Global Burden of Fungal Skin Diseases and Future Projections: An Analysis of the 2021 Global Burden of Disease Study

Abstract

Background: The global prevalence and incidence of fungal skin diseases continue to rise due to population ageing, urbanisation and environmental changes, posing a significant public health challenge. These infections are particularly severe in immunocompromised individuals, potentially leading to deep-seated infections and life-threatening complications. However, comprehensive data on the global burden of fungal skin diseases remain limited, especially in low- and middle-income countries (LMICs) with constrained resources. Methods: Using Global Burden of Disease (GBD) data from 1990 to 2021, this study analysed trends in incidence, prevalence and disability-adjusted life years (DALYs) across 204 countries and territories. Joinpoint regression was employed to identify temporal trend changes, while the Age-Period-Cohort (APC) model was used to disentangle age, period and cohort effects. Additionally, the Bayesian Age-Period-Cohort (BAPC) model was applied to project disease burden from 2022 to 2036. Results: In 2021, the global age-standardised incidence rate (ASIR) was 21,668.4 per 100,000 population, showing a slight increase compared to 1990 (Estimated annual percentage change [EAPC] = 0.11). The burden exhibited marked disparities by Socio-demographic Index (SDI): low-SDI countries had the highest ASIR and DALYs (e.g., Ethiopia's ASIR reached 45,535.04 per 100,000), whereas high-SDI countries demonstrated a declining trend. Joinpoint regression revealed pronounced fluctuations in low-SDI nations, contrasting with sustained declines in high-SDI regions. APC analysis indicated elevated risks among older populations and younger birth cohorts. BAPC projections suggested a continued rise in global incidence by 2030, with females likely facing a higher burden than males. Conclusion: The burden of fungal skin diseases is closely linked to socioeconomic development, with resource-limited regions bearing the highest risks. The projected upward trend underscores the urgent need for targeted public health interventions, particularly in strengthening prevention and management systems in low-SDI countries. This study provides critical evidence to inform global strategies for mitigating the impact of fungal skin diseases.