Abstract: Objective　To analyze the spatiotemporal distribution characteristics of and trends in the disease burden of dengue fever in China from 2005 to 2024, so as to provide insights into formulation of dengue fever control strategies. Methods　Data pertaining to dengue fever cases in China from 2005 to 2024 were retrieved from the Infectious Disease Reporting Information System of Chinese Center for Disease Control and Prevention, and city population, gross domestic product (GDP), GDP per capita, and consumer price index in China were captured from the China Statistical Yearbook, National Bureau of Statistics of China, the China City Statistical Yearbook, and bureaus of statistics in each city. The disability⁃adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) due to dengue fever were calculated in China from 2005 to 2024. The direct and indirect economic burdens of dengue fever were estimated to calculate the total economic burden. The trends in the disease burden of dengue fever were estimated in China from 2005 to 2024 using a Joinpoint regression model with the software Joinpoint 4.9.0.0, and the average annual percent change (AAPC) and its 95% confidence interval (CI) were calculated. In addition, the DALYs rate and economic burden of dengue fever in China were subjected to global and local spatial autocorrelation analyses using the software ArcGIS 10.8.  Results　The gross DALYs due to dengue fever were 5 558 person⁃years in China from 2005 to 2024, and the DALYs of dengue fever increased from 36 person⁃years in 2005 to 899 person⁃years in 2024, with an increase of 23.97 folds. The average annual DALYs rate of dengue fever was 0.02 person⁃years/105 in China during the 20⁃year study period from 2005 to 2024, and the DALYs rate peaked in 2014 (0.13 person⁃years/105) and reduced during the COVID⁃19 pandemic from 2020 to 2022. YLDs were the main contributor of DALYs due to dengue fever in China from 2005 to 2024, with a total of 5 354 person⁃years, accounting for 96.33% (5 354 person⁃years/5 558 person⁃years) of the gross DALYs. The gross DALYs of dengue fever were 2 982 person⁃years among men (53.66%) and 2 575 person⁃years among women (46.34%) in China from 2005 to 2024, and high DALYs of dengue fever were measured among residents at ages of 15 to 30 years (1 639 person⁃years), 30 to 45 years (1 857 person⁃years), and 45 to 60 years (1 204 person⁃years), respectively, accounting for 84.56% (4 700 person⁃years/5 558 person⁃years) of total DALYs due to dengue fever in China. The total economic burden of dengue fever was estimated to be 612 million Yuan in China from 2005 to 2024, with an average annual economic burden of 30.584 million Yuan. The economic burden of dengue fever increased from 196 000 Yuan in 2005 to 121 million Yuan in 2024 in China, with an increase of 616.35 folds, and the per capita economic burden increased from 3 322.21 Yuan in 2005 to 4 940.01 Yuan in 2024, with an increase of 48.70%. Dengue fever cases were reported in 274 cities (counties) across 31 provinces (autonomous regions, municipalities) in China from 2005 to 2024, with relatively higher DALYs in Guangdong Province and Yunnan Province. Spatial autocorrelation analysis revealed that the disease burden of dengue fever appeared positive aggregation in Chinese cities (counties) from 2005 to 2024 (global Moran's I = 0.045, Z = 2.24, P < 0.05), with high⁃high clusters mainly concentrated in the Pearl River Delta region in Guangdong Province and Xishuangbanna Dai Autonomous Prefecture and Pu'er City in Yunnan Province, and the total economic burden (global Moran's I = 0.032, Z = 9.55, P < 0.001), per capita economic burden (global Moran's I = 0.208, Z = 27.34, P < 0.001), and the proportion of total economic burdens in GDP in 2024 (global Moran's I = 0.017, Z = 5.91, P < 0.001) all presented positive aggregation, with relatively higher total economic burdens mainly concentrated in Guangdong Province and Yunnan Province. Joinpoint regression analysis showed that the gross DALYs rates of dengue fever appeared an overall tendency towards a rise in China from 2005 to 2024 (AAPC = 16.24%, P = 0.029), and the DALYs rate presented an overall tendency towards a rise among both men (AAPC = 14.75%, P = 0.028) and women (AAPC = 14.93%, P = 0.037) during the study period. The per capita direct economic burden appeared an overall tendency towards a rise among dengue fever patients in China from 2005 to 2024 (AAPC = 2.16%, P = 0.012); however, there was no significant difference in the trends in the per capita indirect economic burden (AAPC = 0.46%, P = 0.470). In addition, the DALYs rate of dengue fever appeared a tendency towards a rise in 84.67% (232/274) of cities (counties) in China from 2005 to 2024, and the per capita economic burden appeared a tendency towards a rise in 85.40% (234/274) of cities (counties), while the DALYs rate and per capita economic burden of dengue fever appeared a tendency towards a rise in 77.01% (211/274) of cities (counties).  Conclusions　The disease burden of dengue fever significantly increased in China from 2005 to 2024. It is recommended to reinforce integrated dengue fever control in high⁃risk areas and among high⁃risk populations, and to improve the surveillance of imported dengue fever cases and vector control.

