Trends and Cross-Regional Inequalities in the Global Burden of Four Vertical Transmission Infectious Diseases Among Women of Childbearing Age: A Systematic Analysis and Predictions to 2050 Based on the Global Burden of Disease Study 2021

Abstract

Background: Vertical transmission of infectious diseases poses substantial risks to maternal and neonatal health, significantly contributing to the global burden of infectious diseases. This study examines the trends of HIV, syphilis, and total hepatitis B and C virus (HBV and HCV)-related diseases among women of childbearing age (WCBA) from 1990 to 2021, providing key incidence data that can inform global efforts to eliminate these diseases. 

Methods: Using data from the Global Burden of Disease, Injury and Risk Factors Study 2021, we analyzed case numbers, incidence rates, disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs) for HIV, syphilis, and total HBV- and HCV-related diseases, stratified by age, Social Development Index (SDI), and region. Joinpoint regression analysis and the ARIMA model were employed to assess trends and project disease burden through 2050. 

Findings: In 2021, there were approximately 24.1 million (95% uncertainty interval [UI]: 16.9-33.1) new cases of the four diseases, with HBV being the largest contributor; this resulted in a total of 10.0 million (95% UI: 7.5-13.6) DALYs, primarily driven by HIV among WCBA. Southern sub-Saharan Africa had the highest HIV incidence at 558.3 cases per 100,000 population, while Central sub-Saharan Africa reported the highest rates for syphilis (1213.6 per 100,000), HBV (2550.34 per 100,000), and HCV (213.3 per 100,000). From 1990 to 2021, global HBV incidence declined, whereas HIV incidence increased in 13 regions, particularly in Eastern Europe, and in 117 countries. HCV increase rosed in 8 regions, especially in Eastern Europe, and in 95 countries, whereas syphilis rose in 3 regions, notably in Southern Latin America, and in 43 countries. Specifically, from 2010 to 2021, the fastest EAPC for HIV was observed in Kyrgyzstan (from 15.09 in 1990-2009 to 12.86 in 2010-2021), Ukraine (from 9.1 in 1990-2009 to 11.7 in 2010-2021), and Micronesia (from 10.9 in 1990-2009 to 10.29 in 2010-2021). For syphilis, the highest rates were seen in Brazil (from -6.11 in 1990-2009 to 9.43 in 2010-2021), Botswana (from -8.4 in 1990-2009 to 6.87 in 2010-2021), and Thailand (from -3.37 in 1990-2009 to 6.12 in 2010-2021). The fastest increases in HCV were recorded in Iran (from -2.82 in 1990-2009 to 7.47 in 2010-2021), Japan (from -7.75 in 1990-2009 to 5.87 in 2010-2021), and Libya (from -3.97 in 1990-2009 to 4.99 in 2010-2021). By 2050, incidence rates are projected to rise in 8 regions for HIV, 6 for syphilis, and 11 for HCV, while HBV incidence is expected to decline.

Interpretation: Our findings demonstrate significant progress in reducing the global burden of the four infectious diseases among WCBA from 1990 to 2021. However, regions and countries with low and low-middle SDI continue to bear a disproportionately high burden. The resurgence of HIV, syphilis, and HCV in certain areas such as high, high middle and middle SDIs raises serious concerns. These findings underscore the need for targeted public health policies and a more equitable allocation of medical resources to address emerging challenges. 

Funding: This work was supported by the Science and Technology Innovation Committee of Shenzhen Municipality (No. JCYJ20220531102202005) and the Natural Science Foundation of Guangdong Province (No. 2024A1515012118).

Declaration of Interest: The authors do not have a potential conflict of interest.

Keywords: HIV, syphilis, hepatitis B virus, hepatitis C virus, GBD, women of childbearing age