Trends in the global burden of cystic echinococcosis among children and adolescents from 1990 to 2021: An analysis based on the Global Burden of Disease Study 2021

Background: Cystic echinococcosis (CE), caused by Echinococcus granulosus, is a zoonotic disease with major global social and economic impacts. Research on its burden in children and adolescents remains limited. This study evaluates the global CE burden from 1990 to 2021 and projects future trends, supporting WHO NTD Roadmap goals aimed at enhancing control in 17 high-endemic countries by 2030. Methods: Using the Global Burden of Disease (GBD) database, we assessed prevalence, incidence, deaths, DALYs, YLDs, and YLLs due to CE in individuals aged 0–19 at global, regional, and national levels. We computed age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs). Additional analyses included joinpoint regression, inequality measures, frontier and decomposition analysis, age-period-cohort (APC) modeling, Socio-demographic Index (SDI) correlations, and future trend prediction. Results: Over 32 years, the global CE burden declined overall, though disparities persisted. Low SDI regions had high ASPR, ASIR, and ASMR. In 2021, global ASIR was 1.12 per 100,000, ASPR was 3.71, and ASMR was 0.01. Moldova had the highest ASPR; Iceland the lowest. East Asia saw growth in ASPR and ASIR. South Sudan had the highest ASMR; Ethiopia had the highest ASDR. Females showed higher ASPR and ASIR; males had higher ASMR. A strong negative correlation was observed between SDI and health indicators. Population changes primarily influenced ASPR. Frontier analysis indicated elevated ASMR/ASDR in some low-SDI nations and rising trends in certain high SDI countries. Age-specific prevalence increased with age. Projections suggest a slow decline in CE burden over the next 25 years, though some countries will remain severely affected. Conclusions: The global CE burden in children and adolescents decreased from 1990 to 2021, yet challenges remain, especially in low-SDI regions such as Sub-Saharan Africa and Central Asia. The Slope Index of Inequality (SII) for ASPR narrowed from -2.597 to -1.087, reflecting reduced but persistent disparity. Rising ASMR and ASDR in high SDI countries like Germany and Norway underscore the need for targeted interventions. The negative SDI health correlation highlights socioeconomic influences. Prevention should focus on females in low-SDI areas, while improved medical care is needed for males facing higher mortality. Although a continued decline is projected, sustained efforts are essential in high burden countries. These findings, supported by a improving concentration index (CI) for ASPR (-0.358 to -0.218), reveal critical health inequalities and inform public health strategies. Author summary: We studied the impact of cystic echinococcosis (CE), a serious parasitic disease commonly acquired by dogs or livestock, on children and adolescents (0–19 years of age) globally from 1990 to 2021, and what may happen in the future. Using global Burden of disease data, we found that although the overall global burden of cystic echinococcosis has declined over these 32 years, major inequalities persist. Children and adolescents in areas with lower levels of socioeconomic development continue to bear a heavy burden, with consistently high incidence and mortality of CE. Infection rates are generally higher in girls than in boys, who are at higher risk of death. While our model predicts that the burden of disease will continue to decline slowly over the next 25 years, the disease is likely to remain a serious problem in some countries. Our findings highlight that cystic echinococcosis still poses a significant health threat to young people, especially in poorer areas. This study provides critical evidence to help global and national health leaders use resources and interventions more effectively to protect vulnerable children and adolescents, in line with the World Health Organization’s goal of controlling neglected diseases such as cystic echinococcosis by 2030.