The Global Trends and Regional Differences in Incidence of Dengue Infection from 1990 to 2019: An Analysis from the Global Burden of Disease Study 2019

Abstract

Introduction: Dengue, as a neglected tropical disease, brings a heavy socioeconomic burden. To provide tailored global prevention strategies, we analyzed the global trends and regional differences in incidence of dengue infection from 1990 to 2019.

Methods: We obtained data on annual dengue episodes and incidence rates, which reflected the epidemic status of dengue infection from the 2019 Global Burden of Disease (GBD) Study. The changes in dengue episodes and estimated annual percentage changes (EAPCs) of the age-standardized incidence rate (ASR) were calculated to quantify the temporal trends of dengue infection.

Results: Globally, dengue ASR increased by 1.70% (95% CI 1.62%-1.78%) per year from 1990 to 2011; subsequently, it decreased by 0.41% (95% CI 0.20%-0.62%) per year from 2011 to 2019. However, the global number of dengue episodes increased steadily by 85.47% from 30.67 million in 1990 to 56.88 million in 2019. Against the global trend of decreasing ASR from 2011 to 2019, an increasing trend was reported in Oceania (EAPC 11.01, 95% CI 8.79-13.27), East Asia (EAPC 4.84, 95% CI 2.70-7.03) and Southeast Asia (EAPC 0.38, 95% CI 0.13-0.62). For socio-demographic index (SDI) regions, ASR continued to have an increasing trend in the middle (EAPC 0.26, 95% CI 0.07-0.45) and high-middle (EAPC 1.70, 95% CI 0.98-2.42) SDI regions from 2011 to 2019. In contrast to the global peak age of dengue incidence rate (10 to 25 years), the dengue incidence rate of older people (> 65 years) was higher than in other age groups in low and low-middle SDI regions. Additionally, the proportions of dengue episodes in the > 70-year-old age group increased in 2019 (using the baseline in 1990 or 2011) in most GBD regions.

Conclusions: Global dengue episodes have increased tremendously in 3 decades. Although global dengue ASR decreased in the last decade, it is still increasing in hyperendemic regions including Oceania, East Asia and Southeast Asia, and also in the middle and high-middle SDI regions. More attention should be paid to the elderly because of the higher dengue incidence rate among them in low and low-middle SDI regions and the increased proportions of dengue episodes among the elderly in most GBD regions. Therefore, more efforts should be undertaken to develop targeted prevention strategies for crucial regions and older populations.

Keywords: Dengue; Incidence; Trend.

Fig. 1

Global trends in the incidence of dengue infection in 126 countries and territories. A ASRs of dengue infection in 2019; B changes in the number of dengue episodes between 1990 and 2019; C EAPCs of dengue ASRs from 2011 to 2019. ASR, age-standardized incidence rate; EAPC estimated annual percentage change

Fig. 2

EAPCs of dengue ASRs from 1990 to 2011 and 2011 to 2019 by region. EAPCs: estimated annual percentage changes; ASR age-standardized incidence rate, CI confidence interval, SDI sociodemographic index

Fig. 3

Incidence rate of dengue by age group, and by SDI region, from 1990 to 2019. SDI socio-demographic index

Fig. 4

Age group distribution of dengue episodes by GBD region in 1990, 2011 and 2019