Global Burden and Trends of Norovirus-Associated Diseases From 1990 to 2019: An Observational Trend Study

Abstract

Introduction: As an important pathogen causing diarrheal diseases, the burden and change in the death rate of norovirus-associated diseases (NADs) globally are still unknown.

Methods: Based on global disease burden data from 1990 to 2019, we analyzed the age-standardized death rate (ASDR) of NADs by age, region, country, and Socio-Demographic Index (SDI) level. The discrete Poisson model was applied in the analysis of NADs' spatiotemporal aggregation, the Joinpoint regression model to analyze the trend of death burden of NADs over 30 years, and a generalized linear model to identify the risk factors for the death rate from NADs.

Results: The ASDR of NADs significantly decreased by a factor of approximately 2.7 times, from 5.02 (95% CI: 1.1, 11.34) in 1990 to 1.86 (95% CI: 0.36, 4.16) in 2019 [average annual percent change (AAPC) = -3.43, 95% CI: -3.56, -3.29]. The death burden of NADs in 2019 was still highest in African regions despite a great decline in recent decades. However, the ASDR in high SDI countries presented an uptrend [0.12 (95% CI: 0.03, 0.26) in 1990 and 0.24 (95% CI: 0.03, 0.53) in 2019, AAPC = 2.52, 95% CI: 2.02-3.03], mainly observed in the elderly over 70 years old. Compared to children under 5 years old, the 2019 death rate of elderly individuals over 80 years old was much higher in high SDI countries. The generalized linear model showed that factors of the number of physicians (RR = 0.67), the proportions of children under 14 years old (RR = 1.21), elderly individuals over 65 years old (RR = 1.13), educational level (RR = 1.03) and urbanization proportion (RR = 1.01) influenced the ASDR of NADs.

Conclusions: The death burden of NADs has remained high in developing regions over the last three decades and has increased among the elderly in countries with high SDI levels, even though the global trend in NAD-associated deaths has decreased significantly in the past three decades. More effective public health policies against NADs need to be implemented in high SDI regions and for the elderly.

Keywords: Global Burden of Disease; death rate; epidemic features; global trend analysis; norovirus-associated diseases.

Figure 1

Global burden of norovirus-associated diseases (NADs) in 1990 and 2019 with the annual percent change rate and spatial and temporal aggregation over the 30 years. (A) Age-standardized death rate (ASDR) in 1990; (B) ASDR in 2019; (C) average annual percent changes (AAPCs) from 1990 to 2019; (D) Spatial and temporal aggregation from 1990 to 2019.

Figure 2

Age-specific temporal trends of ASDR globally and in different Socio-Demographic Index (SDI) regions over 30 years old. (A–F) Temporal trends of ASDR globally and in different SDI regions; (G–L) Age-specific temporal trends of death rate globally and in different SDI regions. The APCs with asterisks (*) are statistically significant (P < 0.05).

Figure 3

The death rate of NADs among children under 5 and elderly over 80 globally and in 5 SDI regions. (A) Global; (B) High SDI; (C) High-middle SDI; (D) Middle SDI; (E) Low-middle SDI; (F) Low SDI. The orange and blue numbers above the column denote the ratio of elderly over 80 years old to children under 5 years old in 1990 and 2019 separately.