03429nas a2200241   4500000000100000008004100001260005300042653003900095653001200134653001900146653002200165653001800187100001100205700000900216700001000225700001000235245012900245856007300374300000900447490000700456520271000463022001403173       2025                            d  c11/2025bSpringer Science and Business Media LLC10aNeglected tropical diseases (NTDs)10aMalaria10aDisease burden10aHealth Inequality10adecomposition1 aFeng L1 aMo G1 aLiu Z1 aLiu Q00aGlobal, regional, national burden, trends and health inequality of neglected tropical diseases and malaria from 1990 to 2021  uhttps://link.springer.com/content/pdf/10.1186/s12879-025-12068-x.pdf  a1-170 v253 a<p><strong>Background</strong></p>

<p>Neglected tropical diseases and malaria (NTDM) remain persistent public health challenges, disproportionately affecting populations in low- and middle-income countries. This study aims to systematically evaluate the burden, trends, and health inequities of NTDM from 1990 to 2021, and to project trends through 2050.</p>

<p><strong>Methods</strong></p>

<p>This secondary analysis of the Global Burden of Disease (GBD) 2021 database assessed NTDM burden by age, sex, region, and Socio-Demographic Index (SDI). Temporal trends were assessed using joinpoint regression, health inequality was gauged with Concentration Index (CI) and Slope Index of Inequality (SII). Decomposition analysis quantified contributions of population growth, aging, and epidemiological shifts to NTDM burden changes. Bayesian age-period-cohort model predicted future trends.</p>

<p><strong>Results</strong></p>

<p>From 1990 to 2021, global age-standardized incidence rate (ASIR) of NTDM increased by 0.59%, while the age-standardized prevalence rate (ASPR), age-standardized death rate (ASDR), and age-standardized disabilityadjusted life years (DALY) rate declined by 58.05%, 25%, and 32.36%, respectively. Western Sub-Saharan Africa bore the highest burden, while High-income North America and Australasia had the lowest. Liberia, Benin, and Solomon Islands exhibited the highest ASIR and ASPR, whereas Iceland, Ireland, and Finland ranked lowest. Females had higher ASIR, but males faced greater ASDR and DALY rate. Children under five faced the highest ASIR and ASDR. From 1990 to 2021, the global NTDM ASIR showed an overall increasing trend, while ASDR, ASPR, and DALY rate decreased. SII and CI indicated lower-SDI regions carried a higher NTDM burden, with absolute inequality narrowing but relative inequality worsening. Aging and epidemiological changes mitigated NTDM burden in most SDI regions, while population growth significantly exacerbates it, especially in lower SDI regions. Projections to 2050 suggest continued ASPR decline globally, but significant increases in ASIR, ASDR, and DALY rates, with sustained gender and regional gaps.</p>

<p><strong>Conclusions</strong></p>

<p>Despite progress in managing NTDM, the burden will continue to rise due to population growth and other factors. It is crucial to implement targeted interventions for high-risk populations and regions with the highest incidence, mortality, and health disparities. Strengthening health systems, enhancing community engagement, and&nbsp;fostering intersectoral collaboration are essential strategies to reduce NTDM burden, particularly in underdeveloped, high-burden areas.</p>
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