The global, regional, and national burden of Invasive Non-typhoidal Salmonella (iNTS): An analysis from the Global Burden of Disease Study 1990-2021.

Objectives: Invasive Non-typhoidal Salmonella (iNTS) can cause serious, life-threatening, and invasive infections, posing great challenges to public health. We aimed to systematically review the burden of iNTS disease based on Global Burden of Diseases (GBD) 2021.

Methods: We extracted data for the incidence, death, and disability-adjusted life-years (DALYs) associated with iNTS from GBD 2021, providing an overview of its epidemiology while examining trends from 1990 to 2021. Additionally, we decomposed changes of iNTS-related burden, and quantified cross-country inequalities.

Results: GBD 2021 estimated 509976(95%UI,413361 to 606167) incident cases of iNTS worldwide in 2021, with the most cases and highest age-standardized rate (ASR) in Western Sub-Saharan Africa. The low SDI region had the most cases of iNTS in 2021. The incidence and DALYs rates were highest in the Low SDI region. Among all age groups, the incidence, death, and DALYs rate of iNTS were primarily concentrated among the following age groups: <1 year, 1-4 years, 5-9 years, 10-14 years, and 15-19 years. The highest rates were observed in the <1-year group. The results of joinpoint regression analysis revealed that the global burden of iNTS increased overall from 1990 to 2005, followed by notable decrease from 2005 to 2021 at varying rates. Decomposition analysis found that population growth (103.93%) and epidemiological change (48.34%) were responsible for motivating the changes in iNTS global burden. Cross-country inequality analysis revealed that the SDI-related inequalities were moderated from 1990 to 2021.

Conclusions: The global burden of iNTS is still high, and the distribution patterns vary across different countries and territories. The global burden of iNTS was primarily noteworthy among children and adolescents, with the highest burden among infants. The changes in the iNTS burden were primarily driven by population growth and epidemic transition. Despite varying iNTS burdens across different SDI regions, SDI-related inequalities across countries became moderated gradually over time. This study reported the global disease burden and temporal trends of iNTS disease, and underscores the need for age- and region-specific strategies to mitigate the corresponding global burden.