Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015

Christopher Troeger, Mohammad Forouzanfar, Puja C. Rao, Ibrahim Khalil, Alexandria Brown, Robert C. Reiner, Nancy Fullman, Robert L. Thompson, Amanuel Abajobir, Muktar Ahmed, Mulubirhan Assefa Alemayohu, Nelson Alvis-Guzman, Azmeraw T. Amare, Carl Abelardo Antonio, Hamid Asayesh, Euripide Avokpaho, Ashish Awasthi, Umar Bacha, Aleksandra Barac, Balem Demtsu Betsue & 31 others Addisu Shunu Beyene, Dube Jara Boneya, Deborah Carvalho Malta, Lalit Dandona, Rakhi Dandona, Manisha Dubey, Babak Eshrati, Joseph R.A. Fitchett, Tsegaye Tewelde Gebrehiwot, Gessessew Buggsa Hailu, Masako Horino, Peter J. Hotez, Tariku Jibat, Jost B. Jonas, Amir Kasaeian, Niranjan Kissoon, Karen Kotloff, Ai Koyanagi, G. Anil Kumar, Rajesh Kumar Rai, Aparna Lal, Hassan Magdy Abd El Razek, Mubarek Abera Mengistie, Christine Moe, George Patton, James A. Platts-Mills, Mostafa Qorbani, Usha Ram, Hirbo Shore Roba, Juan Sanabria, GBD Diarrhoeal Diseases Collaborators

Research output: Contribution to journalArticle

204 Citations (Scopus)

Abstract

Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides an up-to-date analysis of the burden of diarrhoeal diseases. This study assesses cases, deaths, and aetiologies spanning the past 25 years and informs the changing picture of diarrhoeal disease worldwide. Methods We estimated diarrhoeal mortality by age, sex, geography, and year using the Cause of Death Ensemble Model (CODEm), a modelling platform shared across most causes of death in the GBD 2015 study. We modelled diarrhoeal morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for diarrhoeal diseases using a counterfactual approach that incorporates the aetiology-specific risk of diarrhoeal disease and the prevalence of the aetiology in diarrhoea episodes. We used the Socio-demographic Index, a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in diarrhoeal mortality. The two leading risk factors for diarrhoea—childhood malnutrition and unsafe water, sanitation, and hygiene—were used in a decomposition analysis to establish the relative contribution of changes in diarrhoea disability-adjusted life-years (DALYs). Findings Globally, in 2015, we estimate that diarrhoea was a leading cause of death among all ages (1·31 million deaths, 95% uncertainty interval [95% UI] 1·23 million to 1·39 million), as well as a leading cause of DALYs because of its disproportionate impact on young children (71·59 million DALYs, 66·44 million to 77·21 million). Diarrhoea was a common cause of death among children under 5 years old (499 000 deaths, 95% UI 447 000–558 000). The number of deaths due to diarrhoea decreased by an estimated 20·8% (95% UI 15·4–26·1) from 2005 to 2015. Rotavirus was the leading cause of diarrhoea deaths (199 000, 95% UI 165 000–241 000), followed by Shigella spp (164 300, 85 000–278 700) and Salmonella spp (90 300, 95% UI 34 100–183 100). Among children under 5 years old, the three aetiologies responsible for the most deaths were rotavirus, Cryptosporidium spp, and Shigella spp. Improvements in safe water and sanitation have decreased diarrhoeal DALYs by 13·4%, and reductions in childhood undernutrition have decreased diarrhoeal DALYs by 10·0% between 2005 and 2015. Interpretation At the global level, deaths due to diarrhoeal diseases have decreased substantially in the past 25 years, although progress has been faster in some countries than others. Diarrhoea remains a largely preventable disease and cause of death, and continued efforts to improve access to safe water, sanitation, and childhood nutrition will be important in reducing the global burden of diarrhoea. Funding Bill & Melinda Gates Foundation.

