{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T18:04:09Z","timestamp":1789581849175,"version":"build-2803163510"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Henan Provincial Natural Science Foundation","award":["No.: 262300421599"],"award-info":[{"award-number":["No.: 262300421599"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Visceral leishmaniasis (VL) remains a fatal neglected tropical disease with substantial global burden. The Group of Twenty (G20) encompasses both endemic and non-endemic nations, yet comprehensive multi-country assessments of VL trends and future projections are limited. This study aims to evaluate the 33-year epidemiological transition of VL across G20 countries and forecast its trajectory to 2043.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology\/Principal findings<\/jats:title>\n                    <jats:p>We extracted VL-related prevalence, incidence, mortality, and disability-adjusted life years (DALYs) data for G20 countries from the Global Burden of Disease 2023 database (1990\u20132023). We employed joinpoint regression to identify trend inflection points, decomposition analysis to quantify drivers of change (population growth, aging, and epidemiological changes), and autoregressive integrated moving average (ARIMA) models to project trends to 2043. From 1990 to 2023, G20 countries showed significant declines in age-standardized prevalence rate (EAPC\u2009=\u2009-9.06%), incidence rate (EAPC\u2009=\u2009-9.06%), mortality rate (EAPC\u2009=\u2009-7.23%), and DALYs rate (EAPC\u2009=\u2009-7.40%). Saudi Arabia, Turkey, and India experienced the steepest declines, while Brazil exhibited the smallest reduction and the highest burden in 2023 (age-standardized DALY rate: 30.54 per 100,000). Burden was consistently higher in males and concentrated in children under 5 years, with a slight increase observed among those aged \u226595 years. Decomposition analysis revealed that changes in epidemiological rates were the primary driver of mortality (contributing -82.05%) and DALYs (-52.62%) reductions, counteracting the positive effects of population growth and aging. ARIMA projections (2024\u20132043) suggest a stabilization in mortality, a gradual decline in DALYs, and a subtle increase in incidence and prevalence rates, with persistent gender disparities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions\/Significance<\/jats:title>\n                    <jats:p>While the VL burden in G20 nations has significantly decreased, substantial national disparities are evident. Our analysis specifically identifies Brazil as the priority target for intensified control. Sustained surveillance and international cooperation are crucial to prevent a projected mild resurgence in new infections.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014714","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:39:18Z","timestamp":1789580358000},"page":"e0014714","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiological transitions of Visceral Leishmaniasis in G20 countries: A 33-year retrospective joinpoint and demographic decomposition analysis with 20-year ARIMA projections"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7854-7020","authenticated-orcid":true,"given":"Yongbin","family":"Wang","sequence":"first","affiliation":[{"name":"Henan Medical University","place":["Xinxiang, Henan, People\u2019s Republic of China"],"department":["Department of Epidemiology and Health Statistics, School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renfang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Henan Medical University","place":["Xinxiang, Henan, People\u2019s Republic of China"],"department":["Department of Epidemiology and Health Statistics, School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenzhou","family":"Liu","sequence":"additional","affiliation":[{"name":"Henan Medical University","place":["Xinxiang, Henan, People\u2019s Republic of China"],"department":["Department of Epidemiology and Health Statistics, School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunjie","family":"Xu","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory of Antimicrobial Agents\/Laboratory of Pharmacology, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Lin","sequence":"additional","affiliation":[{"name":"Henan Medical University","place":["Xinxiang, Henan, People\u2019s Republic of China"],"department":["Department of Epidemiology and Health Statistics, School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"issue":"10151","key":"pntd.0014714.ref001","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/S0140-6736(18)31204-2","article-title":"Leishmaniasis","volume":"392","author":"S Burza","year":"2018","journal-title":"Lancet"},{"issue":"1","key":"pntd.0014714.ref002","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.idc.2018.10.005","article-title":"Visceral leishmaniasis: recent advances in diagnostics and treatment regimens","volume":"33","author":"J van Griensven","year":"2019","journal-title":"Infect Dis Clin North Am"},{"key":"pntd.0014714.ref003","author":"World Health Organization","year":"2023"},{"issue":"10","key":"pntd.0014714.