Trends and Cross-Country Inequalities in Dengue, 1990-2021

Abstract Background  The existing body of literature is deficient in the most recent data regarding the global perspective of dengue fever and its associated health inequities.Our aim is to assess the global burden of dengue fever and its health inequities from 1990 to 2021. Methods We utilized the Global Burden of Disease (GBD) database for epidemiological trends, demographic analysis, and epidemiological decomposition. Cross-national inequality and predictive modeling for the global dengue burden up to 2051 were also performed. Results Globally, dengue fever incidence, prevalence, DALYs, and mortality showed increasing trends with significant international disparities. From 1990 to 2021, ASR for incidence and prevalence rose by 1.83% (95% CI: 1.58%-2.08%), and for DALYs and mortality by 1.33% (95% CI: 1.10%-1.57%) and 1.70% (95% CI: 1.45%-1.94%), respectively. Age-period-cohort-model analysis revealed a positive correlation between dengue fever incidence and age, with mortality sharply increasing in those over 80. Decomposition of dengue fever DALYs burden showed population growth as the main contributor to the global burden, with varying impacts across SDI quintiles. Inequalities in dengue fever burden related to SDI persisted, shifting benefits from impoverished to affluent populations. BAPC model projections suggest stabilization of incidence and prevalence ASRs, with declining DALYs and mortality ASRs,     particularly for females. Conclusion This study elucidates the changes in the burden of dengue fever against the backdrop of a burgeoning global population, severe aging, and pronounced health inequities across nations, quantifying these alterations and forecasting the trends in the disease burden over the next three decades. Concurrently, the research proposes effective measures for various countries and regions to mitigate health inequities associated with dengue fever and to reduce the associated disease burden.