LanguageEnglish
Pages909-948
Number of pages40
JournalThe Lancet Infectious Diseases
Volume17
Issue number9
DOIs
Publication statusPublished - 1 Sep 2017

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Troeger, Christopher ; Forouzanfar, Mohammad ; Rao, Puja C. ; Khalil, Ibrahim ; Brown, Alexandria ; Reiner, Robert C. ; Fullman, Nancy ; Thompson, Robert L. ; Abajobir, Amanuel ; Ahmed, Muktar ; Alemayohu, Mulubirhan Assefa ; Alvis-Guzman, Nelson ; Amare, Azmeraw T. ; Antonio, Carl Abelardo ; Asayesh, Hamid ; Avokpaho, Euripide ; Awasthi, Ashish ; Bacha, Umar ; Barac, Aleksandra ; Betsue, Balem Demtsu ; Beyene, Addisu Shunu ; Boneya, Dube Jara ; Malta, Deborah Carvalho ; Dandona, Lalit ; Dandona, Rakhi ; Dubey, Manisha ; Eshrati, Babak ; Fitchett, Joseph R.A. ; Gebrehiwot, Tsegaye Tewelde ; Hailu, Gessessew Buggsa ; Horino, Masako ; Hotez, Peter J. ; Jibat, Tariku ; Jonas, Jost B. ; Kasaeian, Amir ; Kissoon, Niranjan ; Kotloff, Karen ; Koyanagi, Ai ; Kumar, G. Anil ; Rai, Rajesh Kumar ; Lal, Aparna ; El Razek, Hassan Magdy Abd ; Mengistie, Mubarek Abera ; Moe, Christine ; Patton, George ; Platts-Mills, James A. ; Qorbani, Mostafa ; Ram, Usha ; Roba, Hirbo Shore ; Sanabria, Juan ; GBD Diarrhoeal Diseases Collaborators. / Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases : a systematic analysis for the Global Burden of Disease Study 2015. In: The Lancet Infectious Diseases. 2017 ; Vol. 17, No. 9. pp. 909-948.
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abstract = "Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides an up-to-date analysis of the burden of diarrhoeal diseases. This study assesses cases, deaths, and aetiologies spanning the past 25 years and informs the changing picture of diarrhoeal disease worldwide. Methods We estimated diarrhoeal mortality by age, sex, geography, and year using the Cause of Death Ensemble Model (CODEm), a modelling platform shared across most causes of death in the GBD 2015 study. We modelled diarrhoeal morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for diarrhoeal diseases using a counterfactual approach that incorporates the aetiology-specific risk of diarrhoeal disease and the prevalence of the aetiology in diarrhoea episodes. We used the Socio-demographic Index, a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in diarrhoeal mortality. The two leading risk factors for diarrhoea—childhood malnutrition and unsafe water, sanitation, and hygiene—were used in a decomposition analysis to establish the relative contribution of changes in diarrhoea disability-adjusted life-years (DALYs). Findings Globally, in 2015, we estimate that diarrhoea was a leading cause of death among all ages (1·31 million deaths, 95{\%} uncertainty interval [95{\%} UI] 1·23 million to 1·39 million), as well as a leading cause of DALYs because of its disproportionate impact on young children (71·59 million DALYs, 66·44 million to 77·21 million). Diarrhoea was a common cause of death among children under 5 years old (499 000 deaths, 95{\%} UI 447 000–558 000). The number of deaths due to diarrhoea decreased by an estimated 20·8{\%} (95{\%} UI 15·4–26·1) from 2005 to 2015. Rotavirus was the leading cause of diarrhoea deaths (199 000, 95{\%} UI 165 000–241 000), followed by Shigella spp (164 300, 85 000–278 700) and Salmonella spp (90 300, 95{\%} UI 34 100–183 100). Among children under 5 years old, the three aetiologies responsible for the most deaths were rotavirus, Cryptosporidium spp, and Shigella spp. Improvements in safe water and sanitation have decreased diarrhoeal DALYs by 13·4{\%}, and reductions in childhood undernutrition have decreased diarrhoeal DALYs by 10·0{\%} between 2005 and 2015. Interpretation At the global level, deaths due to diarrhoeal diseases have decreased substantially in the past 25 years, although progress has been faster in some countries than others. Diarrhoea remains a largely preventable disease and cause of death, and continued efforts to improve access to safe water, sanitation, and childhood nutrition will be important in reducing the global burden of diarrhoea. Funding Bill & Melinda Gates Foundation.",
author = "Christopher Troeger and Mohammad Forouzanfar and Rao, {Puja C.} and Ibrahim Khalil and Alexandria Brown and Reiner, {Robert C.} and Nancy Fullman and Thompson, {Robert L.} and Amanuel Abajobir and Muktar Ahmed and Alemayohu, {Mulubirhan Assefa} and Nelson Alvis-Guzman and Amare, {Azmeraw T.} and Antonio, {Carl Abelardo} and Hamid Asayesh and Euripide Avokpaho and Ashish Awasthi and Umar Bacha and Aleksandra Barac and Betsue, {Balem Demtsu} and Beyene, {Addisu Shunu} and Boneya, {Dube Jara} and Malta, {Deborah Carvalho} and Lalit Dandona and Rakhi Dandona and Manisha Dubey and Babak Eshrati and Fitchett, {Joseph R.A.} and Gebrehiwot, {Tsegaye Tewelde} and Hailu, {Gessessew Buggsa} and Masako Horino and Hotez, {Peter J.} and Tariku Jibat and Jonas, {Jost B.} and Amir Kasaeian and Niranjan Kissoon and Karen Kotloff and Ai Koyanagi and Kumar, {G. Anil} and Rai, {Rajesh Kumar} and Aparna Lal and {El Razek}, {Hassan Magdy Abd} and Mengistie, {Mubarek Abera} and Christine Moe and George Patton and Platts-Mills, {James A.} and Mostafa Qorbani and Usha Ram and Roba, {Hirbo Shore} and Juan Sanabria and {GBD Diarrhoeal Diseases Collaborators}",
year = "2017",
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language = "English",
volume = "17",
pages = "909--948",
journal = "The Lancet Infectious Diseases",
issn = "1473-3099",
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Troeger, C, Forouzanfar, M, Rao, PC, Khalil, I, Brown, A, Reiner, RC, Fullman, N, Thompson, RL, Abajobir, A, Ahmed, M, Alemayohu, MA, Alvis-Guzman, N, Amare, AT, Antonio, CA, Asayesh, H, Avokpaho, E, Awasthi, A, Bacha, U, Barac, A, Betsue, BD, Beyene, AS, Boneya, DJ, Malta, DC, Dandona, L, Dandona, R, Dubey, M, Eshrati, B, Fitchett, JRA, Gebrehiwot, TT, Hailu, GB, Horino, M, Hotez, PJ, Jibat, T, Jonas, JB, Kasaeian, A, Kissoon, N, Kotloff, K, Koyanagi, A, Kumar, GA, Rai, RK, Lal, A, El Razek, HMA, Mengistie, MA, Moe, C, Patton, G, Platts-Mills, JA, Qorbani, M, Ram, U, Roba, HS, Sanabria, J & GBD Diarrhoeal Diseases Collaborators 2017, 'Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015', The Lancet Infectious Diseases, vol. 17, no. 9, pp. 909-948. https://doi.org/10.1016/S1473-3099(17)30276-1

Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases : a systematic analysis for the Global Burden of Disease Study 2015. / Troeger, Christopher; Forouzanfar, Mohammad; Rao, Puja C.; Khalil, Ibrahim; Brown, Alexandria; Reiner, Robert C.; Fullman, Nancy; Thompson, Robert L.; Abajobir, Amanuel; Ahmed, Muktar; Alemayohu, Mulubirhan Assefa; Alvis-Guzman, Nelson; Amare, Azmeraw T.; Antonio, Carl Abelardo; Asayesh, Hamid; Avokpaho, Euripide; Awasthi, Ashish; Bacha, Umar; Barac, Aleksandra; Betsue, Balem Demtsu; Beyene, Addisu Shunu; Boneya, Dube Jara; Malta, Deborah Carvalho; Dandona, Lalit; Dandona, Rakhi; Dubey, Manisha; Eshrati, Babak; Fitchett, Joseph R.A.; Gebrehiwot, Tsegaye Tewelde; Hailu, Gessessew Buggsa; Horino, Masako; Hotez, Peter J.; Jibat, Tariku; Jonas, Jost B.; Kasaeian, Amir; Kissoon, Niranjan; Kotloff, Karen; Koyanagi, Ai; Kumar, G. Anil; Rai, Rajesh Kumar; Lal, Aparna; El Razek, Hassan Magdy Abd; Mengistie, Mubarek Abera; Moe, Christine; Patton, George; Platts-Mills, James A.; Qorbani, Mostafa; Ram, Usha; Roba, Hirbo Shore; Sanabria, Juan; GBD Diarrhoeal Diseases Collaborators.

