Yakupu et al.

BMC Public Health (2022) 22:1596

https://doi.org/10.1186/s12889-022-13887-2

RESEARCH Open Access

The epidemiological characteristic

and trends of burns globally
Aobuliaximu Yakupu1,2†, Jie Zhang2†, Wei Dong1,2, Fei Song1,2, Jiaoyun Dong1,2,3* and Shuliang Lu1,2,3*

Abstract
Background: Burns is a type of injury, caused by unintentional exposure to substances of high temperature, includ-
ing hot liquid, solid, and objects radiating heat energy, placing a high burden not only on patients’ families but also on
national healthcare systems globally. It is difficult for policymakers and clinicians to formulate targeted management
strategies for burns because data on current epidemiological patterns worldwide are lacking.
Methods: Data on burns were obtained from the Global Burden of Disease (GBD) 2019 Study. The incidence, disa-
bility-adjusted life years (DALYs), and deaths of burns in 204 countries and regions from 1990 to 2019 were calculated
and stratified by sex, age, geographical location, and sociodemographic index (SDI). The estimated annual percent-
age change (EAPC) of incidence, DALYs, and deaths was calculated to evaluate the temporal trends. All analyses were
performed using R software, version 4.1.1, with 2-sided P-values < .05 indicating a statistically significant difference.
Results: A total of 8,378,122 new cases (95% UI, 6,531,887–10,363,109cases) of burns were identified globally in
2019, which is almost evenly split between men and women, and most of the new cases were concentrated in the
10–19-year age group. Besides, burns account for 111,292 deaths (95% UI, 132,392–88,188) globally in 2019, most of
which were concentrated in those aged 1–4 years. The burden of burns measured in DALYs was 7,460,448.65 (95%
UI, 5,794,505.89–9,478,717.81) in 2019, of which 67% and 33% could be attributed to YLLs and YLDs, respectively. The
EAPC of incidence, DALYs, and deaths were negative, the age-standardized rate (ASR) of incidence, DALYs, and deaths
were considered to be decreasing in most of the regions, and the EAPCs were negatively correlated with SDI levels,
universal health coverage (UHC), and gross domestic product (GDP).
Conclusion: Globally, the age-standardized rates of burn incidence, DALYs, and mortality, as well as the number of
burn DALYs and death cases will continuously decrease, but the number of new burn cases has an increasing ten-
dency globally. In addition, the EAPCs of burns in incidence, DALYs, and deaths indicated that the burden of burns
was considered to be decreasing in most of the regions. And from the relationship of EAPCs with SDI, UHC index, and
GDP, indicate that prevention burns not only depend on health spending per capita but also depend on the educa-
tion level per capita and healthcare system performance, but it does not mean higher health spending corresponds
to higher UHC index, which needs high efficiency of translating health spending into individuals health gains.
Keywords: Burns, Burden, Trends, Epidemiology

Background
Burns is a type of injury, caused by unintentional expo-
†
Aobuliaximu Yakupu and Jie Zhang contributed equally to this work. sure to substances of high temperature, including hot liq-
*Correspondence: [email protected]; [email protected] uid, solid, or gas such as cooking stoves, smoke, steam,
1
Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School drinks, machinery, appliances, tools, radiators, and
of Medicine, Shanghai, China objects radiating heat energy [1]. Burn injuries can lead
Full list of author information is available at the end of the article to long-term profound alterations even the wounds have

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. The Creative Commons Public Domain Dedication waiver (http://​creat​iveco​
mmons.​org/​publi​cdoma​in/​zero/1.​0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Yakupu et al. BMC Public Health (2022) 22:1596 Page 2 of 16

