International journal of women's health · 2025
Temporal Trends, Health Inequalities, and Risk Factors in the Global, Regional, and National Burden of Sexually Transmitted Infections Among Women of Child-Bearing Age (1990-2021): Analysis of the Global Burden of Disease Study.
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Zhang Zijiao, Lei Jianbo, Li Ailing, Liang Jun, Chen Shanli, Li Zheng, He Songlin, Liu Gordon
Аннотация
PURPOSE: Sexually transmitted infections (STIs) among women of child-bearing age (WCBA) are a major global public health issue. This study aims to systematically assess the epidemiological burden of HIV and five other major STIs among WCBA worldwide, and analyze their health inequality status and differences of risk factors, so as to help precise prevention and control.
PATIENTS AND METHODS: Using data from the Global Burden of Disease (GBD) between 1990 and 2021, this research systematically analyzed the disease burden of six major STIs (including HIV, syphilis, chlamydia, gonorrhea, trichomoniasis, and genital herpes) among WCBA (15-49 years) worldwide by assessing their incidence, mortality, prevalence, and disability-adjusted life years (DALYs). To analyze temporal trends, the Joinpoint regression model was employed to estimate the annual percentage change (APC) and its 95% confidence interval. Health inequalities were quantified using the slope index of inequality (SII) and concentration index (CI). Additionally, risk factors' contributions to DALYs were assessed by stratifying according to sociodemographic index (SDI) quintiles.
RESULTS: During 1990-2021, globally, the age-standardized incidence rate (ASIR) of HIV among WCBA showed a combined downward trend (AAPC -1.94%). Conversely, other STIs exhibited an upward trend (AAPC 0.13%), with the most notable increase from 2015 to 2019 (APC 1.68%). Regionally, Oceania showed the largest HIV ASIR increase, and Western sub-Saharan Africa had the largest increase for other STIs. In 2021, low SDI countries had the highest ASIR for HIV and other STIs. However, high-middle and low-middle SDI countries had the largest increases in ASIR for all STIs. Additionally, health inequality analysis revealed burden differences and inequality in STIs among WCBA.
CONCLUSION: The global incidence of non-HIV STIs among WCBA increased from 1990 to 2021, with regional variations. Governments and health systems should address social determinants-such as education, poverty, and inequality-to reduce STIs transmission in this group.
PATIENTS AND METHODS: Using data from the Global Burden of Disease (GBD) between 1990 and 2021, this research systematically analyzed the disease burden of six major STIs (including HIV, syphilis, chlamydia, gonorrhea, trichomoniasis, and genital herpes) among WCBA (15-49 years) worldwide by assessing their incidence, mortality, prevalence, and disability-adjusted life years (DALYs). To analyze temporal trends, the Joinpoint regression model was employed to estimate the annual percentage change (APC) and its 95% confidence interval. Health inequalities were quantified using the slope index of inequality (SII) and concentration index (CI). Additionally, risk factors' contributions to DALYs were assessed by stratifying according to sociodemographic index (SDI) quintiles.
RESULTS: During 1990-2021, globally, the age-standardized incidence rate (ASIR) of HIV among WCBA showed a combined downward trend (AAPC -1.94%). Conversely, other STIs exhibited an upward trend (AAPC 0.13%), with the most notable increase from 2015 to 2019 (APC 1.68%). Regionally, Oceania showed the largest HIV ASIR increase, and Western sub-Saharan Africa had the largest increase for other STIs. In 2021, low SDI countries had the highest ASIR for HIV and other STIs. However, high-middle and low-middle SDI countries had the largest increases in ASIR for all STIs. Additionally, health inequality analysis revealed burden differences and inequality in STIs among WCBA.
CONCLUSION: The global incidence of non-HIV STIs among WCBA increased from 1990 to 2021, with regional variations. Governments and health systems should address social determinants-such as education, poverty, and inequality-to reduce STIs transmission in this group.