Comprehensive analysis of the Global Burden and epidemiological trends of meningitis from 1990 to 2021.

Background: Despite significant advances in prevention and treatment strategies, meningitis continues to pose a substantial global health challenge. The disease burden demonstrates marked geographical disparities, with disproportionate impact in resource-limited settings, particularly within the "meningitis belt" of Sub-Saharan Africa. The global meningitis burden is influenced by a complex interplay of environmental, behavioral, and socioeconomic determinants.

Methods: Leveraging the Global Burden of Disease (GBD) 2021 database, we conducted a comprehensive analysis of global meningitis burden from 1990 to 2021. The study employed DisMod-MR 2.1, an advanced Bayesian meta-regression tool, for epidemiological modeling. We implemented age-period-cohort analysis to evaluate mortality trends and utilized the Comparative Risk Assessment framework to assess risk factors. The relationship between socio-demographic index (SDI) and disease burden was examined through Spearman's rank correlation analysis.

Results: Our analysis revealed significant geographical and pathogen-specific variations in disease burden. Globally, the age-standardized incidence rate stands at 31.65 per 100,000 with a corresponding mortality rate of 2.95 per 100,000. The disease burden demonstrates a striking gradient across SDI levels, with low SDI regions experiencing the highest burden, approximately 17 times higher than high SDI regions. Neonatal mortality rates remain particularly concerning at 129.69 per 100,000, while under-5 mortality rates stand at 34.50 per 100,000. The Eastern Sub-Saharan African region emerges as an area of particular concern, with disease burden significantly exceeding global averages. Behavioral risks, child and maternal malnutrition, and low birth weight/short gestation emerged as the primary risk factors, each contributing to 0.15 million deaths and 13.41 million DALYs. Strong negative correlations were observed between all risk factors and SDI values (correlation coefficients ranging from - 0.55 to -0.75), indicating higher disease burden in regions with lower socio-demographic development.

Conclusion: While substantial progress has been achieved in global meningitis control, particularly in reducing under-5 mortality rates, significant disparities persist between high and low SDI regions. Our findings emphasize the critical need for targeted interventions in resource-limited settings and continued surveillance efforts to address remaining challenges in meningitis control.