Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016

Abstract

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provides an up-to-date analysis of the burden of diarrhoea in 195 countries. This study assesses cases, deaths, and aetiologies in 1990–2016 and assesses how the burden of diarrhoea has changed in people of all ages.

Methods

We modeled diarrhea mortality with a Bayesian hierarchical modeling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We modeled diarrhea incidence with a compartmental meta-regression tool that enforces an association between incidence and prevalence, and relies on scientific literature, population representative surveys, and health care data. Diarrhea deaths and episodes were attributed to 13 pathogens by use of a counterfactual population attributable fraction approach. Diarrhea risk factors are also based on counterfactual estimates of risk exposure and the association between the risk and diarrhea. Each modeled estimate accounted for uncertainty.

Findings

In 2016, diarrhea was the eighth leading cause of death among all ages (1,655,944 deaths, 95% uncertainty interval [UI] 1,244,073–2,366,552) and the fifth leading cause of death among children younger than 5 years (446,000 deaths, 390,894–504,613). Rotavirus was the leading etiology for diarrhea mortality among children younger than 5 years (128,515 deaths, 105,138–155,133) and among all ages (228,047 deaths, 183,526–292,737). Childhood wasting (low weight-for-height score), unsafe water, and unsafe sanitation were the leading risk factors for diarrhea, responsible for 80.4% (95% UI 68.2–85.0), 72.1% (34.0–91.4), and 56.4% (49.3–62.7) of diarrhea deaths in children younger than 5 years, respectively. Prevention of wasting in 1,762 children (95% UI 1,521–2,170) could avert one death from diarrhea.

Interpretation

Substantial progress has been made globally in reducing the burden of diarrheal diseases, driven by decreases in several primary risk factors. However, this reduction has not been equal across locations, and burden among adults older than 70 years requires attention.