ArticleFrontiers in public health2025
Global burden of diphtheria, 1990-2021: a 204-country analysis of socioeconomic inequality based on SDI and DTP3 vaccination differences before and after the COVID-19 pandemic (GBD 2021).
Article in Frontiers in public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Epidemiology and clinical profile of suspected diphtheria cases in the Governorate of Ibb, Yemen: a 6-year retrospective analysis (2020-2025).IJID regions · 2026Article
- Impact of the COVID-19 pandemic on the global burden of pertussis: An analysis of trends and the emergence of an immunity gap.Human vaccines & immunotherapeutics · 2026Article
- Global, regional, and national burden of immune-mediated inflammatory skin diseases: Insights from the GBD 2021 study.iScience · 2026Article
- Diphtheria outbreak in Somalia: a weekly sitrep on the recent health crisis-2025.Tropical medicine and health · 2025Article
- Global trends in disease burdens attributable to ambient and household air pollution: a comparative study of ten populous countries.Frontiers in public health · 2025Article
- Spatiotemporal patterns and future trends of global ischemic stroke burden.Frontiers in neurologyArticle
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Abstract
Objective: This study aimed to comprehensively assess the temporal trends and regional disparities in the global burden of diphtheria across 204 countries and territories from 1990 to 2021, as well as evaluate the impact of vaccination coverage on disease transmission. Methods: Data were extracted from the Global Burden of Disease (GBD) 2021 study. Statistical approaches, including Joinpoint regression, nonlinear fitting, and calculation of the average annual percentage change (AAPC), were employed to analyze diphtheria incidence, mortality, and disability-adjusted life years (DALYs). The Pearson correlation coefficient was used to quantify the association between diphtheria-tetanus-pertussis (DTP3) vaccination coverage and incidence. Analyses were stratified by region, sex, age, and socio-demographic index (SDI). Results: Between 1990 and 2021, the global age-standardized incidence rate (ASIR), mortality rate (ASMR), and DALY rate (ASMR) of diphtheria declined by 86.7, 75.0, and 86.4%, respectively, yet marked regional disparities persisted. Higher SDI levels correlated with reduced burden, with low-SDI regions accounting for 88.4% of global DALYs in 2021, while high-SDI regions approached elimination. DTP3 coverage negatively correlated with incidence ( Conclusion: Over the past three decades, global efforts have significantly reduced the diphtheria burden, but systemic challenges remain in low-SDI regions. Vaccination remains pivotal; however, post-pandemic declines in coverage underscore latent epidemic risks. Low-SDI regions require integrated nutrition-vaccination strategies, conflict-adapted delivery, and robust cold chains, while high-SDI areas should enhance genomic surveillance, adult boosters, and equitable technology sharing. This study provides the first systematic quantification of spatiotemporal diphtheria burden patterns, offering critical evidence for the WHO 2030 Diphtheria Elimination Roadmap. Eliminating regional disparities necessitates strengthened healthcare systems and adult booster immunization strategies.
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