healed, which affects not only the physical health but also and for age structure. We further calculated the esti-
the mental health and quality of life of the patient, plac- mated annual percentage change (EAPC) to describe
ing a high burden not only on patients’ families but also the temporal trend in various age-standardized rates
on national healthcare systems globally [2–4]. (ASRs) of burns burden and the detailed methods have
The knowledge about burn epidemiology is essential been described in previous research [14–17]. we ana-
for resource allocation and prevention, but the previous lyzed a set of behavioral, environmental and occupa-
works mainly focused on a specific country or region, tional, and metabolic risks that contribute to health
which led to a lack of epidemiological information on outcomes. Which was evaluated in GBD 2019 [10].
burns at the global level, and the results are not compa- The 95% uncertainty intervals (UIs) for every met-
rable because of the variable and inconsistent dates have ric in the 2019 GBD study were calculated to reflect
not been standardized; In addition, there is no multi-level the certainty of the estimates, which were determined
and multi-angle analysis on burns epidemiological char- by the 2 ­ 5th and 9
­ 75th values of the 1,000 values, after
acters [4–9]. Therefore, it is necessary to understand the ordering them from smallest to largest [1, 10, 18]. We
latest spatial distribution and temporal trends of burns also calculated 95% confidence intervals (95%CIs) for
worldwide to establish more reasonable and effective the EAPCs [19]. Temporal trends in ASRs were rec-
prevention and treatment programs to improve patients’ ognized to be in an increasing trend when the EAPCs
quality of life and reduce avoidable medical expenses. and the lower boundary of the 95% CI were positive;
To investigate the level, trends, and burden of burns at conversely, to be a decreasing trend when EAPCs and
the national, regional, and global levels, to identify the the upper boundary of the 95% CI were negative. Oth-
risk factors and potential influences of economic income erwise, the ASRs were considered to be stable [19, 20].
and health services coverage on disease prevalence, we The data that we extracted from GBD 2019 were col-
have extracted and analyzed annual data on burns inci- lected from 204 countries and territories (data sources
dence, disability-adjusted life years (DALYs) and deaths including censuses, household surveys, civil registra-
by location, sex, and age, as well as risk factors from tion and vital statistics, disease registries, health service
behavioral, environmental and occupational, and meta- use, air pollution monitors, satellite imaging, disease
bolic aspects [10]. This study will provide a basis for opti- notifications, and other sources) and were divided into
mizing strategies for the management of burns. five regions according to their sociodemographic index
(SDI) that was developed by GBD researchers and is a
Materials and methods composite indicator constructed from measures of per
We collected annual case data and age-standardized capita income, average years of education, and total fer-
rates (ASRs) for burns incidence, deaths, and DALYs tility rates. In short, SDI is the geometric mean of 0 to
from 1990 to 2019 from the Institute for Health Metrics 1 index of total fertility rate (TFR) for those younger
and Evaluation using the Global Health Data Exchange than 25 years old (TFU25), mean education for those
(GHDx) online query tool (http://​ghdx.​healt​hdata.​org/​ 15 years old and older (EDU15 +), and lag distributed
gbd-​resul​ts-​tool) [1]. income (LDI) per capita. For GBD 2019, after calculat-
The detailed original data introduction and general ing SDI, values were multiplied by 100 for a scale of 0 to
analysis methods of the GBD 2019 Study have been 100. Geographically, the 204 countries and territories
described in previous research [1, 10–13]. Briefly, the were further classified into 45 regions by their location
GBD estimation process is based on identifying multi- and the detailed information can be seen in the supple-
ple relevant data sources for each disease or injury and mentary material (Supplemental Table 1). Besides, we
correcting the known bias. Then, the processed data are also analyzed the risk factors relative to burns by MR-
modeled using standardized tools to generate estimates BRT and ST-GPR modeling [10].
of each quantity of interest by age, sex, location, and For exploring the potential factors of changing trends,
year. There are three main standardized tools: Cause we also calculated the association between universal
of Death Ensemble model (CODEm) which is a highly health coverage (UHC), gross domestic product (GDP)
systematized tool to analyze the cause of death data, with EAPCs in burns burden. Achieving universal
spatiotemporal Gaussian process regression (ST-GPR) health coverage (UHC) involves all individuals receiving
that borrow strength between locations and over time the health services they need, of high quality, without
for single metrics of interest, and DisMod-MR that is experiencing financial difficulty and the UHC effective
a Bayesian meta-regression tool that allows evaluation coverage index provides the understanding of whether
of all available data on incidence, prevalence, remission, health services are aligned with countries’ health pro-
and mortality for a disease. ASRs were calculated by files and are of sufficient quality to produce health gains
adjusting for population size (per 100 000 population) for populations [21].
Yakupu et al. BMC Public Health (2022) 22:1596 Page 3 of 16