In: The Lancet Infectious Diseases, Vol. 17, No. 9, 01.09.2017, p. 909-948.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases

T2 - The Lancet Infectious Diseases

AU - Troeger, Christopher

AU - Forouzanfar, Mohammad

AU - Rao, Puja C.

AU - Khalil, Ibrahim

AU - Brown, Alexandria

AU - Reiner, Robert C.

AU - Fullman, Nancy

AU - Thompson, Robert L.

AU - Abajobir, Amanuel

AU - Ahmed, Muktar

AU - Alemayohu, Mulubirhan Assefa

AU - Alvis-Guzman, Nelson

AU - Amare, Azmeraw T.

AU - Antonio, Carl Abelardo

AU - Asayesh, Hamid

AU - Avokpaho, Euripide

AU - Awasthi, Ashish

AU - Bacha, Umar

AU - Barac, Aleksandra

AU - Betsue, Balem Demtsu

AU - Beyene, Addisu Shunu

AU - Boneya, Dube Jara

AU - Malta, Deborah Carvalho

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Dubey, Manisha

AU - Eshrati, Babak

AU - Fitchett, Joseph R.A.

AU - Gebrehiwot, Tsegaye Tewelde

AU - Hailu, Gessessew Buggsa

AU - Horino, Masako

AU - Hotez, Peter J.

AU - Jibat, Tariku

AU - Jonas, Jost B.

AU - Kasaeian, Amir

AU - Kissoon, Niranjan

AU - Kotloff, Karen

AU - Koyanagi, Ai

AU - Kumar, G. Anil

AU - Rai, Rajesh Kumar

AU - Lal, Aparna

AU - El Razek, Hassan Magdy Abd

AU - Mengistie, Mubarek Abera

AU - Moe, Christine

AU - Patton, George

AU - Platts-Mills, James A.

