Abstract: Objective　To investigate the global burden of visceral leishmaniasis (VL) from 1990 to 2021 and predict the trends in the burden of VL from 2022 to 2035, so as to provide insights into global VL prevention and control. Methods　 The global age⁃standardized incidence, prevalence, mortality and disability⁃adjusted life years (DALYs) rates of VL and their 95% uncertainty intervals (UI) were captured from the Global Burden of Disease Study 2021 (GBD 2021) data resources. The trends in the global burden of VL were evaluated with average annual percent change (AAPC) and 95% confidence interval (CI) from 1990 to 2021, and gender⁃, age⁃, country⁃, geographical area⁃ and socio⁃demographic index (SDI)⁃stratified burdens of VL were analyzed. The trends in the global burden of VL were projected with a Bayesian age⁃period⁃cohort (BAPC) model from 2022 to 2035, and the associations of age⁃standardized incidence, prevalence, mortality, and DALYs rates of VL with SDI levels were examined with a smoothing spline model. Results　The global age⁃standardized incidence [AAPC = -0.25%, 95% CI: (-0.25%, -0.24%)], prevalence [AAPC = -0.06%, 95% CI: (-0.06%, -0.06%)], mortality [AAPC = -0.25%, 95% CI: (-0.25%, -0.24%)] and DALYs rates of VL [AAPC = -2.38%, 95% CI: (-2.44%, -2.33%)] all appeared a tendency towards a decline from 1990 to 2021, and the highest age⁃standardized incidence [2.55/105, 95% UI: (1.49/105, 4.07/105)], prevalence [0.64/105, 95% UI: (0.37/105, 1.02/105)], mortality [0.51/105, 95% UI: (0, 1.80/105)] and DALYs rates of VL [33.81/105, 95% UI: (0.06/105, 124.09/105)] were seen in tropical Latin America in 2021. The global age⁃standardized incidence and prevalence of VL were both higher among men [0.57/105, 95% UI: (0.45/105, 0.72/105); 0.14/105, 95% UI: (0.11/105, 0.18/105)] than among women [0.27/105, 95% UI: (0.21/105, 0.33/105); 0.06/105, 95% UI: (0.05/105, 0.08/105)], and the highest mortality of VL was found among children under 5 years of age [0.24/105, 95% UI: (0.08/105, 0.66/105)]. The age⁃standardized incidence (r = -0.483, P < 0.001), prevalence (r = -0.483, P < 0.001), mortality (r = -0.511, P < 0.001) and DALYs rates of VL (r = -0.514, P < 0.001) correlated negatively with SDI levels from 1990 to 2021. In addition, the global burden of VL was projected with the BAPC model to appear a tendency towards a decline from 2022 to 2035, and the age⁃standardized incidence, prevalence, mortality and DALYs rates were projected to be reduced to 0.11/105, 0.03/105, 0.02/105 and 1.44/105 in 2035, respectively. Conclusions　Although the global burden of VL appeared an overall tendency towards a decline from 1990 to 2021, the burden of VL showed a tendency towards a rise in Central Asia and western sub⁃Saharan African areas. The age⁃standardized incidence and prevalence rates of VL were relatively higher among men, and the age⁃standardized mortality of VL was relatively higher among children under 5 years of age. The global burden of VL was projected to continue to decline from 2022 to 2035.

Key words: Visceral leishmaniasis, Burden of disease, Disability?adjusted life year, Incidence, Prevalence, Mortality, Average annual percent change 

摘要： 目的　分析1990—2021年全球内脏利什曼病（visceral leishmaniasis，VL）疾病负担变化，并预测2022—2035年VL疾病负担变化趋势，为全球VL防控提供科学依据。方法　基于2021年全球疾病负担研究（Global Burden of Disease Study 2021）数据库，获取全球VL年龄标化发病率、患病率、死亡率和伤残调整寿命年（disability⁃adjusted life years，DALYs）率及其95%不确定性区间（uncertainty interval，UI），采用平均年度变化百分比（average annual percent change，AAPC）及其95%可信区间（confidence interval，CI）描述1990—2021年全球VL疾病负担变化趋势，并按性别、年龄组、国家、地理区域和社会人口学指数（socio⁃demographic index，SDI）分层后进行分析。采用贝叶斯年龄⁃时期⁃队列（Bayesian age⁃period⁃cohort，BAPC）模型预测2022—2035年全球VL疾病负担及其变化趋势，采用平滑样条模型分析VL年龄标化发病率、患病率、死亡率、DALYs率与SDI间的相关性。结果　1990—2021全球VL年龄标化发病率［AAPC = -0.25%，95% CI：（-0.25%，-0.24%）］、患病率［AAPC = -0.06%，95% CI：（-0.06%，-0.06%）］、死亡率［AAPC = -0.25%，95% CI：（-0.25%，-0.24%）］和DALYs率［AAPC = -2.38%，95% CI：（-2.44%，-2.33%）］均呈显著下降趋势。2021年全球不同地理区域中，热带拉丁美洲地区VL年龄标化发病率［2.55/10万，95% UI：（1.49/10万，4.07/10万）］、患病率［0.64/10万，95% UI：（0.37/10万，1.02/10万）］、死亡率［0.51/10万，95% UI：（0，1.80/10万）］、DALYs率［33.81/10万，95% UI：（0.06/10万，124.09/10万）］均最高；全球男性VL年龄标化发病率［0.57/10万，95% UI：（0.45/10万，0.72/10万）］和患病率［0.14/10万，95% UI：（0.11/10万，0.18/10万）］均高于女性［0.27/10万，95% UI：（0.21/10万，0.33/10万）；0.06/10万，95% UI：（0.05/10万，0.08/10万）］；各年龄组中，5岁以下儿童VL死亡率［0.24/ 10万，95% UI：（0.08/10万，0.66/10万）］最高。1990—2021年，全球VL年龄标化发病率（r = -0.483，P < 0.001）、患病率（r = -0.483，P < 0.001）、死亡率（r = -0.511，P < 0.001）和DALYs率（r = -0.514，P < 0.001）与SDI等级呈显著负相关。经BAPC模型预测，2022—2035年全球VL疾病负担呈下降趋势，2035年VL年龄标化发病率、患病率、死亡率、DALYs率将分别下降至0.11/10万、0.03/10万、0.02/10万、1.44/10万。结论　1990—2021年全球VL疾病负担总体呈下降趋势，但中亚和西部撒哈拉以南非洲地区呈上升趋势；男性VL年龄标化发病率及患病率、5岁以下儿童VL年龄标化死亡率相对较高。预测2022—2035年全球VL疾病负担将持续下降。

关键词: 内脏利什曼病, 疾病负担, 伤残调整寿命年率, 发病率, 患病率, 死亡率, 平均年度变化百分比