The burden and trends of infectious diseases among children aged 14 and below in China from 1990 to 2021: a systematic analysis from the 2021 global burden of disease study.

BACKGROUND

Infectious diseases remain one of the leading causes of death among children worldwide. This study aims to analyze the burden and trends of infectious diseases among children aged 0-14 years in China from 1990 to 2021, and evaluate their gender- and age-specific impacts.

METHODS

This study utilizes data from the Global Burden of Disease (GBD) 2021 to analyze mortality, incidence, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), age-standardized incidence rates (ASIR), and age-standardized DALY rates (ASDR) for infectious diseases in Chinese children. Statistical analysis was performed using R and ggplot2.

RESULTS

From 1990 to 2021, China observed substantial declines in pediatric infectious disease burdens. Acute hepatitis mortality decreased from 7,349 deaths (95% UI:5,987-9,059) to 87 (EAPC: -13.78), with a fivefold reduction in ASMR. Enteric infections exhibited the steepest decline: incidence dropped by 86% (EAPC: -6.72), and ASDR fell from 2,257 to 67/100,000. HIV/AIDS deaths rose from 62 to 555 (EAPC:8.28), though post-2018 declines emerged. By 2021, lower respiratory infections remained the leading cause of death (ASMR:5.11/100,000), while upper respiratory infections had the highest incidence. Females showed faster reductions in enteric (EAPC: -7.44 vs. -6.20) and lower respiratory infections (EAPC: -10.39 vs. -9.76). Children under 5 faced the highest burden, particularly for lower respiratory infections (ASMR:13.02/100,000).

CONCLUSION

The overall burden of infectious diseases among children in China has declined, especially for enteric infections and acute hepatitis. The burden of pediatric HIV/AIDS has also decreased in recent years, though adolescent HIV/AIDS education remains a key area of concern. Children under 5 continue to represent the highest burden group. While China's infectious disease control measures and immunization programs have played a vital role, further strengthening policies to address ongoing challenges is essential for effectively reducing the burden of infectious diseases and achieving the Healthy China 2030 goals.