Data analysis incidence distribution by age can be seen in supplemen-

EAPCs were calculated on a regression model. The natu- tal materials (Table 1, Supplemental Figure S 1A, D, E).
ral logarithm of the regression line is fitted to ASR with Among the SDI quintiles, countries with Middle SDI
the following formula, y = α + β x + ε, where y = ln (ASR), level has the highest incident cases than countries with
and x = calendar year; The EAPCs 95% CI were calcu- other SDI levels, both in 1990 and 2019, and the num-
lated based on 100 × [exp(β) − 1] [17–19, 22]. The corre- ber of incident cases increased in Low, Low-middle,
lations of EAPCs with UHC in 2019, GDP in 2019, and and Middle SDI levels from 1990 to 2019, whereas the
SDI value using a Pearson correlation analysis [22]. All number decreased in High and High-middle SDI levels
analyses were performed using R software, version 4.1.1, (Table 1, Supplemental Figure S 1B). However, the ASIR
with 2-sided P-values < 0.05 indicating a statistically sig- decreased for all SDI levels and countries with the High
nificant difference. SDI level had the highest ASIR than those with lower SDI
levels, both in 1990 and 2019 (Fig. 1C). The number of
new cases was higher in females than in males in Low-
Results middle, Low SDI levels than in other SDI levels both in
Incidence of burns 1990 and 2019 (Fig. 1D, Supplemental Figure S 1B).
Globally, a total of 8,955,228 new cases (95% UI The absolute number of burns cases increased in most
6,820,977–11157666cases) of burns were identified in of GBD regions. Asia had the most new cases in 2019
2019, which is almost evenly split between men and (3,913,524.80 [95% UI 2,946,199.45–4,959,607.51]), with a
women, and most of the new cases were concentrated in 19% increase relative to cases in 1990 (3,287,567.95 [95%
the 10–19-year age group (Table 1, Fig. 1A). From 1990 UI, 2,473,836.69–4,165,597.49]), whereas Oceania had the
to 2015, the number of incident cases fluctuates within a fewest new cases in 2019 (27,510.31 [95% UI,21,933.81–
certain degree, but the number of incident cases sharply 33,261.04]). The regions that had the most significantly
increased from 2016 (Table 1, Fig. 1B). Females affected increased and decreased numbers of new cases, respec-
occupied about 87% of the increased cases from 1990 to tively, were World Bank Lower Middle Income category
2019 (Table 1). However, the age-standardized incidence (from 2,118,416.48 [95% UI, 1,626,255.73–2,646,959.73]
rate (ASIR) was found to have decreased by an average to 2,827,973.07 [95% UI, 2,124,427.64–3,575,667.26]) and
of 0.7% per year in the same period (from 149.86 per the Europe (from 1,982,378.87 [95% UI, 1,585,062.86–
100,000 in 1990 to 117.51 per 100,000 in 2019) and the 2,411,800.64] to 1,492,624.00 [95% UI,1,169,397.61–
ASIR value of both genders is similar in 2019, besides 1,831,234.57]) Europe (Supplemental Figure S 1I). As for

Table 1 Incident Cases, Age-Standardized Incidence Rate (ASIR), and Temporal Trends for Burns From 1990 to 2019
No. (95% UI) No. (95% CI)
1990 2019 1990–2019

Variable Incident cases ASIR per 100,000 Incident cases ASIR per 100,000 EAPC
Global 8,378,121.71(6,531,886.66 to 149.86(118.1 to 183.52) 8,955,227.69(6,820,977.02 to 117.51(88.79 to 146.66) -0.93(-0.82 to -1.03)
10,363,108.53) 11,157,666.34)
male 4,444,900.33(3,503,352.17 to 157.69(125.36 to 191.85) 4,520,220.92(3,458,623.54 to 117.04(89.04 to 145.43) -1.13(-1.04 to -1.22)
5,467,109.97) 5,616,794.5)
female 3,933,221.38(3,001,685.66 to 142.08(109.68 to 174.96) 4,435,006.77(3,356,767.64 to 118.26(88.71 to 148.07) -0.71(-0.59 to -0.82)
4,896,272.45) 5,533,943.36)
SDI
High 1,829,400.67(1,449,098.13 to 231.04(182.62 to 281.57) 1,617,342.41(1,242,112.77 to 182.79(137.78 to 229.19) -1.09(-0.89 to -1.29)
2,233,743.92) 1,998,030.5)
High-middle 2,268,203.43(1,767,421.04 to 193.43(151.47 to 235.99) 1,968,714.13(1,520,777.66 to 150.53(113.48 to 188.45) -0.97(-0.87 to -1.07)
2,791,394.84) 2,446,137.06)
Middle 2,318,376.08(1,758,311.51 to 122.15(94.32 to 151.55) 2,489,842.35(1,867,023.57 to 108.16(80.58 to 137.69) -0.32(-0.21 to -0.43)
2,925,009.94) 3,119,116.86)
Low-middle 1,261,052.24(958,368.21 to 100.76(78.12 to 124.86) 1,578,840.04(1,180,460.57 to 84.85(64.03 to 106.79) -0.69(-0.58 to -0.79)
1,588,226.97) 2,007,600.31)
Low 694,078.23(535,540.88 to 118.29(92.6 to 145.79) 1,291,495.65(947,627.72 to 101.2(77.25 to 127.39) -0.66(-0.57 to -0.76)
876,228.73) 1,674,261.6)
Abbreviations: ASIR Age-standardized incidence rate, EAPC Estimated annual percentage change, SDI Sociodemographic index, UI Uncertainty interval, CI Confidence
interval
Yakupu et al. BMC Public Health (2022) 22:1596 Page 4 of 16

