Epidemiological transitions of Visceral Leishmaniasis in G20 countries: A 33-year retrospective joinpoint and demographic decomposition analysis with 20-year ARIMA projections
- 1Department of Epidemiology and Health Statistics, School of Public Health, Henan Medical University, Xinxiang, Henan, People’s Republic of China
- 2Beijing Key Laboratory of Antimicrobial Agents/Laboratory of Pharmacology, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
Abstract
Background: Visceral leishmaniasis (VL) remains a fatal neglected tropical disease with substantial global burden. The Group of Twenty (G20) encompasses both endemic and non-endemic nations, yet comprehensive multi-country assessments of VL trends and future projections are limited. This study aims to evaluate the 33-year epidemiological transition of VL across G20 countries and forecast its trajectory to 2043. Methodology/Principal findings: We extracted VL-related prevalence, incidence, mortality, and disability-adjusted life years (DALYs) data for G20 countries from the Global Burden of Disease 2023 database (1990–2023). We employed joinpoint regression to identify trend inflection points, decomposition analysis to quantify drivers of change (population growth, aging, and epidemiological changes), and autoregressive integrated moving average (ARIMA) models to project trends to 2043. From 1990 to 2023, G20 countries showed significant declines in age-standardized prevalence rate (EAPC = -9.06%), incidence rate (EAPC = -9.06%), mortality rate (EAPC = -7.23%), and DALYs rate (EAPC = -7.40%). Saudi Arabia, Turkey, and India experienced the steepest declines, while Brazil exhibited the smallest reduction and the highest burden in 2023 (age-standardized DALY rate: 30.54 per 100,000). Burden was consistently higher in males and concentrated in children under 5 years, with a slight increase observed among those aged ≥95 years. Decomposition analysis revealed that changes in epidemiological rates were the primary driver of mortality (contributing -82.05%) and DALYs (-52.62%) reductions, counteracting the positive effects of population growth and aging. ARIMA projections (2024–2043) suggest a stabilization in mortality, a gradual decline in DALYs, and a subtle increase in incidence and prevalence rates, with persistent gender disparities. Conclusions/Significance: While the VL burden in G20 nations has significantly decreased, substantial national disparities are evident. Our analysis specifically identifies Brazil as the priority target for intensified control. Sustained surveillance and international cooperation are crucial to prevent a projected mild resurgence in new infections. Author summary: VL is a deadly parasitic disease that disproportionately affects vulnerable populations in tropical and subtropical regions. The G20 brings together the world’s largest economies, including countries where VL is common (such as India and Brazil) and those where it is rare (such as the United States and Germany). In this study, we analyzed VL trends across G20 countries from 1990 to 2023 and projected future patterns through 2043. We found that VL burden has dropped dramatically over the past three decades, largely due to successful vector control, better diagnostics, and improved treatments. However, progress has been uneven—Brazil now carries the heaviest burden among G20 nations, while India, Turkey, and Saudi Arabia achieved the greatest reductions. Young children and males remain most affected, and we observed a concerning slight rise in VL among the very elderly. Looking ahead, we project a mild rebound in new infections, highlighting the need for sustained vigilance. Our findings provide an evidence base for G20 policymakers to allocate resources effectively, strengthen cross-border cooperation, and address emerging challenges such as climate change and population mobility that may reshape VL transmission dynamics in the coming decades.
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BibTeX
@article{wang2026epidemiological,
title = {{Epidemiological transitions of Visceral Leishmaniasis in G20 countries: A 33-year retrospective joinpoint and demographic decomposition analysis with 20-year ARIMA projections}},
author = {Yongbin Wang and Renfang Zhang and Zhenzhou Liu and Chunjie Xu and Fei Lin},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = sep,
doi = {10.1371/journal.pntd.0014714},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014714},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Epidemiological transitions of Visceral Leishmaniasis in G20 countries: A 33-year retrospective joinpoint and demographic decomposition analysis with 20-year ARIMA projections
AU - Yongbin Wang
AU - Renfang Zhang
AU - Zhenzhou Liu
AU - Chunjie Xu
AU - Fei Lin
PY - 2026
DA - 2026/09/16
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014714
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014714
AB - Background: Visceral leishmaniasis (VL) remains a fatal neglected tropical disease with substantial global burden. The Group of Twenty (G20) encompasses both endemic and non-endemic nations, yet comprehensive multi-country assessments of VL trends and future projections are limited. This study aims to evaluate the 33-year epidemiological transition of VL across G20 countries and forecast its trajectory to 2043. Methodology/Principal findings: We extracted VL-related prevalence, incidence, mortality, and disability-adjusted life years (DALYs) data for G20 countries from the Global Burden of Disease 2023 database (1990–2023). We employed joinpoint regression to identify trend inflection points, decomposition analysis to quantify drivers of change (population growth, aging, and epidemiological changes), and autoregressive integrated moving average (ARIMA) models to project trends to 2043. From 1990 to 2023, G20 countries showed significant declines in age-standardized prevalence rate (EAPC = -9.06%), incidence rate (EAPC = -9.06%), mortality rate (EAPC = -7.23%), and DALYs rate (EAPC = -7.40%). Saudi Arabia, Turkey, and India experienced the steepest declines, while Brazil exhibited the smallest reduction and the highest burden in 2023 (age-standardized DALY rate: 30.54 per 100,000). Burden was consistently higher in males and concentrated in children under 5 years, with a slight increase observed among those aged ≥95 years. Decomposition analysis revealed that changes in epidemiological rates were the primary driver of mortality (contributing -82.05%) and DALYs (-52.62%) reductions, counteracting the positive effects of population growth and aging. ARIMA projections (2024–2043) suggest a stabilization in mortality, a gradual decline in DALYs, and a subtle increase in incidence and prevalence rates, with persistent gender disparities. Conclusions/Significance: While the VL burden in G20 nations has significantly decreased, substantial national disparities are evident. Our analysis specifically identifies Brazil as the priority target for intensified control. Sustained surveillance and international cooperation are crucial to prevent a projected mild resurgence in new infections. Author summary: VL is a deadly parasitic disease that disproportionately affects vulnerable populations in tropical and subtropical regions. The G20 brings together the world’s largest economies, including countries where VL is common (such as India and Brazil) and those where it is rare (such as the United States and Germany). In this study, we analyzed VL trends across G20 countries from 1990 to 2023 and projected future patterns through 2043. We found that VL burden has dropped dramatically over the past three decades, largely due to successful vector control, better diagnostics, and improved treatments. However, progress has been uneven—Brazil now carries the heaviest burden among G20 nations, while India, Turkey, and Saudi Arabia achieved the greatest reductions. Young children and males remain most affected, and we observed a concerning slight rise in VL among the very elderly. Looking ahead, we project a mild rebound in new infections, highlighting the need for sustained vigilance. Our findings provide an evidence base for G20 policymakers to allocate resources effectively, strengthen cross-border cooperation, and address emerging challenges such as climate change and population mobility that may reshape VL transmission dynamics in the coming decades.
SN - 1935-2735
ER -