Burden of Soil-Transmitted Helminth Infections in China: Historical Trends (1990-2021) and Future Projections (2035)

Soil-transmitted helminth (STH) infections, including ascariasis, trichuriasis, and hookworm disease, are among the most common neglected tropical diseases (NTDs) globally. This study evaluates the disease burden of STH in China from 1990 to 2021 and projects trends to 2035.

Data from the Global Burden of Disease 2021 database were utilized to analyze the prevalence and disability-adjusted life years (DALYs) of STH infections in China from 1990 to 2021. The estimated annual percentage change (EAPC) was calculated to assess trends over time, and a Bayesian age-period-cohort model was used to project the disease burden up to 2035.

From 1990 to 2021, the prevalence and DALYs of STH infections decreased significantly by 85.08% and 98.01% in China, respectively. The age-standardized prevalence rate (ASPR) of STH infections dropped from 34,073.24/10⁵ to 4981.01/10⁵ with an EAPC of -6.62% [95% confidence interval (CI): -7.40%, -5.83%], and the age-standardized DALY rate (ASDR) decreased from 1.77/10⁵ to 0.18/10⁵, with an EAPC of -14.05% (95% CI: -15.04%, -13.06%). Trichuriasis contributed to 78.85% of the total ASPR for STH, whereas hookworm disease accounted for 51.14% of STH's ASDR. The highest disease burden due to STH peaked in the 5-9 years age group, with prevalence of 8030.05/10⁵ [95% uncertainty interval (UI): 5356.86/10⁵-11,662.62/10⁵] and DALYs rate of 2.99/10⁵ (95% UI: 1.56/10⁵-4.87/10⁵). The projected ASDR and ASPR of trichuriasis rose to 0.55/10⁵ and 5362.50/10⁵ by 2035.

China has achieved remarkable reductions in the burden of STH infections over the past three decades. However, the predominance between the species has changed. The projected rebound in trichuriasis underscores the importance of sustained control efforts. To achieve the 2030 elimination target outlined in the WHO NTDs roadmap, it is crucial to integrate precision epidemiology with ongoing water, sanitation, and hygiene initiatives, targeted chemotherapy and health education.