Global, regional, and national burdens of <i>Clostridioides difficile</i> infection over recent decades: a trend analysis informed by the Global Burden of Disease Study

This study aimed to assess the global burden of <i>Clostridioides difficile</i> infection (CDI) from 1990 to 2019, focusing on disability-adjusted life years (DALYs) rates, mortality, and trends. Data were extracted from the Global Burden of Disease Study 2019 and analyzed globally, regionally, and nationally by age, sex, region, and socio-demographic index (SDI). Measures included age-standardized DALYs rate (ASDR), mortality rate (ASMR), and average annual percentage changes (AAPCs). Decomposition analysis and Bayesian age-period-cohort model were used to evaluate factors affecting CDI trends and predict future progress, respectively. Globally, the overall ASDR and ASMR of CDI showed an increasing trend (AAPC_ASDR = 1.39, 95% CI: 1.23-1.55; AAPC_ASMR = 2.79, 95% CI: 2.66-2.93). High SDI countries showed the highest ASDR (18.86, 95% CI: 17.46-20.24) and ASMR (0.99, 95% CI: 0.87- 1.11), with the fastest growth rate (AAPC_ASDR = 2.84, 95% CI: 2.64-3.04; AAPC_ASMR = 4.26, 95% CI: 3.98-4.55). Conversely, the low SDI regions exhibit negative growth; however, some low-middle SDI regions, such as South Africa, experienced a heavy disease burden. While most of the disease burden occurs in people over 70 years of age, the burden of children under 5 years of age should also be considered. Moreover, the increased burden on high SDI regions is primarily driven by epidemiological changes. CDI burden has risen globally, particularly in high SDI regions. Moreover, clinicians should take care to consider the burden in individuals under 5 years of age.IMPORTANCEThe global burden of <i>Clostridioides difficile</i> infection (CDI) is increasing, with notable disparities across regions, age groups, and socioeconomic levels. The higher mortality and disability risks, particularly among older adults, children under 5, and in high socio-demographic index regions, highlight the urgent need for targeted public health interventions and policy adjustments to address these vulnerabilities and reduce the impact of CDI on global health.