Fig. 1 Incidence of burns. A distribution of new cases among different age categories in 2019. B the global changing trend in the number of
new cases by sex from 1990 to 2019. C a comparison of the ASIR between 1990 and 2019 at global and different SDI levels. D a comparison of the
ASIR by sex in 2019 at global and different SDI levels. E the top increased or decreased in the number of new cases by sex in 2019 compared with
1990 among 204 countries and territories. F the top increased or decreased in ASIR by sex in 2019 compared with 1990 among 204 countries and
territories. ASIR, age-standardized incidence rate; SDI, sociodemographic index

the ASIR, Caribbean had the highest ASIR in 2019 (336.06 The ASIRs decreased in most of the regions. The most
[95% UI, 267.46–414.72]), whereas Eastern Mediterra- greatest reduction detected was in Tropical Latin Amer-
nean Region had the lowest (57.43 [95% UI, 44.27–71.52]). ica (from 286.29 [95% UI, 219.37–352.94] to 140.70
Yakupu et al. BMC Public Health (2022) 22:1596 Page 5 of 16

Incidence Number
1000000

750000

500000

250000

Fig. 2 The map of new cases in 2019. A the map of new cases in 2019 among 204 countries and territories

[95% UI, 107.88–175.49]), whereas the most significant and decrease in the ASIR were Cuba and Estonia,
increase was detected in East Asia (from 76.47 [95% UI, respectively (Fig. 1F). Furthermore, we visualized the
57.12–96.95] to 85.93 [95% UI, 61.61–110.91]) (Supple- number of cases in 2019 among 204 countries and ter-
mental Figure S 1J). ritories by map (Fig. 2A).
At the national level, the most highest num-
ber of cases were recorded in Mainland of China
in 2019, which account for 12% of the new cases DALYs of burns
detected globally (overall, 1,079,670.14 [95% UI, The burden of burns measured in DALYs was 7,460,448.65
786,947.53–1,389,157.59]; males, 565,448.23 [95% (95% UI, 5,794,505.89–9,478,717.81) in 2019, of which 67%
UI, 417,357.69–728,230.85]; females, 514,221.91 [95% and 33% could be attributed to YLLs and YLDs, respec-
UI,370,324.64–660,910.29]) (cases number peaked in tively. The burden decreased gradually from 1990 to 2019
those who were 30–34 years of age), followed by India (Table 2, Fig. 3A). And the age-standardized DALYs rate
(1,009,518.92 [95% UI, 742,769.05–1,295,202.13]), col- (ASDAR) also decreased substantially from 1990 to 2019
lectively accounting for 11% of all new cases, glob- (Table 2, Supplemental Figure S 2A, B). The DALYs among
ally. Niue had the fewest new cases in 2019 (1.84 [95% females was higher than among males, and the ASDAR
UI, 1.35–2.39] cases). The most significant reduc- among females also was higher than among males in 2019,
tion detected was in Brazil (from 463,695.51 [95% which is just the opposite in 1990 (Table 2, Fig. 3 C, D, E, F).
UI, 350,241.35–583,046.27] to 290,004.98 [95% UI, DALYs were high in the younger population and the high-
225,525.87–362,276.26]), whereas the most signifi- est DALYs were observed in the 1–4-year age group both in
cant increase was detected in India (from 716,858.75 2019 and 1990, DALYs rate distribution by age can be seen
[95% UI, 534,524.91–918,816.44] to 1,009,518.92 [95% in supplemental materials (Figure S 2 G). In addition, 15%
UI, 742,769.05–1,295,202.13]), followed by Main- of DALYs were attributable to risk factors for both sexes
land of China where increased about 972,398 cases combined globally in 2019, of which 10% and 5% could be
(Fig. 1E). Cuba had the highest ASIR in 2019 (over- attributed to occupational risks and alcohol use (Fig. 3 H).
all, 460.33 [95% UI, 347.29–585.47]; males, 483.27 Among the SDI quintiles, DALYs were decreased in all
[95% UI, 364.71–615.59); females, 435.87 [95% UI, SDI levels except the Low SDI level in 2019 compared to
326.68–555.02]), and the lowest ASIR was observed in those in 1990, and countries with the Middle SDI level
Pakistan(overall, 35.50 [95% UI, 26.20–45.88]; males, had higher DALYs than countries with other SDI levels
29.48 [95% UI, 21.69–38.07]; females, 41.90 [95% UI, in 1990 and the Low-middle SDI level in 2019 (Table 2,
54.77–30.63]). The regions with the largest increase Fig. 3B). The ASDARs were significantly decreased in
Yakupu et al. BMC Public Health (2022) 22:1596 Page 6 of 16

Table 2 DALYs, Age-Standardized DALYs Rates and Temporal Trends for Burns From 1990 to 2019
No. (95% UI) No. (95% CI)
1990 2019 1990–2019

