Fig 1.
Global distribution and temporal trends in age-standardized incidence rates of rabies from 1990 to 2021.
(A) Age-standardized incidence rates of rabies per 100,000 population in 2021. (B) Percentage change in rabies age-standardized incidence rates between 1990 to 2021. Negative values indicate reductions in incidence, while positive values indicate increased trends. Subregional insets provide detailed visualization for selected regions. Note: The basemap shapefile was from R package ‘rnaturalearth’ version 1.1.0 in the CRAN package repository. https://CRAN.R-project.org/package=rnaturalearth.
Table 1.
The number of incidence, DALY and ASDR of rabies in 1990 and 2021.
Fig 2.
Global distribution and temporal trends in rabies burden measured by ASDR from 1990 to 2021.
(A) DALY ASRs per 100,000 population attributable to rabies in 2021. (B) Percentage change in DALYs ASR between 1990 to 2021. Negative values indicate reductions in rabies burden, while positive values denote increasing trends. Sub-regional insets are provided for areas of interest including the Caribbean, Persian Gulf, Balkan Peninsula, Southeast Asia, West Africa, Eastern Mediterranean, and Northern Europe. Note: The basemap shapefile was from R package ‘rnaturalearth’ version 1.1.0 in the CRAN package repository. https://CRAN.R-project.org/package=rnaturalearth.
Fig 3.
Trends in age-standardized incidence and DALY rates of rabies by SDI region, 1990-2021.
(A) Age-standardized incidence rates (ASRs) of rabies per 100,000 population across five SDI regions from 1990 to 2021. (B) DALY ASR per 100,000 population from 1990 to 2021 across SDI regions. Error bars represent 95% uncertainty intervals derived from the Global Burden of Disease 2021 estimates.
Fig 4.
Age- and sex-specific rabies incidence and DALY by sex in 1990 and 2021.
(A) Age- and sex-specific incidence of dog-mediated rabies in 1990 (left) and 2021 (right): red and blue bars show the number of new cases in each 5-year age group for females and males (with 95% uncertainty intervals), while the corresponding-colored lines and shaded ribbons indicate incidence rates per 100 000 population (95% UI). (B) The same structure for disability-adjusted life years (DALYs), with bars representing total DALYs and lines showing DALY rates per 100 000 population. Age groups range from <5 years through ≥95 years.
Fig 5.
Age-period-cohort analysis of global rabies incidence (1990-2021).
(A) Observed incidence trends by age group and birth cohort. (I) Age-specific incidence rates across six calendar periods (1992-2021). (II) Birth cohort-specific incidence rates, stratified by age. (B) APC model-estimated effects and drift. (I) Net drift and local drifts by age. (II) Age effect adjusted for period and cohort. (III) Period effect showing steady decline in rate ratio from 1.32 in 1995 to 0.47 in 2020. (IV) Cohort effect with RR decreasing from 10.4 in the 1897 birth cohort to 0.10 in cohorts born after 2010.
Fig 6.
Age-period-cohort (APC) analysis of global rabies burden (1990-2021).
(A) Observed trends in age- and cohort-specific DALY rates. (I) Age-specific DALY rates per 100,000 population across six calendar periods (1992-1996 to 2017-2021). (II) Cohort-specific DALY rates by age group. (B) APC model-based decomposition of temporal effects on DALY rates. (I) Net drift (dashed line) and local drifts (points and 95% CI bands) indicate average annual percentage change across ages. (II) Modeled age effect after adjusting for period and cohort. (III) Period effects reflect temporal risk changes independent of age and cohort. (IV) Cohort effects show a dramatic generational decline in DALY burden.
Fig 7.
Decomposition of Changes in Rabies Incidence and DALYs by Region (1990-2021).
(A) Absolute change in rabies incidence attributed to demographic aging (red), population growth (green), and epidemiological change (blue). (B) Absolute change in DALY attributed to the same three components. Black dots represent the net overall change in each region. Positive values indicate increased burden, while negative values indicate reductions.
Fig 8.
Frontier analysis of age-standardized rabies incidence and DALYs rates by SDI (1990-2021).
(A) Incidence rate per 100,000 population across SDI spectrum. Left panel: all country-year observations plotted from 1990 to 2021, color-coded by year. Right panel: 2021 values only, with countries labeled and classified by trend direction (increase vs. decrease) relative to 1990. (B) DALYs rate per 100,000 population across SDI spectrum. Left panel: all country-year observations from 1990 to 2021, color-coded by year. Right panel: 2021 values with labeled countries and corresponding burden trend direction. The black frontier line represents the best-achieved outcomes (lowest burden) at each SDI level, serving as a benchmark for potential optimization. Countries below the frontier suggest room for improvement relative to their development status.