Analysis of the burden and trends of communicable diseases in Pacifc Island countries from 1990 to 2019

Abstract
Background Communicable diseases contribute substantially to morbidity and death rates worldwide, particularly
in low-and middle-income countries. Pacific Island countries face unique challenges in addressing these diseases due
to their remote locations and limited resources. Understanding the burden and trends of these diseases in this region
is crucial for developing effective public health interventions.
Objective This study aimed to analyze the burden and trends of communicable diseases in Pacific Island countries
from 1990 to 2019.
Methods We utilized data from the 2019 Global Burden of Disease (GBD) study to analyze indicators including incidence, death, and disability-adjusted life years (DALYs). Excel 2016, R 4.2.1, and GraphPad Prism 9 were used to analyze
and visualize the data. Join point regression models were used for trend analysis, and the average annual percent
change (AAPC) was calculated.
Results From 1990 to 2019, the standardized incidence rate of communicable diseases in Pacific Island countries showed an upward trend (AAPC=0.198%, 95% CI=0.0174~0.221), while the standardized death rate
(AAPC=-1.098%, 95% CI=–1.34~0.86) and standardized DALY rate (AAPC=-1.008%, 95% CI=-1.187~-0.828) showed
downward trends. In 2019, the standardized incidence, death, and DALY rates of communicable diseases were higher
among males than among females, but the standardized death and DALY rates among males decreased faster
than those among females from 1990 to 2019. There were significant differences in the disease burden among different Pacific Island countries. The Solomon Islands had the highest standardized death rate (363.73/100,000), and Guam
had the lowest (50.42/100,000). Papua New Guinea had the highest standardized DALY rate (16,041.14/100,000),
and the Cook Islands had the lowest (2,740.13/100,000). In 2019, the main attributable risk factors for communicable
disease deaths in Pacific Island countries were child and maternal malnutrition (28.32%), followed by unsafe water,
sanitation, and handwashing (27.14%), air pollution (16.11%), and unsafe sex (14.96%). There were considerable geographical variations in risk factors.
Conclusion The burden of communicable diseases in Pacific Island countries remains high, despite improvements
in mortality and disability-adjusted life-year rates over the past few decades. This study provides valuable insights
into the burden and trends of communicable diseases in Pacific Island countries from 1990 to 2019. The findings reveal several important insights and highlight the need for targeted public health interventions in the region