Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries : a systematic analysis for the Global Burden of Disease Study 2016

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provides an up-to-date analysis of the burden of diarrhoea in 195 countries. This study assesses cases, deaths, and aetiologies in 1990-2016 and assesses how the burden of diarrhoea has changed in people of all ages. Methods: We modelled diarrhoea mortality with a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We modelled diarrhoea incidence with a compartmental meta-regression tool that enforces an association between incidence and prevalence, and relies on scientific literature, population representative surveys, and health-care data. Diarrhoea deaths and episodes were attributed to 13 pathogens by use of a counterfactual population attributable fraction approach. Diarrhoea risk factors are also based on counterfactual estimates of risk exposure and the association between the risk and diarrhoea. Each modelled estimate accounted for uncertainty. Findings: In 2016, diarrhoea was the eighth leading cause of death among all ages (1"ˆ655"ˆ944 deaths, 95% uncertainty interval [UI] 1"ˆ244"ˆ073-2"ˆ366"ˆ552) and the fifth leading cause of death among children younger than 5 years (446"ˆ000 deaths, 390"ˆ894-504"ˆ613). Rotavirus was the leading aetiology for diarrhoea mortality among children younger than 5 years (128"ˆ515 deaths, 105"ˆ138-155"ˆ133) and among all ages (228"ˆ047 deaths, 183"ˆ526-292"ˆ737). Childhood wasting (low weight-for-height score), unsafe water, and unsafe sanitation were the leading risk factors for diarrhoea, responsible for 80·4% (95% UI 68·2-85·0), 72·1% (34·0-91·4), and 56·4% (49·3-62·7) of diarrhoea deaths in children younger than 5 years, respectively. Prevention of wasting in 1762 children (95% UI 1521-2170) could avert one death from diarrhoea. Interpretation: Substantial progress has been made globally in reducing the burden of diarrhoeal diseases, driven by decreases in several primary risk factors. However, this reduction has not been equal across locations, and burden among adults older than 70 years requires attention.