Variable DALYs ASDAR per 100,000 DALYs ASDAR per 100,000 EAPC
people people
Global 9,240,519.41(6,971,954.76 169.85(129.91 to 209.27) 7,460,448.65(5,794,505.89 96.6(75.03 to 123.05) -2.13(-2.06 to -2.21)
to 11,508,751.2) to 9,478,717.81)
Male 4,862,036.55(3,630,820.92 179.26(138.91 to 209.21) 3,706,456.4(2,900,689.35 to 95.91(75.01 to 119.1) -2.33(-2.24 to -2.43)
to 5,672,841.93) 4,597,302.42)
Female 4,378,482.86(2,430,157.83 160.84(93.48 to 219.06) 3,753,992.25(2,820,247.72 97.63(73.02 to 127.98) -1.92(-1.84 to -1.99)
to 6,087,956.08) to 4,897,043.09)
SDI
High 1,008,484.65(822,574.1 to 121.48(101.06 to 150.14) 785,070.61(577,164.47 to 64.9(48.56 to 89.23) -2.36(-2.17 to -2.56)
1,271,676.7) 1,104,553.7)
High-middle 1,777,696.5(1,525,910.33 to 157.37(135.25 to 182.22) 1,273,402.1(1,031,688.77 to 79.11(64.33 to 100.63) -2.86(-2.55 to -3.16)
2,060,491.85) 1,646,553.63)
Middle 2,688,458.99(2,001,006.36 154.13(116.77 to 189.75) 1,859,086.98(1,385,859.19 76.87(57.21 to 100.44) -2.55(-2.47 to -2.63)
to 3,355,364.82) to 2,429,347.02)
Low-middle 2,280,046.88(1,474,160.34 187.95(128.19 to 246.34) 1,855,910.26(1,435,536.98 107.04(83.44 to 130.59) -2.06(-2.01 to -2.12)
to 3,095,008.34) to 2,276,397.59)
Low 1,477,894.5(949,450 to 237.17(168.86 to 306.75) 1,678,780.87(1,268,530.73 149.99(114.86 to 188.57) -1.58(-1.55 to -1.6)
2,012,908.16) to 2,162,104.1)
Abbreviations: DALYs Disability-adjusted life years, ASDAR Age-standardized DALYs rate, EAPC Estimated annual percentage change, SDI Sociodemographic index, UI
Uncertainty interval, CI Confidence interval

regions with all SDI levels, countries with the Low SDI Central Asia (from 438.56 [95% UI, 393.52–493.45] to
level had higher DALYs than countries with other SDI 196.25 [95% UI, 163.25–242.53]), whereas the most sig-
levels both in 1990 and 2019 (Table 2, Supplemental nificant increase was detected in Oceania (from 419.79
Figure S2B). Concerning the sex ratios of DALYs and [95% UI, 664.47–145.61] to 425.30 [95% UI, 118.75–
ASDARs among SDI levels, except for the low-middle 687.13]) (Supplemental Figure S2F).
SDI level, the DALYs and ASDAR were higher in males For the assessment of changes at the national level, the
for all SDI levels in both 1990 and 2019 (Fig. 3C, D, E, highest DALYs, accounting for 11% of the value glob-
F). In 2019, occupational risks are the highest contribu- ally, was recorded in India in 2019 (overall, 1,577,243.30
tion of DALYs in countries with lower SDI levels, while [95% UI, 1,069,291.85–2,223,193.75]; males,
alcohol use is the highest contribution in countries with (423,295.84 [95% UI, 321,148.61–528,849.46]); females,
higher SDI levels (Fig. 3H). (28,036.17 [95% UI, 20,767.08–35,787.12])), followed by
For most of the GBD regions, the absolute DALYs of Mainland of China (1,153,947.45 [95% UI, 711,833.97–
burns was decreased, with the highest DALYs observed 1,778,176.96]). In India, the 6% of age-standardized
in 2019 is in Asia (3,735,101.26 [95%UI, 2,763,340.35– DALYs result from occupational injuries and the
4,744,685.60]) and the lowest observed in Australasia DALYs reached a peak among those 20 ~ 24 years of
(20,813.30 [95%UI, 13,842.51–30,776.21); meanwhile, age in 2019. The lowest DALYs were observed in Toke-
Western Sub-Saharan Africa (from 471,311.76 [95% lau (0.92 [95%UI, 0.66–1.31). As for measures of the
UI, 311,274.–77,648,837.12] to 670,821.92 [95% UI, ASDAR, Papua New Guinea had the highest ASDAR
493,686.72–928,527.33]) and World Bank Upper in 2019 (overall, 497.21 [95% UI, 116.10–824.53]);
Middle Income regions(from 3,309,575.83 [95% UI, males, (868.96 [95% UI, 180.42–1446.77]); females,
2,642,128.26–3,932,627.20] to 2,066,166.93 [95% UI, (95.77 [95% UI, 40.06–165.90])). Italy had the low-
1,644,020.10–2,697,166.96]) exhibited the most sig- est ASDAR in 2019 (26.83 [95% UI, 19.82–36.37]);
nificant increase and decrease in numbers, respectively males, (32.71 [95% UI, 24.16–44.24]); females, (21.13
(Supplemental Figure S2E). As for the ASDAR of burns, [95% UI, 15.50–28.76]). The places that exhibited the
for all except one GBD regions, namely Oceania, the rate most significantly increased and decreased DALY val-
decreased. The greatest ASDAR was observed in 2019 ues, respectively, were Nigeria(from 204,791.75 [95%
in the Oceania (472.12 [95%UI, 118.52–780.73])and the UI, 128,433.17–305,529.32] to 278,416.67 [95% UI,
lowest was in East Asia (48.28 [95%UI, 34.94–68.00). The 197,549.76–400,510.66]) and Mainland of China(from
most significant decrease in the ASDAR was detected in 1,204,419.61 [95% UI, 862,545.83–1,493,528.50] to
Yakupu et al. BMC Public Health (2022) 22:1596 Page 7 of 16

