Comparative analysis of cystic echinococcosis burden trends: a systematic evaluation of global and Chinese regional patterns using global burden of disease study 2021 data

TL;DR

This study analyzed global and Chinese trends in cystic echinococcosis burden from 1990 to 2021, revealing rising incidence in China despite global declines.

Contribution

The study provides a systematic evaluation of CE burden trends in China using GBD 2021 data, identifying drivers and reduction potential.

Findings

China's CE incidence and prevalence increased sharply from 1990 to 2021, contrasting with stable global rates.

Healthcare improvements reduced mortality and DALYs in China, but reduction rates lagged behind global trends.

CE burden is negatively correlated with the Sociodemographic Index, highlighting the need for interventions in low-SDI regions.

Abstract

This study leveraged the Global Burden of Disease (GBD) 2021 database to comprehensively evaluate the trends in the disease burden of cystic echinococcosis (CE) in China from 1990 to 2021, situating its unique trajectory within the global context to inform targeted control strategies.

Based on data from the GBD 2021 study, the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of CE were analyzed. Joinpoint regression was applied to calculate the average annual percentage change (AAPC), decomposition analysis was conducted to identify key driving factors, and frontier analysis was used to assess reduction potential. Subgroup analyses were stratified by age, sex, and region.

Globally, the age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of CE remained relatively stable from 1990 to 2021. In contrast, China experienced sharp increases in ASIR (AAPC = 2.94%) and ASPR (AAPC = 3.13%). Age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) declined globally and in China, though China’s ASDR reduction (AAPC = −2.71%) lagged behind the global rate (AAPC = −4.0%). Decomposition analysis indicated that epidemiological deterioration was the primary driver of increased cases in China, while healthcare improvements contributed to reduced deaths and DALYs. Females had higher incidence and prevalence, particularly among those aged over 35, whereas males exhibited higher mortality and DALYs. The global CE burden was negatively correlated with the Sociodemographic Index (SDI). Although China approached the efficiency frontier in disease control, elevated ASPR and ASDR indicated persistent transmission and latent infections, suggesting further reduction potential.

China faces rising CE incidence and prevalence despite improved outcomes, owing to delayed diagnosis and unbalanced resources. Aging and persistent exposure have worsened the burden, especially among middle-aged adults and females. Strategic priorities include enhanced prevention in the elderly, improved screening for women, intensified management of severe male cases, and balanced treatment/prevention approaches. SDI is a key determinant of CE burden, requiring focused interventions in low-SDI regions. Targeted monitoring of ASPR and ASDR is crucial to reduce the impact of historical transmission and achieve World Health Organization (WHO) targets.

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