Evolution of the Burden of Carbapenem-Resistant Klebsiella pneumoniae Infections in the Elderly, 1990-2021: Global Trends, Regional Heterogeneity, and Health Inequalities.

BACKGROUND

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a critical global health threat, particularly for older adults. Understanding its precise burden and the associated health inequalities in the elderly population is crucial for informed policy-making.

METHODS

Using data from the Global Burden of Disease 2021 study, we analyzed deaths and disability-adjusted life years attributable to and associated with CRKP in individuals aged ≥ 65 years from 1990 to 2021. We calculated age-standardized rates, assessed temporal trends via average annual percentage change (AAPC), and quantified health inequalities using the Slope Index of Inequality (SII) and Relative Concentration Index. Frontier analysis identified countries with the greatest potential for burden reduction.

RESULTS

The CRKP burden in the elderly increased substantially over the past three decades, as the age-standardized mortality rate associated with CRKP more than doubled from 7.44 (95% CI: 5.65 to 9.23) to 16.17 (95% CI: 13.1 to 19.25) per 100,000 (AAPC = 2.54, p < 0.001), with the most rapid increases occurring in South Asia, Eastern Europe, and Latin America. Conversely, high-income regions such as Western Europe witnessed substantial declines. Health inequalities widened markedly, as the absolute mortality gap (SII) associated with CRKP expanded from -8.69 (95% CI: -11.25,-6.14) to -41.96 (95% CI: -46.97,-36.95), an approximate fivefold increase. Frontier analysis further revealed significant potentially avoidable burden in low- and middle-income countries, independent of socioeconomic development.

CONCLUSION

Formal assessment of socioeconomic trends and health inequalities demonstrates an increasing concentration of the CRKP burden in low- and middle-income regions, exacerbating global health inequities. Combating this requires integrated strategies that combine antimicrobial stewardship and infection control with broader improvements in health care infrastructure and social determinants.