Global burden associated with 85 pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019.

BACKGROUND

Despite a global epidemiological transition towards increased burden of non-communicable diseases, communicable diseases continue to cause substantial morbidity and mortality worldwide. Understanding the burden of a wide range of infectious diseases, and its variation by geography and age, is pivotal to research priority setting and resource mobilisation globally.

METHODS

We estimated disability-adjusted life-years (DALYs) associated with 85 pathogens in 2019, globally, regionally, and for 204 countries and territories. The term pathogen included causative agents, pathogen groups, infectious conditions, and aggregate categories. We applied a novel methodological approach to account for underlying, immediate, and intermediate causes of death, which counted every death for which a pathogen had a role in the pathway to death. We refer to this measure as the burden associated with infection, which was estimated by combining different sources of information. To compare the burden among all pathogens, we used pathogen-specific ratios to incorporate the burden of immediate and intermediate causes of death for pathogens modelled previously by the GBD. We created the ratios by using multiple cause of death data, hospital discharge data, linkage data, and minimally invasive tissue sampling data to estimate the fraction of deaths coming from the pathway to death chain. We multiplied the pathogen-specific ratios by age-specific years of life lost (YLLs), calculated with GBD 2019 methods, and then added the adjusted YLLs to age-specific years lived with disability (YLDs) from GBD 2019 to produce adjusted DALYs to account for deaths in the chain. We used standard GBD methods to calculate 95% uncertainty intervals (UIs) for final estimates of DALYs by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. We provided burden estimates pertaining to all ages and specifically to the under 5 years age group.

FINDINGS

Globally in 2019, an estimated 704 million (95% UI 610-820) DALYs were associated with 85 different pathogens, including 309 million (250-377; 43·9% of the burden) in children younger than 5 years. This burden accounted for 27·7% (and 65·5% in those younger than 5 years) of the previously reported total DALYs from all causes in 2019. Comparing super-regions, considerable differences were observed in the estimated pathogen-associated burdens in relation to DALYs from all causes, with the highest burden observed in sub-Saharan Africa (314 million [270-368] DALYs; 61·5% of total regional burden) and the lowest in the high-income super-region (31·8 million [25·4-40·1] DALYs; 9·8%). Three leading pathogens were responsible for more than 50 million DALYs each in 2019: tuberculosis (65·1 million [59·0-71·2]), malaria (53·6 million [27·0-91·3]), and HIV or AIDS (52·1 million [46·6-60·9]). Malaria was the leading pathogen for DALYs in children younger than 5 years (37·2 million [17·8-64·2]). We also observed substantial burden associated with previously less recognised pathogens, including Staphylococcus aureus and specific Gram-negative bacterial species (ie, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, and Helicobacter pylori). Conversely, some pathogens had a burden that was smaller than anticipated.

INTERPRETATION

Our detailed breakdown of DALYs associated with a comprehensive list of pathogens on a global, regional, and country level has revealed the magnitude of the problem and helps to indicate where research funding mismatch might exist. Given the disproportionate impact of infection on low-income and middle-income countries, an essential next step is for countries and relevant stakeholders to address these gaps by making targeted investments.

FUNDING

Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests B S Cooper reports support to their institution (University of Oxford) for their contribution to this research from the Wellcome Trust, and from the Department of Health and Social Care using UK aid funding managed by the Fleming Fund. E Chung reports support from the US National Institutes of Health (training grant NICHD T32HD007233). S J Dunachie has received support from the UK Fleming Fund at the Department of Health and Social Care, the Bill & Melinda Gates Foundation, Wellcome Trust, the UK National Institute of Health and Care Research, and a Wellcome Drug Resistant Infections Discretionary Award; served as Scientific Advisor for the Scottish Parliament, for which a fee was received; served on funding committees for Wellcome Trust, for which fees were received; served as a Data Monitoring Committee member for the UK STABILISE study of BCG vaccine in COPD; is a member of the New and Emerging Respiratory Virus Threats Advisory Group; is Chair of the Wellcome SEDRIC subgroup on Data Standards and Harmonisation in Antimicrobial Resistance; is a member of the Variant Technical Group for SARS-CoV-2 (invited as a T-cell specialist) for the UK Health Security Agency; is an expert advisor to WHO's Global Antimicrobial Resistance Surveillance System; and is a member of the WHO Guidelines Development Group on Treatment of Ebola. C E Moore reports participation on an advisory board for an MRC grant (no payments received); participation in a WHO Advisory Group for the WHO Medically Important Antimicrobial List; participation in a REVIVE Advisory Group as a member of the Steering Group for the REVIVE study; and served as an unpaid Co-Chair of the Impact and Influence Group for the Microbiology Society. J F Mosser reports grant funding from the Bill & Melinda Gates Foundation and GAVI, and travel support for attending meetings from the Bill & Melinda Gates Foundation. A Stergachis reports being a member of the Executive Board for the Safety Platform for Emergency Vaccines, Brighton Collaboration, based at the Task Force for Global Health; Chair of the Data Safety Monitoring Board for the IMPROVE 1 and 2 trials in Malawi, Tanzania, and Kenya; member of the Data Safety Monitoring Board for the Improving Neonatal Health Through Rapid Malaria Testing in Early Pregnancy with High-Sensitivity Diagnostics study; and member of the Scientific Advisory Board for Vivli AMR Register.