9000000

8500000
7500000

Both
8000000
DALYs_Number

DALYs_Number
7500000 5000000
4400000

4200000

Female
4000000

3800000
2500000
3600000

4500000

Male
0
4000000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Global High SDI High−middle SDI Middle SDI Low−middle SDI Low SDI
Year Location
sex Both Female Male year 1990 2019

6000000 7500000

DALYs_Number
DALYs_Number

4000000 5000000

2000000 2500000

0 0

Global High SDI High−middle SDI Middle SDI Low−middle SDI Low SDI Global High SDI High−middle SDI Middle SDI Low−middle SDI Low SDI
Location Location
sex Both Female Male sex Both Female Male
250
150

200
DALYs_Rate( per 100,000)

DALYs_Rate( per 100,000)

100
150

100
50

50

0 0

Global High SDI High−middle SDI Middle SDI Low−middle SDI Low SDI Global High SDI High−middle SDI Middle SDI Low−middle SDI Low SDI
Location Location
sex Both Female Male sex Both Female Male
15

750000

10
Percentage(%)
DALYs_Number

500000
Both

5
250000

0 0

Neonatal 1 to 4 5 to 9 10 to 14 15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 to 74 75 to 79 80 to 84 85 to 89 90 to 94 95 plus
Age
Global High SDI High−middle SDI Middle SDI Low−middle SDI Low SDI
location Global High−middle SDI Low−middle SDI Location
High SDI Middle SDI Low SDI
Risks Occupational injuries Alcohol use

Fig. 3 DALYs of burns. A the global changing trend in DALYs by sex from 1990 to 2019. B a comparison of the DALYs between 1990 and 2019
at global and different SDI levels. C a comparison of the DALYs by sex at global and different SDI levels in 2019. D a comparison of the DALYs by
sex at global and different SDI levels in 1990. E a comparison of the ASDAR by sex at global and different SDI levels in 2019. F a comparison of
the ASDAR by sex at global and different SDI levels in 1990. G distribution of DALYs among different age categories in 2019. H the percentage of
DALYs attributable to top risk factors for both sexes combined at global and different SDI levels in 2019. DALYs, disability-adjusted life years; ASDAR,
age-standardized DALYs rate; SDI, sociodemographic index
Yakupu et al. BMC Public Health (2022) 22:1596 Page 8 of 16

130000

10000 125000

120000

Both
7500
115000

Deaths_Number
Deaths_Number

110000

Both
5000 58000

Female
56000
54000
52000
72000
2500

68000

Male
64000

0
60000

Neonatal 1 to 4 5 to 9 10 to 14 15 to 19 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 65 to 69 70 to 74 75 to 79 80 to 84 85 to 89 90 to 94 95 plus
Age 56000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

location Global High−middle SDI Low−middle SDI Year

High SDI Middle SDI Low SDI
sex Both Female Male
120000

90000

80000
Deaths_Number

Deaths_Number
60000

40000
30000

0 0

Global High SDI High−middle SDI Middle SDI Low−middle SDI Low SDI Global High SDI High−middle SDI Middle SDI Low−middle SDI Low SDI
Location Location
year 1990 2019 sex Both Female Male
3

7.5
Deaths_Rate( per 100,000)

2
Percentage(%)

5.0

1
2.5

0 0.0

Global High SDI High−middle SDI Middle SDI Low−middle SDI Low SDI Global High SDI High−middle SDI Middle SDI Low−middle SDI Low SDI
Location Location
sex Both Female Male Risks Occupational injuries Alcohol use

