Global burden and cross-country inequalities in rabies from 1990 to 2021: a systemic analysis of the global burden of disease study 2021

BACKGROUND: Rabies is a nearly 100% fatal, vaccine-preventable disease. This study provides a comprehensive global analysis of rabies burden from 1990 to 2021, highlighting health inequality, and aims to inform resource allocation and reduce the overall burden. METHODS: The study systematically evaluated the global, regional, and national burden of rabies and its trends from 1990 to 2021 using data from the GBD 2021 database. The Bayesian age-period-cohort (BAPC) model was applied to project future disease burden trends, including age-standardized incidence rate (ASIR), mortality rate (ASMR), and disability-adjusted life-years rate (ASDR). Frontier analysis was conducted to estimate achievable outcomes across different development levels, and decomposition analysis was employed to identify the driving factors behind changes in disease burden. RESULTS: From 1990 to 2021, the global burden of rabies showed a significant decline across multiple indicators. Specifically, the ASIR decreased from 0.42 per 100,000 population [95% uncertainty interval (UI): 0.30, 0.55] in 1990 to 0.13 per 100,000 population (95% UI: 0.08, 0.18) in 2021, reflecting a 69.38% reduction [95% UI: −77.61, −61.03; estimated annual percentage change (EAPC): −4.06% (95% confidence interval, CI: −4.32, −3.80)]. Similar reductions were observed in the ASMR, and ASDR, which declined by 69.35% (95% UI: −77.62, −61.02), and 69.39% (95% UI: −79.35, −59.48), respectively. Frontier analysis showed that significant room for improvement in rabies prevention and control remains in several high-SDI countries and regions, such as the United Arab Emirates, Norway, the United States, Latvia, and Greenland, and many low SDI countries. CONCLUSION: Despite progress in reducing rabies burden, low-SDI regions remain a priority. Key strategies include enhancing canine vaccination, post-exposure prophylaxis, stray dog control, and international collaboration. Future research should improve data quality and adapt interventions to local contexts to achieve the 2030 goal of eliminating dog-mediated human rabies. CLINICAL TRIAL NUMBER: Not applicable.