Global, regional, and national burden of pneumococcal disease among children and adolescents aged <20 years from 1990-2021: a predictive analysis

Gan-min Wang^1,2Wei Tao³Xiang-Yang Pang²Yi Xin²Zi-han Gou⁴Yao Wang^1*

• ¹The Thirteenth People's Hospital of Chongqing, Chongqing, China
• ²The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
• ³Stomatological Hospital Affiliated to Chongqing Medical University, Chongqing, China
• ⁴The People's Hospital of Kaizhou District, Chongqing, China

Background: Pneumococcal infections remain a leading cause of preventable deaths among children and adolescents aged <20 years. Despite a global decrease in burden, significant regional and socioeconomic disparities, as well as long-term trends, are not fully understood. Methods: We used data from the Global Burden of Disease Study 2021 (GBD 2021) to evaluate mortality and disability-adjusted life years (DALYs) attributable to pneumococcal infections among those aged 0-19 years across global, regional, and 204 national settings from 1990-2021. Temporal trends were assessed using estimated annual percentage change (EAPC), and Spearman correlation examined associations with the sociodemographic index (SDI). Decomposition analysis quantified the contributions of demographic and epidemiological drivers. Health inequality was assessed via the slope index of inequality (SII) and concentration index (CI). A Bayesian age-period-cohort (BAPC) model projected future burden to 2036. Results: In 2021, pneumococcal infections caused 179,354 deaths (95% UI: 142,347 to 217,280) and 15,757,828 DALYs (95% UI: 12,500,395 to 19,088,138) among individuals aged 0-19 years, with the highest burden in children under 5. From 1990-2021, global age-standardized mortality rate (ASMR) dropped from 36.18 to 6.80 per 100,000 (EAPC –4.89%, 95% CI: –5.23 to –4.54). High-middle SDI regions had the largest decline (EAPC –8.63%), while Oceania had the smallest (EAPC –2.20%). Epidemiological changes were the main drivers of burden reduction, partly offset by population growth. The SII for ASMR and age-standardized DALY rate (ASDR) decreased from –83.91 to –11.19 and from –7395.42 to –975.38, respectively, indicating a reduction in absolute inequality, while the CI for both increased from 0.47 to 0.55, suggesting a growing relative concentration of burden in high-SDI countries despite the persistently high absolute burden in low-SDI regions. BAPC projections indicate the global ASMR will fall to 1.59 per 100,000 (95% UI: 0.82 to 2.35) by 2036. Conclusions: Over the past 30 years, the global burden of pneumococcal disease among children and adolescents has significantly declined. However, high burdens persist in low-SDI regions and among children under 5, with increasing relative inequalities. Strengthening vaccination coverage, healthcare systems, and interventions for high-risk populations is essential to further reduce the global burden.