Fig. 4 Mortality of burns. A distribution of death cases among different age categories in 2019. B the global changing trend in the number of
death cases by sex from 1990 to 2019. C a comparison of the number of death cases between 1990 and 2019 at global and different SDI levels.
D a comparison of the number of death cases by sex at global and different SDI levels in 2019. E a comparison of the ASDR by sex at global and
different SDI levels in 2019. F Percentage of deaths attributable to top risk factors for both sexes combined at global and different SDI levels in 2019.
ASDR, age-standardized death rate; SDI, sociodemographic index

687,955.14 [95% UI, 494,849.21–973,860.45]) (Supple- 1994, then begins to decline with a slightly fluctuates,
mental Figure S2G), whereas, for the ASIR, the loca- especially in males (Fig. 4B, Table 3). The age-standard-
tions were, respectively, Lesotho (from 272.21 [95% UI, ized deaths rate (ASDR) of burns gradually decreased
198.26–375.43] to 336.32 [95% UI, 246.06–442.86]) and from 2019 to 1990 (Table 3, Supplemental Figure S 3A,
Haiti(from 827.26 [95% UI, 324.99–1,258.22] to 385.90 B), and the ASDR and the number of deaths were higher
[95% UI, 210.16–525.93]) (Supplemental Figure S2H). in males than in females, both in 1990 and 2019(Fig. 4D,
Table 3, Supplemental Figure S 3E, F). In addition, 13%
Mortality of burns of deaths were attributable to risk factors for both sexes
A total of 111,292 deaths (95% UI, 88,189–132,392) asso- combined globally in 2019, of which 10% and 3% could be
ciated with burns were identified globally in 2019, most attributed to occupational risks and alcohol use. Besides,
of which were concentrated in those aged 1–4 years death rate distribution by age can be seen in supplemen-
(Fig. 3A). The number of deaths increased from 1990 to tal materials (Fig. 4F, Supplemental Figure S 3D).
Yakupu et al. BMC Public Health (2022) 22:1596 Page 9 of 16

Table 3 Deaths Cases, Age-Standardized Deaths Rates, and Temporal Trends for Burns From 1990 to 2019
No. (95% UI) No. (95% UI)
1990 2019 1990–2019

Variable Deaths cases ASDR per 100,000 people Deaths cases ASDR per 100,000 people EAPC
Global 123,213.46 (95,472.73 to 2.51 (2.01 to 3) 111,292.39 (88,188.86 to 1.44 (1.14 to 1.72) -2.16 (-2.02 to -2.3)
151,399.41) 132,392.34)
male 66,454.79 (49,765.66 to 2.84 (2.21 to 3.14) 56,854.07 (44,072.37 to 1.53 (1.19 to 1.81) -2.36 (-2.18 to -2.55)
74,334.55) 67,315.99)
female 56,758.67 (29,388.76 to 2.23 (1.23 to 3.01) 54,438.32 (39,110.13 to 1.37 (0.98 to 1.78) -1.93 (-1.83 to -2.02)
78,772.85) 69,985.43)
SDI
High 13,818.45 (13,273.62 to 1.57 (1.51 to 1.63) 10,257.9 (9298.42 to 0.68 (0.62 to 0.74) -3.04 (-2.91 to -3.17)
14,266.95) 11,035.41)
High-middle 25,586.04 (23,374.97 to 2.4 (2.19 to 2.6) 21,486.04 (18,615.42 to 1.23 (1.06 to 1.37) -2.89 (-2.4 to -3.39)
27,776.91) 23,804.92)
Middle 34,836.88 (25,141.73 to 2.38 (1.82 to 2.89) 27,772.69 (20,017.38 to 1.22 (0.89 to 1.53) -2.47 (-2.42 to -2.53)
43,397.49) 34,978.77)
Low-middle 29,736.85 (18,605.80 to 2.96 (2.02 to 3.88) 28,424.96 (21,859.46 to 1.84 (1.44 to 2.2) -1.8 (-1.74 to -1.86)
40,630.72) 34,569.4)
Low 19,145.18 (12,568.06 to 4.04 (2.95 to 5.1) 23,254.21 (17,019.13 to 2.81 (2.08 to 3.55) -1.26 (-1.23 to -1.29)
26,000.12) 30,275.53)
Abbreviations: ASDR Age-standardized deaths rate, EAPC Estimated annual percentage change, SDI Sociodemographic index, UI Uncertainty interval, CI Confidence
interval