Key words: Dengue fever, Disability?adjusted life year, Economic burden, Trend, Spatiotemporal distribution, China

摘要： 目的　分析2005—2024年我国登革热疾病负担时空分布特征及其变化趋势，为登革热防控策略的制定提供科学参考。方法　于中国疾病预防控制中心传染病报告信息系统获取2005—2024年我国登革热病例数据。于《中国统计年鉴》、国家统计局、《中国城市统计年鉴》及各市（县）统计局获取我国城市人口、国内生产总值（gross domestic product，GDP）、人均GDP及消费者价格指数数据。计算2005—2024年我国登革热伤残调整寿命年（disability⁃adjusted life years，DALYs）、寿命损失年（years of life lost，YLLs）和健康寿命损失年（years lived with disability，YLDs），估算登革热直接和间接经济负担，并计算总经济负担。采用Joinpoint 4.9.0.0软件建立Joinpoint回归模型，分析2005—2024年我国登革热疾病负担变化趋势，计算平均年度百分比变化（annual average percentage change，AAPC）及其95%置信区间（confidence interval，CI）。采用ArcGIS 10.8软件对我国登革热DALYs率及经济负担进行全局及局部空间自相关分析。结果　2005—2024年我国登革热总DALYs为5 558人·年；DALYs从2005年的36人·年增至2024年的899人·年，增加了23.97倍；平均DALYs率为0.02人·年/10万，其中2014年（0.13人·年/10万）较高，并于2020—2022年新型冠状病毒感染疫情期间降低。2005—2024年我国登革热DALYs主要由YLDs构成，YLDs累计为5 354人·年，占总DALYs的96.33%（5 354/5 558）。2005—2024年，我国男性登革热DALYs累计为2 982人·年（占53.66%），女性为2 575人·年（占46.34%）。各年龄组中，15 ~ < 30、30 ~ < 45、45 ~ < 60岁人群登革热DALYs较高，分别为1 639、1 857人·年和1 204人·年，共占我国登革热总DALYs的84.56%（4 700/5 558）。2005—2024年，我国估算登革热总经济负担为6.12亿元，年平均经济负担为3 058.40万元；经济负担从2005年的19.60万元增至2024年的1.21亿元，增加了616.35倍；人均经济负担从3 322.21元增至4 940.01元，增加了48.70%。2005—2024年，我国31个省（自治区、直辖市）274个市（县）有登革热病例报告，其中广东省和云南省DALYs较高。空间自相关分析发现，2005—2024年我国市（县）层面登革热疾病负担呈正向聚集（全局Moran’s I = 0.045，Z = 2.24，P < 0.05），高⁃高聚集区主要集中于广东省珠江三角洲地区及云南省西双版纳傣族自治州和普洱市；总经济负担、人均经济负担和2024年总经济负担占GDP比例均呈正向聚集（全局Moran’s I = 0.032、0.208和0.017，Z = 9.55、27.34和5.91，P均< 0.001），其中总经济负担较高的地区主要集中于广东省和云南省。Joinpoint回归分析显示，2005—2024年我国登革热总体（AAPC = 16.24%，P = 0.029）、男性（AAPC = 14.75%，P = 0.028）和女性（AAPC = 14.93%，P = 0.037）DALYs率均整体呈上升趋势；登革热患者人均直接经济负担（AAPC = 2.16%，P = 0.012）整体呈上升趋势；人均间接经济负担变化趋势无统计学意义（AAPC = 0.46%，P = 0.470）。2005—2024年，我国84.67%（232/274）的市（县）登革热DALYs率呈上升趋势，85.40%（234/274）的市（县）登革热人均经济负担呈上升趋势，77.01%（211/274）的市（县）DALYs率和人均经济负担均呈上升趋势。结论　2005—2024年我国登革热疾病负担显著上升，建议强化高风险地区与重点人群综合防控，加强登革热输入性病例监测与媒介控制。

关键词: 登革热, 伤残调整寿命年, 经济负担, 趋势, 时空分布, 中国