Two Decades of Dengue in Indonesia: Long-Term Trends in Incidence, Mortality, and Disability-Adjusted Life Years, 2005-2024.

Dengue continues to be a significant public health concern in Indonesia. However, a comprehensive assessment of long-term national trends in disease burden and fatality composition remains to be developed. Ecological time-series analysis for 20 years (2005-2024) was carried out using national surveillance data. Incidence, mortality, and disability-adjusted life year (DALY) rates were calculated using mid-year population estimates. Log-linear regression was applied to estimate the annual percentage change (APC). Joinpoint regression was used to assess potential trend inflection points. Case fatality rate (CFR) trends were examined using negative binomial regression. DALYs were decomposed into years of life lost (YLL) and years lived with disability (YLD). The results indicated that incidence rates did not demonstrate a significant long-term trend, while both mortality and DALY rates declined significantly over time. CFR decreased by approximately 2.2% annually (RR 0.978, 95% CI 0.969-0.987; p < 0.001). Although DALYs remained predominantly driven by premature mortality (>98%), the proportional contribution of YLL declined modestly but significantly over time. Despite persistent dengue transmission, fatal severity has substantially decreased in Indonesia over the past two decades (2005-2024). The findings suggest improved clinical outcomes and a modest structural shift in disease burden composition.