Journal article
Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990–2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021
The Lancet infectious diseases, v 25(5), pp 519-536
01 May 2025
PMID: 39708822
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: Diarrhoeal diseases claim more than 1 million lives annually and are a leading cause of death in children younger than 5 years. Comprehensive global estimates of the diarrhoeal disease burden for specific age groups of children younger than 5 years are scarce, and the burden in children older than 5 years and in adults is also understudied. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to assess the burden of, and trends in, diarrhoeal diseases overall and attributable to 13 pathogens, as well as the contributions of associated risk factors, in children and adults in 204 countries and territories from 1990 to 2021. Methods: We used the Cause of Death Ensemble modelling strategy to analyse vital registration data, verbal autopsy data, mortality surveillance data, and minimally invasive tissue sampling data. We used DisMod-MR (version 2.1), a Bayesian meta-regression tool, to analyse incidence and prevalence data identified via systematic reviews, population-based surveys, and claims and inpatient data. We calculated diarrhoeal disability-adjusted life-years (DALYs) as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for each location, year, and age–sex group. For aetiology estimation, we used a counterfactual approach to quantify population-attributable fractions (PAFs). Additionally, we estimated the diarrhoeal disease burden attributable to the independent effects of risk factors using the comparative risk assessment framework. Findings: In 2021, diarrhoeal diseases caused an estimated 1·17 million (95% uncertainty interval 0·793–1·62) deaths globally, representing a 60·3% (50·6–69·0) decrease since 1990 (2·93 million [2·31–3·73] deaths). The most pronounced decline was in children younger than 5 years, with a 79·2% (72·4–84·6) decrease in diarrhoeal deaths. Global YLLs also decreased substantially, from 186 million (147–221) in 1990 to 51·4 million (39·9–65·9) in 2021. In 2021, an estimated 59·0 million (47·2–73·2) DALYs were attributable to diarrhoeal diseases globally, with 30·9 million (23·1–42·0) of these affecting children younger than 5 years. Leading risk factors for diarrhoeal DALYs included low birthweight and short gestation in the neonatal age groups, child growth failure in children aged between 1–5 months and 2–4 years, and unsafe water and poor sanitation in older children and adults. We estimated that the removal of all evaluated diarrhoeal risk factors would reduce global DALYs from 59·0 million (47·2–73·2) to 4·99 million (1·99–10·0) among all ages combined. Globally in 2021, rotavirus was the predominant cause of diarrhoeal deaths across all ages, with a PAF of 15·2% (11·4–20·1), followed by norovirus at 10·6% (2·3–17·0) and Cryptosporidium spp at 10·2% (7·03–14·3). In children younger than 5 years, the fatal PAF of rotavirus was 35·2% (28·7–43·0), followed by Shigella spp at 24·0% (15·2–37·9) and adenovirus at 23·8% (14·8–36·3). Other pathogens with a fatal PAF greater than 10% in children younger than 5 years included Cryptosporidium spp, typical enteropathogenic Escherichia coli, and enterotoxigenic E coli producing heat-stable toxin. Interpretation: The substantial decline in the global burden of diarrhoeal diseases since 1990, particularly in children younger than 5 years, supports the effectiveness of health interventions such as oral rehydration therapy, enhanced water, sanitation, and hygiene (WASH) infrastructure, and the introduction and scale-up of rotavirus vaccination. Targeted interventions and preventive measures against key risk factors and pathogens could further reduce this burden. Continued investment in the development and distribution of vaccines for leading pathogens remains crucial. Funding: Bill & Melinda Gates Foundation.
Metrics
1 Record Views
Details
- Title
- Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990–2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021
- Creators
- Hmwe Hmwe Kyu - University of WashingtonAvina Vongpradith - University of WashingtonRegina Mae Villanueva Dominguez - University of WashingtonJianing Ma - The Ohio State UniversitySamuel B. Albertson - University of WashingtonAmanda Novotney - University of WashingtonIbrahim A. Khalil - University of WashingtonChristopher E. Troeger - University of WashingtonMatthew C. Doxey - Seattle Indian Health BoardJorge R. Ledesma - University of WashingtonSarah Brooke Sirota - University of WashingtonRose Grace Bender - University of New HavenLucien R. Swetschinski - University of WashingtonMatthew Cunningham - University of WashingtonSandra Spearman - University of WashingtonYohannes Habtegiorgis Abate - Department of Clinical Governance and Quality Improvement, Aleta Wondo General Hospital, Aleta Wondo, EthiopiaAbdallah H.A. Abd Al Magied - Ajman UniversitySamar Abd ElHafeez - Alexandria UniversityMeriem Abdoun - Department of Health, Sétif, AlgeriaBayeh Abera - Ghent UniversityHassan Abidi - Yasuj University of Medical SciencesRichard Gyan Aboagye - University of Health and Allied SciencesYonas Derso Abtew - Arba Minch UniversityHasan Abualruz - Al-Zaytoonah University of JordanEman Abu-Gharbieh - University of JordanHana J. Abukhadijah - Hamad Medical CorporationSalahdein Aburuz - United Arab Emirates UniversityIsaac Yeboah Addo - UNSW SydneyVictor Adekanmbi - Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United StatesCharles Oluwaseun Oluwaseun Adetunji - Edo State University UzairueTemitayo Esther Adeyeoluwa - University of IbadanRipon Kumar Adhikary - University of CanberraQorinah Estiningtyas Sakilah Adnani - Department of Public Health, Universitas Padjadjaran (Padjadjaran University), Bandung, IndonesiaSaryia Adra - Clinical Sciences Department, Sharjah, United Arab EmiratesLeticia Akua Adzigbli - University of Health and Allied SciencesAanuoluwapo Adeyimika Afolabi - Memphis Center For Reproductive HealthMuhammad Sohail Afzal - Department of Life Sciences, University of Management and Technology, Lahore, PakistanSaira Afzal - Department of Public Health, Public Health Institute, Lahore, PakistanSuneth Buddhika Agampodi - International Vaccine InstituteFeleke Doyore Agide - Wachemo UniversityBright Opoku Ahinkorah - University of Technology SydneyAqeel Ahmad - Shaqra UniversitySajjad Ahmad - American University of BeirutAli Ahmed - University of California San DiegoAyman Ahmed - University of BaselHaroon Ahmed - COMSATS University IslamabadSaeed Ahmed - Department of Biological Sciences, National University of Medical Sciences (NUMS), Rawalpindi, PakistanKarolina Akinosoglou - Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, Patras, GreeceEma Akter - International Centre for Diarrhoeal Disease ResearchSalah Al Awaidy - Middle East, Eurasia, and Africa Influenza Stakeholders Network, Muscat, OmanMuaaz M. Alajlani - Al-Sham Private UniversityKhurshid Alam - Murdoch UniversityAlmaza Albakri - Department of Medicine, Royal Jordanian Medical Services, Amman, JordanMohammed Albashtawy - Al al-Bayt UniversityWafa A. Aldhaleei - Mayo ClinicAbdelazeem M. Algammal - Suez Canal UniversityAdel Ali Saeed Al-Gheethi - Cooperative Research Centre for Contamination Assessment and Remediation of the EnvironmentAbid Ali - Abdul Wali Khan University MardanSyed Shujait Ali - University of SwatWaad Ali - Sultan Qaboos UniversitySheikh Mohammad Alif - Monash UniversitySyed Mohamed Aljunid - National University of MalaysiaSabah Al-Marwani - Irbid, JordanJoseph Uy Almazan - Nazarbayev UniversityHesham M. Al-Mekhlafi - Sana'a UniversitySami Almustanyir - Ministry of Health, Riyadh, Saudi ArabiaSaleh A. Alqahatni - Department of Medicine, Baltimore, MD, United StatesAhmad Alrawashdeh - Jordan University of Science and TechnologyRami H. Al-Rifai - United Arab Emirates UniversityMohammed A. Alsabri - St. Christopher's Hospital for ChildrenAwais Altaf - University of LahoreKhalid A. Altirkawi - University of SharjahNelson Alvis-Guzman - Universidad de la CostaNelson J. Alvis-Zakzuk - National Health Observatory, National Institute of Health, Bogota, ColombiaMohammad Sharif Ibrahim Alyahya - Jordan University of Science and TechnologyWalid A. Al-Zyoud - German Jordanian UniversityDickson A. Amugsi - African Population and Health Research CenterCatalina Liliana Andrei - Carol Davila University of Medicine and PharmacySebastien Antoni - Department on Immunization, Vaccines and Biologicals, World Health Organization (WHO), Geneva, SwitzerlandBoluwatife Stephen Anuoluwa - University of Medical Sciences, OndoIyadunni Adesola Anuoluwa - University of Medical Sciences, OndoSaleha Anwar - Jamia HamdardPalwasha Anwari - University of LondonGeminn Louis Carace Apostol - Inter-Agency Committee on Environmental Health, Department of Health Philippines, Manila, PhilippinesJalal Arabloo - Iran University of Medical SciencesMosab Arafat - Al Ain UniversityAleksandr Y. Aravkin - University of WashingtonDemelash Areda - Arizona State UniversityBrhane Berhe Aregawi - Adigrat UniversityAbdulfatai Aremu - University of IlorinMichael Benjamin Arndt - University of WashingtonAkeza Awealom Asgedom - Mekelle UniversityTahira Ashraf - University of LahoreSeyyed Shamsadin Athari - Zanjan University of Medical SciencesAlok Atreya - Lumbini Medical CollegeFirayad Ayele - Haramaya UniversityDavood Azadi - Arak University of Medical SciencesGulrez Shah Azhar - The World Bank, Washington, DC, United StatesShahkaar Aziz - The University of Agriculture, PeshawarAhmed Y. Azzam - October 6 UniversityGBD 2021 Diarrhoeal Diseases Collaborators
- Publication Details
- The Lancet infectious diseases, v 25(5), pp 519-536
- Publisher
- Elsevier
- Number of pages
- 18
- Grant note
- MR/M015084/1 / Medical Research Council (http://data.elsevier.com/vocabulary/SciValFunders/501100000265) Medical Research Council (http://data.elsevier.com/vocabulary/SciValFunders/501100000265) Anindya Sekhar Bose
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:001494128700001
- Scopus ID
- 2-s2.0-85214328670
- Other Identifier
- 991022197327604721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
Source: SDGs in the Output
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
Highly Cited Paper
- Web of Science research areas
- Infectious Diseases