Global burdens of TC in children and adolescents at the age of 5–19 years
From 1990 to 2019, the incidence and prevalence of TC in children and adolescents at the age of 5–19 years showed overall increasing trends (Table 1). Specifically, the incidence of TC increased from 1990 to 1999 (AAPC, 1.47; 95% CI 1.36, 1.57). The overall incidence of TC increased from 0.19 (95% UI 0.15, 0.21) per 100,000 individuals in 1990 to 0.26 (95% UI 0.23, 0.28) per 100,000 individuals in 2019 (AAPC, 1.14; 95% CI 1.00, 1.27; Table 2). Joinpoint regression analysis showed that the increasing trend in the incidence of TC was segmented into four periods: 1990–2000, 2003–2010, 2010–2016, and 2016–2019 (Fig.
1). The overall global prevalence of TC increased from 26,697 (95% UI 22,170, 29,527) in 1990 to 44,170 (95% UI 39,144, 48,983) in 2019, representing a 65.44% increase within the past 3 decades (Table 3). In addition, the increasing trend in the prevalence of TC was segmented into five periods: 1990–2000, 2000–2003, 2003–2010, 2010–2016, and 2016–2019 (Fig. 1). From 1990 to 2019, DALYs of TC exhibited a declining trend, showing a substantial change in 2000, 2003, 2010 and 2016 (Table 5).
Sex differences in the global burdens of TC in children and adolescents at the age of 5–19 years
Among the 44,170 children and adolescents (5–19 years of age) with TC globally in 2019, 69.49% (n = 30,694) of them were females. Significant increases in the incidence and prevalence of TC over the past 30 years were detected in both male and female children and adolescents at the age of 5–19 years. In detail, the incidence of TC in female children and adolescents increased from 2,175.83 (95% UI 1,679.48, 2,479.48) cases in 1990 to 3,395.09 (95% UI 2,949.30, 3,873.70) cases in 2019, yielding a 56.03% increase. In male children and adolescents, the incidence of TC increased from 877.32 (95% UI 782.69, 986.29) cases in 1990 to 1,523.49 (95% UI 1,328.25, 1,721.57) cases in 2019, obtaining a 73.65% increase (Table 2). Moreover, the prevalence of TC increased from 19,299.14 (95% UI 14,946.52, 21,976.06) cases in 1990 to 30,694.25 (95% UI 26,684.60, 35,027.86) cases in 2019 (59.04% increase), and from 7,397.92 (95% UI 6,603.98, 8,281.98) cases in 1990 to 13,476.17 (95% UI 11,733.36, 15,254.09) cases in 2019 (82.18% increase) among female and male children and adolescents, respectively. The global trends in the DALYs and mortality of TC in both female and male children and adolescents at the age of 5–19 years were declined (Table 3, Fig. 2).
Age differences in the global burdens of TC in children and adolescents at the age of 5–19 years
Global trends in disease burden of TC varied with age in children and adolescents at 5–19 years. Specifically, the most rapid increases in the incidence (AAPC, 1.26; 95% CI 1.11, 1.42) and prevalence (AAPC, 1.34; 95% CI 1.19, 1.50) of TC over the past 30 years were observed in adolescents at the age of 15–19 years (Table 2–3). Despite the increased incidence and prevalence of TC in three age subgroups of 5–9 years, 10–14 years and 15–19 years, we observed decreases in the mortality and DALYs of TC in all age subgroups. The greatest declines in the mortality (AAPC, -0.91; 95% CI -1.03, -0.80) and DALYs (AAPC, -0.81; 95% CI -0.92, -0.70) of TC between 1990 and 2019 were observed among children aged 5–9 years; while the least declines in the mortality (AAPC, -0.31; 95% CI -0.61, 0.00) and DALYs (AAPC, -0.20; 95% CI -0.50, 0.09) were detected among older adolescents at the age of 15–19 years (Table 4–5, Fig. 3).
SDI differences in the global burdens of TC in children and adolescents at the age of 5–19 years
Global trends in TC among children and adolescents aged 5–19 years in 204 countries and territories(Fig. 4). Global burdens in TC among children and adolescents at 5–19 years of age differed substantially from SDI. High SDI countries provided the highest prevalence and incidence of TC in 2019 at 3.22 (AAPC, 0.51; 95% CI 0.45, 0.58; 95% UI 2.95, 3.52) and 0.35 (AAPC, 0.50; 95% CI 0.43, 0.57; 95% UI 0.32, 0.38) per 100,000 individuals, respectively(Table 2–3). Lowest incidence (0.16 [95% UI 0.13, 0.19] cases per 100,000 individuals; AAPC, 1.15; 95% CI 0.84, 1.46) and prevalence (1.35 [95% UI 1.08, 1.68] cases per 100,000 individuals; AAPC, 1.43; 95% CI 1.10, 1.75), as well as the highest mortality (0.03 [95% UI 0.02, 0.03] deaths per 100,000 individuals; AAPC, -0.48; 95% CI -0.61, -0.35) and DALYs (0.85 [95% UI 0.70, 1.03] deaths per 100,000 individuals; AAPC, -0.41; 95% CI -0.53, -0.28) of TC in 2019 were detected in low SDI countries(Table 4–5). Over the past 30 years, we observed increased incidence and prevalence of TC in high, high-middle, middle, middle-low and low SDI countries, where the mortality and DALYs of TC all decreased. Furthermore, the decomposition analysis highlighted the global increase in epidemiologic changes of TC, which were more evident in middle SDI countries(Fig. 5).