Global, Regional, and National Burdens of Otitis Media From 1990 to 2019: A Population Based Study

Abstract

Objectives: Otitis media is one of the most important causes of hearing loss at an early age. Effective vaccination with the routine 7-valent pneumococcal conjugate vaccine (PCV-7) was introduced in 2000. It has been gradually replaced by the pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine or the higher-valent 13-valent PCV (PCV-13) since 2010. Data on the change in otitis media burden in recent years are sparse at the global, regional, and national levels.

Design: The Global Burden of Disease 2019 study was used to evaluate the prevalence, incidence, mortality, disability-adjusted life year (DALY) rates, and the average annual percentage changes (AAPCs) in otitis media in geographic populations worldwide from 1990 to 2019. These global trends were further analyzed by subgroup (age, sex, and sociodemographic index [SDI]).

Results: Globally, the all-age rate of prevalence (AAPC = -0.7, 95% confidence interval [CI] = -0.7 to -0.8), DALYs (AAPC = -1.0, 95% CI = -1.1 to -1.0), and mortality (AAPC = -6.8, 95% CI = -7.3 to -6.4) from otitis media decreased constantly between 1990 and 2019. The all-age rate of incidence decreased sharply between 2000 and 2009 with an AAPC of -1.2 (95% CI = -1.4 to -0.9) and continued the downward trend between 2010 and 2019 (AAPC = -0.2, 95% CI = -0.3 to -0.1). In 2019, children aged 1 to 4 years old had the highest incidence at 29,127.3 per 100,000 population, while young adults under 30 years old accounted for 91.3% of the incident cases. Individuals living in middle-SDI countries had the largest increase in the incidence of otitis media, with an AAPC of 0.3 (95% CI = 0.3 to 0.3) between 1990 and 2019. The incidence and DALYs from otitis media decreased with increasing SDI. Regionally, the largest increase in incidence was observed in high-income Asia Pacific, Eastern Europe, and Western Sub-Saharan Africa between 1990 and 2019. Nationally, the largest increase in the incidence of otitis media was observed in the Republic of Korea, with an AAPC of 0.8 (95% CI = 0.6 to 1.1) in the same time period.

Conclusions: There have been successful previous endeavors to reduce DALYs and mortality attributed to otitis media on a global scale. The worldwide incidence of otitis media experienced a sharp decline following the introduction of PCV-7 in 2000, and this downward trend persisted in subsequent years with the adoption of PCV-13/pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine. Continual epidemiological surveillance of otitis media's global trends, pathogen distribution, and resistance patterns remains imperative.

Fig. 1.

Joinpoint regression analysis of global otitis media for all-age rate of incidence (A), prevalence (B), mortality (C), and DALYs (D) from 1990 to 2019. APC indicates average annual percentage change; DALYs, disability-adjusted life year.

Fig. 2.

Global map of 2019 age-standardized incidence (A) and DALYs (B) of otitis media and average annual percentage changes in incidence (C) and DALYs (D) from 1990 to 2019. AAPC indicates average annual percentage change; DALYs, disability-adjusted life years.

Fig. 3.

Age-standardized incidence and disability-adjusted life years of otitis media in 2019 in 204 countries and territories by sociodemographic and HAQ Index. (A) Incidence and SDI; (B) DALYs and SDI; (C) Incidence and HAQ index; (D) DALYs and HAQ index. The circles represent countries that had available sociodemographic, healthcare, and quality index data. CI indicates confidence interval; DALY, disability-adjusted life year; HAQ, healthcare access and quality; SDI, sociodemographic index.