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0012423","article-title":"The economic burden of visceral leishmaniasis and barriers to accessing healthcare in Tigray, North Ethiopia: a field based study","volume":"18","author":"SB Tessema","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014714.ref005","unstructured":"International Monetary Fund. G20 Report on Strong, Sustainable, Balanced, and Inclusive Growth. IMF; 2026. Available from: https:\/\/www.imf.org\/en\/-\/media\/files\/research\/imf-and-g20\/2025\/g20-report-on-strong-sustainable-balanced-and-inclusive-growth.pdf"},{"issue":"4","key":"pntd.0014714.ref006","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1016\/j.jaad.2020.08.043","article-title":"The global, regional, and national burden of leishmaniasis: an ecologic analysis from the Global Burden of Disease Study 1990-2017","volume":"84","author":"CJ Scheufele","year":"2021","journal-title":"J Am Acad Dermatol"},{"issue":"8","key":"pntd.0014714.ref007","doi-asserted-by":"crossref","DOI":"10.1093\/jtm\/taz055","article-title":"Cutaneous and mucocutaneous leishmaniasis in travellers and migrants: a 20-year GeoSentinel Surveillance Network analysis","volume":"26","author":"AK Boggild","year":"2019","journal-title":"J Travel Med"},{"issue":"10513","key":"pntd.0014714.ref008","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1016\/S0140-6736(25)01637-X","article-title":"Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023","volume":"406","author":"GBD 2023 Disease and Injury and Risk Factor Collaborators","year":"2025","journal-title":"Lancet"},{"issue":"6","key":"pntd.0014714.ref009","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1007\/s40257-022-00726-8","article-title":"Cutaneous leishmaniasis: a 2022 updated narrative review into diagnosis and management developments","volume":"23","author":"HJC de Vries","year":"2022","journal-title":"Am J Clin Dermatol"},{"key":"pntd.0014714.ref010","article-title":"Discrepancies in neglected tropical diseases burden estimates in China: comparative study of real-world data and Global Burden of Disease 2021 data (2004-2020)","volume":"388","author":"G-J Yang","year":"2025","journal-title":"BMJ"},{"issue":"1","key":"pntd.0014714.ref011","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1186\/s13071-025-06796-x","article-title":"Global, regional, and national burden of visceral leishmaniasis, 1990-2021: findings from the global burden of disease study 2021","volume":"18","author":"SX Zhang","year":"2025","journal-title":"Parasit Vectors"},{"issue":"10513","key":"pntd.0014714.ref012","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1016\/S0140-6736(25)01917-8","article-title":"Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023","volume":"406","author":"GBD 2023 Causes of Death Collaborators","year":"2025","journal-title":"Lancet"},{"issue":"10513","key":"pntd.0014714.ref013","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1016\/S0140-6736(25)01330-3","article-title":"Global age-sex-specific all-cause mortality and life expectancy estimates for 204 countries and territories and 660 subnational locations, 1950-2023: a demographic analysis for the Global Burden of Disease Study 2023","volume":"406","author":"GBD 2023 Demographics Collaborators","year":"2025","journal-title":"Lancet"},{"issue":"10512","key":"pntd.0014714.ref014","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1016\/S0140-6736(25)01635-6","article-title":"The global, regional, and national burden of cancer, 1990-2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023","volume":"406","author":"GBD 2023 Cancer Collaborators","year":"2025","journal-title":"Lancet"},{"issue":"3","key":"pntd.0014714.ref015","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1002\/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z","article-title":"Permutation tests for joinpoint regression with applications to cancer rates","volume":"19","author":"HJ Kim","year":"2000","journal-title":"Stat Med"},{"issue":"7","key":"pntd.0014714.ref016","doi-asserted-by":"crossref","first-page":"100719","DOI":"10.1016\/j.lanhl.2025.100719","article-title":"Method-specific suicide mortality rates among older adults in 47 countries and territories, 1996-2021, with projections to 2050: a global time series and modelling study","volume":"6","author":"H Cho","year":"2025","journal-title":"Lancet Healthy Longev"},{"issue":"1","key":"pntd.0014714.ref017","doi-asserted-by":"crossref","first-page":"5873","DOI":"10.1038\/s41598-021-84176-y","article-title":"Determine neighboring region spatial effect on dengue cases using ensemble ARIMA models","volume":"11","author":"L Thiruchelvam","year":"2021","journal-title":"Sci Rep"},{"issue":"1","key":"pntd.0014714.ref018","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1038\/s41572-025-00663-w","article-title":"Leishmaniasis","volume":"11","author":"M Pareyn","year":"2025","journal-title":"Nat Rev Dis Primers"},{"issue":"4","key":"pntd.0014714.ref019","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1007\/s12639-025-01854-8","article-title":"Molecular diagnosis of leishmaniasis: current updates and future prospectives","volume":"49","author":"O Hamarsheh","year":"2025","journal-title":"J Parasit Dis"},{"issue":"6","key":"pntd.0014714.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0012242","article-title":"A phase II, non-comparative randomised trial of two treatments involving liposomal amphotericin B and miltefosine for post-kala-azar dermal leishmaniasis in India and Bangladesh","volume":"18","author":"S Sundar","year":"2024","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0014714.ref021","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciy007","article-title":"Policy recommendations from transmission modeling for the elimination of visceral leishmaniasis in the Indian subcontinent","volume":"66","author":"EA Le Rutte","year":"2018","journal-title":"Clin Infect Dis"},{"key":"pntd.0014714.ref022","doi-asserted-by":"crossref","first-page":"105707","DOI":"10.1016\/j.actatropica.2020.105707","article-title":"Visceral leishmaniasis in Saudi Arabia: from hundreds of cases to zero","volume":"212","author":"AA Abuzaid","year":"2020","journal-title":"Acta