AU - Qorbani, Mostafa

AU - Ram, Usha

AU - Roba, Hirbo Shore

AU - Sanabria, Juan

AU - GBD Diarrhoeal Diseases Collaborators

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides an up-to-date analysis of the burden of diarrhoeal diseases. This study assesses cases, deaths, and aetiologies spanning the past 25 years and informs the changing picture of diarrhoeal disease worldwide. Methods We estimated diarrhoeal mortality by age, sex, geography, and year using the Cause of Death Ensemble Model (CODEm), a modelling platform shared across most causes of death in the GBD 2015 study. We modelled diarrhoeal morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for diarrhoeal diseases using a counterfactual approach that incorporates the aetiology-specific risk of diarrhoeal disease and the prevalence of the aetiology in diarrhoea episodes. We used the Socio-demographic Index, a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in diarrhoeal mortality. The two leading risk factors for diarrhoea—childhood malnutrition and unsafe water, sanitation, and hygiene—were used in a decomposition analysis to establish the relative contribution of changes in diarrhoea disability-adjusted life-years (DALYs). Findings Globally, in 2015, we estimate that diarrhoea was a leading cause of death among all ages (1·31 million deaths, 95% uncertainty interval [95% UI] 1·23 million to 1·39 million), as well as a leading cause of DALYs because of its disproportionate impact on young children (71·59 million DALYs, 66·44 million to 77·21 million). Diarrhoea was a common cause of death among children under 5 years old (499 000 deaths, 95% UI 447 000–558 000). The number of deaths due to diarrhoea decreased by an estimated 20·8% (95% UI 15·4–26·1) from 2005 to 2015. Rotavirus was the leading cause of diarrhoea deaths (199 000, 95% UI 165 000–241 000), followed by Shigella spp (164 300, 85 000–278 700) and Salmonella spp (90 300, 95% UI 34 100–183 100). Among children under 5 years old, the three aetiologies responsible for the most deaths were rotavirus, Cryptosporidium spp, and Shigella spp. Improvements in safe water and sanitation have decreased diarrhoeal DALYs by 13·4%, and reductions in childhood undernutrition have decreased diarrhoeal DALYs by 10·0% between 2005 and 2015. Interpretation At the global level, deaths due to diarrhoeal diseases have decreased substantially in the past 25 years, although progress has been faster in some countries than others. Diarrhoea remains a largely preventable disease and cause of death, and continued efforts to improve access to safe water, sanitation, and childhood nutrition will be important in reducing the global burden of diarrhoea. Funding Bill & Melinda Gates Foundation.

AB - Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides an up-to-date analysis of the burden of diarrhoeal diseases. This study assesses cases, deaths, and aetiologies spanning the past 25 years and informs the changing picture of diarrhoeal disease worldwide. Methods We estimated diarrhoeal mortality by age, sex, geography, and year using the Cause of Death Ensemble Model (CODEm), a modelling platform shared across most causes of death in the GBD 2015 study. We modelled diarrhoeal morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for diarrhoeal diseases using a counterfactual approach that incorporates the aetiology-specific risk of diarrhoeal disease and the prevalence of the aetiology in diarrhoea episodes. We used the Socio-demographic Index, a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in diarrhoeal mortality. The two leading risk factors for diarrhoea—childhood malnutrition and unsafe water, sanitation, and hygiene—were used in a decomposition analysis to establish the relative contribution of changes in diarrhoea disability-adjusted life-years (DALYs). Findings Globally, in 2015, we estimate that diarrhoea was a leading cause of death among all ages (1·31 million deaths, 95% uncertainty interval [95% UI] 1·23 million to 1·39 million), as well as a leading cause of DALYs because of its disproportionate impact on young children (71·59 million DALYs, 66·44 million to 77·21 million). Diarrhoea was a common cause of death among children under 5 years old (499 000 deaths, 95% UI 447 000–558 000). The number of deaths due to diarrhoea decreased by an estimated 20·8% (95% UI 15·4–26·1) from 2005 to 2015. Rotavirus was the leading cause of diarrhoea deaths (199 000, 95% UI 165 000–241 000), followed by Shigella spp (164 300, 85 000–278 700) and Salmonella spp (90 300, 95% UI 34 100–183 100). Among children under 5 years old, the three aetiologies responsible for the most deaths were rotavirus, Cryptosporidium spp, and Shigella spp. Improvements in safe water and sanitation have decreased diarrhoeal DALYs by 13·4%, and reductions in childhood undernutrition have decreased diarrhoeal DALYs by 10·0% between 2005 and 2015. Interpretation At the global level, deaths due to diarrhoeal diseases have decreased substantially in the past 25 years, although progress has been faster in some countries than others. Diarrhoea remains a largely preventable disease and cause of death, and continued efforts to improve access to safe water, sanitation, and childhood nutrition will be important in reducing the global burden of diarrhoea. Funding Bill & Melinda Gates Foundation.

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U2 - 10.1016/S1473-3099(17)30276-1

DO - 10.1016/S1473-3099(17)30276-1

M3 - Article

VL - 17

SP - 909

EP - 948

JO - The Lancet Infectious Diseases

JF - The Lancet Infectious Diseases

SN - 1473-3099

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ER -