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. 2025 Apr 1;19(4):e0012960.
doi: 10.1371/journal.pntd.0012960. eCollection 2025 Apr.

The global, regional, and national burden of Invasive Non-typhoidal Salmonella (iNTS): An analysis from the Global Burden of Disease Study 1990-2021

Yunjuan He  1 , Qingqing Jia  2 , Kang Cai  1 , Shanshan Xu  1 , Huajun Li  1 , Qiuling Xie  1 , Yushu Qiu  1 , Liya Zhang  1 , Xianting Jiao  1
Affiliations

The global, regional, and national burden of Invasive Non-typhoidal Salmonella (iNTS): An analysis from the Global Burden of Disease Study 1990-2021

Yunjuan He et al. PLoS Negl Trop Dis. .

Abstract

Objectives: Invasive Non-typhoidal Salmonella (iNTS) can cause serious, life-threatening, and invasive infections, posing great challenges to public health. We aimed to systematically review the burden of iNTS disease based on Global Burden of Diseases (GBD) 2021.

Methods: We extracted data for the incidence, death, and disability-adjusted life-years (DALYs) associated with iNTS from GBD 2021, providing an overview of its epidemiology while examining trends from 1990 to 2021. Additionally, we decomposed changes of iNTS-related burden, and quantified cross-country inequalities.

Results: GBD 2021 estimated 509976(95%UI,413361 to 606167) incident cases of iNTS worldwide in 2021, with the most cases and highest age-standardized rate (ASR) in Western Sub-Saharan Africa. The low SDI region had the most cases of iNTS in 2021. The incidence and DALYs rates were highest in the Low SDI region. Among all age groups, the incidence, death, and DALYs rate of iNTS were primarily concentrated among the following age groups: <1 year, 1-4 years, 5-9 years, 10-14 years, and 15-19 years. The highest rates were observed in the <1-year group. The results of joinpoint regression analysis revealed that the global burden of iNTS increased overall from 1990 to 2005, followed by notable decrease from 2005 to 2021 at varying rates. Decomposition analysis found that population growth (103.93%) and epidemiological change (48.34%) were responsible for motivating the changes in iNTS global burden. Cross-country inequality analysis revealed that the SDI-related inequalities were moderated from 1990 to 2021.

Conclusions: The global burden of iNTS is still high, and the distribution patterns vary across different countries and territories. The global burden of iNTS was primarily noteworthy among children and adolescents, with the highest burden among infants. The changes in the iNTS burden were primarily driven by population growth and epidemic transition. Despite varying iNTS burdens across different SDI regions, SDI-related inequalities across countries became moderated gradually over time. This study reported the global disease burden and temporal trends of iNTS disease, and underscores the need for age- and region-specific strategies to mitigate the corresponding global burden.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. iNTS Incidence, Deaths, and Disability-Adjusted Life-Years (DALYs) at different age groups in 2021.
A. age-related distributions of age-standardized incidence rate. B. age-related distributions of age-standardized death rate. C. age-related distributions of age-standardized DALYs rate.
Fig 2
Fig 2. Epidemiologic Trends of Incidence, Death, and Disability-Adjusted Life-Years (DALYs) Rates in five Sociodemographic Index (SDI) Regions of iNTS from 1990 to 2021.
A. Trends in incidence rate. B. Trends in death rate. C. Trends in DALYs rate.
Fig 3
Fig 3. The Associations Between SDI and iNTS across 21 GBD Regions. A.
Association between age-standardized DALYs rate of iNTS and SDI. B. Association between age-standardized death rate of iNTS and SDI. C. Association between age-standardized incidence rate of iNTS and SDI.
Fig 4
Fig 4. The age-standardized rate of iNTS incidence, death, DALYs in 2021 across 204 countries.
A. The incidence rate of iNTS; B. The death rate of iNTS; C. DALYs rate of iNTS. Note: The basemap shapefile was from R package ‘maps’ version 3.4.2. https://cran.rstudio.com/web/packages/maps/index.html.
Fig 5
Fig 5. The joinpoint regression analysis on age-standardized rate of iNTS incidence, death, DALYs.
A.age-standardized rate of incidence; B. age-standardized rate of death; C. age-standardized rate of DALYs. APC:annual percentage change.
Fig 6.
Fig 6.. A Decomposition analysis of iNTS change in incidence by SDI, 1990 to 2021. Fig 6B. SDI-related health inequality regression for the incidence rate of iNTS worldwide, 1990 and 2021.
See this image and copyright information in PMC

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