Trop"},{"key":"pntd.0014714.ref023","doi-asserted-by":"crossref","first-page":"100150","DOI":"10.1016\/j.crpvbd.2023.100150","article-title":"Knock, knock, knocking on Europe's door: threat of leishmaniasis in Europe with a focus on Turkey","volume":"4","author":"V Tunal\u0131","year":"2023","journal-title":"Curr Res Parasitol Vector Borne Dis"},{"issue":"1","key":"pntd.0014714.ref024","doi-asserted-by":"crossref","first-page":"25186","DOI":"10.1038\/s41598-025-11366-3","article-title":"Spatiotemporal analysis of environmental factors associated with visceral leishmaniasis in northeastern Brazil, 2007-2022","volume":"15","author":"QMDS Ara\u00fajo","year":"2025","journal-title":"Sci Rep"},{"issue":"9","key":"pntd.0014714.ref025","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003136","article-title":"Visceral leishmaniasis and HIV coinfection in Latin America","volume":"8","author":"JA Lindoso","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0014714.ref026","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1080\/00365540701466215","article-title":"Long term failure of miltefosine in the treatment of refractory visceral leishmaniasis in AIDS patients","volume":"40","author":"J Troya","year":"2008","journal-title":"Scand J Infect Dis"},{"key":"pntd.0014714.ref027","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1016\/j.drudis.2013.08.005","article-title":"Novel therapeutic strategies for treatment of visceral leishmaniasis","volume":"18","author":"K Jain","year":"2013","journal-title":"Drug Discov Today"},{"issue":"6","key":"pntd.0014714.ref028","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1089\/vbz.2016.2052","article-title":"Distinct Leishmania infantum strains circulate in humans and dogs in the Emilia-Romagna region, Northeastern Italy","volume":"17","author":"G Rugna","year":"2017","journal-title":"Vector Borne Zoonotic Dis"},{"issue":"5","key":"pntd.0014714.ref029","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0000235","article-title":"Age-related alteration of arginase activity impacts on severity of leishmaniasis","volume":"2","author":"I M\u00fcller","year":"2008","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"pntd.0014714.ref030","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2023-012638","article-title":"Social determinants of visceral leishmaniasis elimination in Eastern Africa","volume":"8","author":"J Alvar","year":"2023","journal-title":"BMJ Glob Health"},{"issue":"9","key":"pntd.0014714.ref031","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1017\/S0031182022000828","article-title":"Ageing impairs protective immunity and promotes susceptibility to murine visceral leishmaniasis","volume":"149","author":"C Loureiro Salgado","year":"2022","journal-title":"Parasitology"},{"issue":"6","key":"pntd.0014714.ref032","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1179\/2047773215Y.0000000029","article-title":"Late diagnosis: a factor associated with death from visceral leishmaniasis in elderly patients","volume":"109","author":"M Driemeier","year":"2015","journal-title":"Pathog Glob Health"},{"key":"pntd.0014714.ref033","first-page":"63","article-title":"Reversible ototoxicity: a rare adverse reaction of liposomal amphotericin-B used for the treatment of antimony-resistant visceral leishmaniasis in an elderly male","volume":"7","author":"P Das","year":"2014","journal-title":"Clin Med Insights Case Rep"},{"issue":"1","key":"pntd.0014714.ref034","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s12879-017-2192-4","article-title":"A severe case of visceral leishmaniasis and liposomal amphotericin B treatment failure in an immunosuppressed patient 15 years after exposure","volume":"17","author":"A Eichenberger","year":"2017","journal-title":"BMC Infect Dis"},{"issue":"7","key":"pntd.0014714.ref035","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.1016\/j.transproceed.2014.07.064","article-title":"Elderly kidney transplant recipient with intermittent fever: a case report of leishmaniasis with acute kidney injury during liposomal amphotericin B therapy","volume":"46","author":"JA Pedroso","year":"2014","journal-title":"Transplant Proc"},{"issue":"10","key":"pntd.0014714.ref036","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.3390\/microorganisms10101887","article-title":"Visceral leishmaniasis: epidemiology, diagnosis, and treatment regimens in different geographical areas with a focus on pediatrics","volume":"10","author":"S Scarpini","year":"2022","journal-title":"Microorganisms"},{"issue":"8","key":"pntd.0014714.ref037","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1038\/s41579-024-01026-0","article-title":"Effects of climate change and human activities on vector-borne diseases","volume":"22","author":"WM de Souza","year":"2024","journal-title":"Nat Rev Microbiol"},{"issue":"4","key":"pntd.0014714.ref038","doi-asserted-by":"crossref","first-page":"2002028","DOI":"10.2807\/1560-7917.ES.2022.27.4.2002028","article-title":"Surveillance of leishmaniasis cases from 15 European centres, 2014 to 2019: a retrospective analysis","volume":"27","author":"G Van der Auwera","year":"2022","journal-title":"Euro Surveill"}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014714","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T17:39:27Z","timestamp":1789580367000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0014714"}},"subtitle":[],"editor":[{"given":"Nisha","family":"Singh","sequence":"first","affiliation":[{"name":"University of Lucknow","place":["INDIA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":38,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0014714","relation":{},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]}}}