Burden of typhoid fever in primary and hospital care in Indonesia: a serial cross-sectional study using national health insurance (BPJS Kesehatan) data, 2015–2023

Background Despite Indonesia's high typhoid burden, subnational prevalence data remain sparse, limiting risk mapping and targeted interventions. We characterised trends in typhoid presentation in primary care and hospital settings, described geographic patterns, and identified factors associated with hospitalisation. Methods We conducted a serial cross-sectional study using the multi-year Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan national insurance sample. Typhoid fever cases were identified using ICD-10 codes A01.0-A01.09, with sampling weights applied to generate nationally representative estimates. Temporal trends were assessed using time-series analyses, and factors associated with hospitalisation using Poisson regression. Findings From 1 January 2015 to 31 December 2023, an estimated 8,180,668 ICD-10 coded typhoid-related healthcare visits were recorded, including 3,895,695 hospital admissions. Mean annual prevalence peaked at 314 per 100,000 in hospitals (2016) and 347 per 100,000 in primary care (2017), with the highest prevalence among children younger than 5 years. Cases were concentrated on Java. Higher proportion of hospitalisation was observed among BPJS Kesehatan-subsidised participants (aPR 1·07; 95% CI: 1·05–1·09), elderly aged ≥65 years (aPR 1·07; 95% CI: 1·04–1·09), and children (0–5 years: aPR 1·02; 95% CI: 1·01–1·03; 6–18 years: aPR 1·03; 95% CI: 1·02–1·04). Interpretation Typhoid fever remains a substantial public health burden in Indonesia despite a declining trend. Higher hospitalisation among subsidised participants and vulnerable age groups reflects persistent socioeconomic and age-related inequities. Control efforts should integrate water and sanitation improvements and vaccination, informed by epidemiological patterns to optimise geographic targeting and dose scheduling. Funding Gates Foundation.