Methods: We collected data from the GBD 2021 results tool on the number of AC cases, prevalence, deaths, age-standardized incidence rates(ASIR), age-standardized mortality rates(ASMR), age-standardized disability-adjusted life year (DALY) rates (ASDR), and age-standardized prevalence rates(ASPR) by global, gender, Sociodemographic Index (SDI), super-regional, and regional across 204 countries or territories from 1990 to 2021. We present percentage change (1990-2021) of those indicators as the difference in the natural log of the values at the start and end of the time interval divided by the number of years in the interval. Building on the literature review, we selected six factors influencing the ASIR of AC based on data accessibility and quality within the "Production-Living-Ecological" spatial framework. We employed a geographically weighted regression (GWR) model to analyze the relationships between these factors and the ASIR of AC. Compared to the traditional ordinary least squares (OLS) model, the GWR model provides a better analysis of the relationship under spatial heterogeneity.
Findings: In 2021, the global number of cases due to animal contact was 50,547,871.86 (95% UI: 42,041,271.95-60,586,965.63), with an ASIR of 646.98 (537.38-779.78). The number of deaths was 88,531.17 (68,123.98-106,475.1), with an ASMR of 1.1 (0.84 to 1.33). Compared to 1990, the number of cases increased by 1.18% (-3.37-5.58), while the ASIR decreased by 28.52% (26.97-30.07). The number of deaths decreased by 13.72% (-27.54-29.28), and the ASMR decreased by 45.25% (19.06-53.8). At the super-regional level, in 2021, South Asia had the highest number of cases due to animal contact, with 20,550,656.25 (17,534,724.9-24,041,260.87), followed by Sub-Saharan Africa with 8,295,115.52 (6,817,843.73-9,989,761.65). At the national level in 2021, the highest and lowest numbers of cases due to animal contact were observed in India and Tokelau, with 17,033,677.22 (14,565,638.87-19,880,704.02) and 3.54 (2.69-4.6), respectively. More than 80% of global deaths occur in low and low-middle SDI regions. In 2021, the global number of cases due to venomous animal contact was 15,524,932.78 (11,659,218.32-19,807,965.9) with an ASIR of 197.63 (148.06-252.07). The number of deaths and ASMR were 79,367.21 (59,826.33-95,256.51) and 0.98 (0.74-1.19), respectively. In the gender grouping, in 2021, the global number of cases, ASIR, number of deaths, and ASMR for males were all higher than those for females. The burden of mortality from animal contact transitioned from predominantly among adolescents in 1990 to primarily impacting middle-aged and older adults over 40 in 2021. The results of the GWR model indicate that the ASIR of AC in different countries is influenced by "Production-Living-Ecological" factors to varying extents and in different directions. Production and ecological factors have a greater impact in LMICs, whereas middle- to high-income regions are more sensitive to living factors.
Interpretation: Between 1990 and 2021, the disease burden of AC exhibited multidimensional spatiotemporal health inequalities. Although the ASIR and ASMR for AC have significantly decreased, the number of deaths has shown a smaller decline, and the number of cases continues to rise, leading to disparities in health outcomes for individuals affected by AC. The disease burden of AC has formed a negative association with SDI, resulting in spatial entrapment of high disease burden in low SDI regions. Overall, contact with venomous animals remains a leading cause of disability and death, with a higher disease burden in males compared to females, although regional differences exist. Children and the elderly bear the greatest disease burden, and there is a trend towards an aging population. Analysis of ASIR influencing factors reveals distinct spatial heterogeneity, with production and ecological factors having a greater impact in LMICs, while middle-high income regions are more sensitive to living factors. Therefore, there is an urgent need for countries worldwide to adopt differentiated strategies to alleviate the disease burden of AC and address the inequality gap.
Funding: National Natural Science Foundation of China (Grant No. 72174047, 71874045).
Declaration of Interest: We declare no competing interests.
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