12 to -4.53)
Clostridium difficile	0.02 (0.01 to 0.03)	0.02 (0.01 to 0.03)	-0.01 (-0.22 to 0.19)
Cryptosporidium	38.32 (23.65 to 59.95)	10.4 (5.91 to 16.65)	-4.2 (-4.34 to -4.07)
Enterotoxigenic E coli	29.72 (17.32 to 47.09)	6.96 (3.83 to 11.72)	-4.62 (-4.73 to -4.52)
Enteropathogenic E coli	26.83 (15.46 to 42.14)	7.04 (3.95 to 11.59)	-4.31 (-4.39 to -4.23)
Entamoeba	12.28 (5.88 to 23.03)	2.44 (1.07 to 4.91)	-5.11 (-5.28 to -4.95)
Non-typhoidal salmonella	8.16 (1.20 to 17.77)	1.8 (0.24 to 4.17)	-4.8 (-5.12 to -4.48)
Norovirus	22.35 (7.64 to 40.06)	4.49 (1.47 to 8.36)	-5.09 (-5.24 to -4.94)
Rotavirus	100.31 (74.21 to 127.24)	18.21 (12.63 to 25.74)	-5.41 (-5.51 to -5.31)
Shigella	48.35 (29.24 to 78.08)	12.42 (7.28 to 20.96)	-4.34 (-4.51 to -4.18)

图5 2021年全球5岁以下儿童腹泻死亡病因GBD区域差异

Fig.5 Causes of diarrheal deaths in children under 5 across GBD regions in 2021. A: Etiology of diarrheal deaths ranked by mortality rate globally (by SDI in 2021). B: Etiology of diarrheal deaths ranked by mortality rate globally (by GBD regions in 2021). The numbers represent the rank of diarrheal mortality rates among children under 5 for the corresponding GBD regions and pathogen. A smaller number indicates a higher mortality rate.

图6 全球5岁以下儿童腹泻疾病不平等分析

Fig.6 Global inequality analysis for diarrheal diseases in children under 5 years. A: Inequality regression curve between 1999 and 2021. B: Concentration curve between 1999 and 2021. C: Inequality regression curve between male and female. D: Concentration curve between male and female.

图7 基于BAPC模型对2022~2050年全球5岁以下儿童腹泻发病率的预测

Fig.7 Predicted global incidence rate of diarrheal diseases among female (A) and male (B) children under 5 years from 2022 to 2050 based on the BAPC model (per 100 000). The black line represents the predicted mean incidence rate, and the gradient area is its 95% confidence interval.

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