The rapidly growing burden of dengue fever in China from 2005 to 2024: spatiotemporal patterns and age-sex-specific disparities in incidence and disability-adjusted life years

Abstract Background Dengue fever has transitioned from a sporadic imported infection to an established domestic threat in China, challenging the conventional view of its non-endemic status. Understanding its evolving epidemiological landscape over the past two decades is critical for evidence-based intervention planning. Methods We analyzed national notifiable dengue surveillance data from 2005 to 2024. Temporal trends were assessed using Joinpoint regression to estimate average annual percent changes (AAPC) in incidence, stratified by age, sex, and province, with particular focus on Guangdong and Yunnan. Spatial heterogeneity was characterized through standardized provincial incidence mapping. Disease burden was quantified using disability-adjusted life years (DALYs), incorporating years of life lost and years lived with disability, based on locally derived severity distributions and disability weights. Results A total of 138,885 cases and 14 deaths were reported. Annual case counts rose sharply from 40 to 24,278, with major epidemic peaks in 2014, 2019, 2023, and 2024. The age-standardized incidence increased significantly (AAPC: + 30.1%). Adults aged 25–49 years constituted 49.2% of all cases, yet the steepest relative increases occurred among children aged 0–9 years (male AAPC + 32.7%, female + 35.4%) and adults aged ≥ 70 years (male + 43.3%, female + 39.6%). High-risk category I regions accounted for 87.1% of the national burden, though other low-risk regions exhibited accelerating incidence among specific adult male subgroups. Total DALYs reached 2206.9 person-years (age-standardized rate: 0.0744 per million), predominantly driven by YLD and concentrated in the working-age population (79.5%). Conclusions Dengue in China has entered a phase of rapid burden escalation with widening demographic and geographic reach. While the working-age population bears the largest absolute burden, children and older adults face the fastest-rising risk. These findings underscore the urgency of transitioning from reactive outbreak response to precision public health, integrating age-targeted interventions, regionally stratified surveillance, and serological monitoring within a One Health framework to inform future vaccine deployment.