Trends and levels of the global, regional, and national burden of injuries from 1990 to 2021: findings from the global burden of disease study 2021

Abstract

Background/objectives: Injuries remain a major global public health challenge. This study aimed to analyze the global, regional, and national burden of injuries from 1990 to 2021 and project future trends to 2046, addressing a gap in long-term trend analyses and projections accounting for demographic shifts.

Patients/materials and methods: We conducted an observational analysis using data from the Global Burden of Disease (GBD) Study 2021, covering 204 countries and territories. We extracted data on injury incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Age-standardized rates (ASRs) were calculated. Temporal trends (1990-2021) were assessed using estimated annual percentage change (EAPC). Future burden (2022-2046) was projected using statistical modeling.

Results: Globally, while absolute numbers of injury incidence, prevalence, deaths, and DALYs increased from 1990 to 2021, all corresponding ASRs declined significantly (EAPC: incidence - 0.96%, prevalence - 0.73%, mortality - 1.55%, and DALYs - 1.75%). Males consistently bore a greater burden than females (mortality ratio male:female = 2.41). Marked disparities existed: mortality rates in low Socio-demographic Index (SDI) regions were 2.5 times higher than in high SDI regions. Afghanistan, the Central African Republic, and Lesotho had the highest national mortality rates; Singapore, Spain, and Italy the lowest. Projections indicate rising absolute cases but declining ASRs through 2046.

Conclusion: Despite declining ASRs, the increasing absolute injury burden necessitates intensified prevention efforts. Targeted interventions are crucial to address persistent geographic, demographic (especially males), and socioeconomic (low SDI regions) disparities.

Keywords: Age-Period-Cohort (APC); Age-Standardized rates (ASRs); Disability-Adjusted life years (DALYs); Disease burden; Global burden of disease (GBD); autoregressive Integrated moving average (ARIMA); injuries; trend.

Figure 1.

Numbers and age-standardized rates of injury-related incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for both sexes in 2021. The figure presents detailed data on incidence (new cases and age-standardized incidence rates), prevalence (existing cases and age-standardized prevalence rates), deaths (number and age-standardized death rates), and DALYs (disability-adjusted life years and age-standardized DALY rates), with emphasis on differences between male and female populations.

Figure 2.

Numbers and age-standardized rates of injury-related incidence, prevalence, deaths, and DALYs across different age groups in 2021. The figure provides detailed data on incidence (new cases and age-standardized incidence rates), prevalence (existing cases and age-standardized prevalence rates), deaths (number and age-standardized death rates), and DALYs (disability-adjusted life years and age-standardized DALY rates), highlighting variations among different age groups.

Figure 3.

Predicted injury-related numbers (bars) and age-standardized rates (trend lines per 100,000 population) of incidence, prevalence, deaths, and DALYs by sex globally from 2022 to 2046, using the age-period-cohort (APC) model. The figure displays age-standardized incidence rates, prevalence rates, death rates, and DALY rates for both males and females across the forecast period.

Figure 4.

Predicted injury-related numbers (bars) and age-standardized rates (trend lines per 100,000 population) of incidence, prevalence, deaths, and DALYs by sex globally from 2022 to 2046, using the autoregressive integrated moving average (ARIMA) model. The figure shows age-standardized incidence rates, prevalence rates, death rates, and DALY rates for both males and females over the prediction period.