Deaths were lower among all SDI quantiles except 19,592.70–45,344.34] to 38,255.11[95% UI, 26,466.17–
for the Low SDI level in 2019 than in 1990, and coun- 50,950.82]) (Supplemental Figure S3G). Except for in
tries with the Middle SDI level had the highest num- one GBD region, namely Oceania, the ASDR of burns
bers of deaths compared with countries with other decreased, where has the highest ASDR in 2019 and has
SDI levels in 1990, and Low-middle SDI level in 2019 the most significant increased ASDR value among 45
(Fig. 4C, Table 3). The ASDR increased at all SDI levels, GBD regions (from 6.24 [95% UI, 1.65–3.10] to 6.34 [95%
and countries with the Low SDI level had higher ASDR UI, 1.17 -10.61]). The most significant decrease in ASDR
than countries with other SDI levels both in 1990 and was detected in Central Asia (from 5.66 [95% UI, 5.37–
2019 (Supplemental Figure S3B, Table 3). In terms of 6.03] to 2.64 [95% UI, 2.28–3.10]) (Supplemental Figure
sex, except for the Low-middle SDI level, the number of S 3H).
deaths was higher in males than females not only in 2019 At the national level, the highest number of deaths was
but also in 1990, surprisingly, the ASDR values distrib- recorded in India in 2019 (25,876.39 [95% UI, 16,992.26–
uted mode the same as the distribution of deaths among 37,389.59]), an increase of 12% from 1990 (23,031.84
genders. (Fig. 4D, E, Table 3, Supplemental Figure S3E, [95% UI, 12,259.04–33,464.85]). The deaths number of
F). In 2019, occupational risks are the highest contribu- India increased the most globally, accounting for about
tion to Deaths in countries with lower SDI levels, while 23% of global deaths in 2019, 27% and 73% of which
alcohol use is the highest contribution in countries with occurred in males and females, respectively. This was
higher SDI levels (Fig. 4D). followed by deaths in the Mainland of China (11,095.91
For GBD regions, the numbers of deaths decreased [95% UI, 7,938.48–14,085.43]), 63% and 37% of which
in most of the GBD regions, with the most significant occurred in males and females, respectively. In India,
decrease detected in World Bank Upper-Middle Income 4.8% of age-standardized deaths result from occupa-
area (from 44,295.11 [95% UI, 36,096.24–51,049.62] to tional injuries, and deaths peaked in those 20–24 years of
32,500.09 [95% UI, 27,061.87–36,865.88]) and Australasia age in 2019. The most significant decrease in the num-
has the lowest deaths in 2019(131.83 [95% UI, 119.11– ber of deaths was detected in Mainland of China (from
141.72]), where also has the lowest ASDR in 2019 (0.32 17,289.45 [95% UI, 12,545.78–21,015.43] to 11,095.91
[95% UI, 0.29–0.34]). Asia has the highest death cases in [95% UI, 7,938.48–14,085.43]) (Supplemental Figure S3I),
2019 (57,202.37 [95% UI, 41,804.00–70,564.74]), the most Tokelau has the lowest death number and almost reach
significant increase from 1990 to 2019 was detected in zero(0.01 [95% UI, 0.01–0.02]) in 2019. Lesotho had
Commonwealth Middle Income area (32,612.48 [95% UI, the highest ASDR (7.75 [95% UI, 5.63–10.45]), whereas
Yakupu et al. BMC Public Health (2022) 22:1596 Page 10 of 16

Singapore had the lowest (0.19 [95% UI, 0.17–0.20]) in Mauritius, Taiwan (Province of China) and Armenia,
2019. The most significant increase in the ASDR was respectively (Fig. 6B, C, D). Furthermore, we visualized
detected in Lesotho (from 6.19 [95% UI, 4.38–8.82] to the EAPCs of incidence, DALYs, and deaths in 2019
7.75 [95% UI, 5.63–10.45]), whereas the most significant among 204 countries and territories by map (Fig. 7A,
decrease was detected in Armenia (from 7.38 [95% UI, Supplemental Figure S 4C, D).
6.89–7.91] to 1.28 [95% UI, 1.09–1.49]) (Supplemental
Figure S3J). Furthermore, we visualized the number of Relationship of EAPC of burns incidence, DALYs, and death
deaths in 2019 among 204 countries and territories by with SDI, UHC, and GDP.
map (Fig. 5A). We analyzed the correlation between the 2019 SDI and
EAPCs in burns incidence, DALYs, and deaths. SDI
Temporal trends of burns was negatively correlated with all EAPCs (incidence,
We analyzed the temporal trends in burns incidence, R =  − 0.029, p = 0.68; DALYs, R =  − 0.16, p = 0.026;
DALYs, and deaths at the national, regional, and global deaths, R =  − 0.49, p = 0.00000000000016), indicating
levels from 1990 to 2019. Incidence, DALYs, and deaths that incidence, DALYs, and deaths of burns declined
of burns cline to decrease at the global level and all SDI with increasing SDI values. SDI values also negatively
levels. Meanwhile, the EAPC of incidence and deaths are and significantly correlated with the EAPC of DALYs
all higher at the High SDI level, and the EAPC of DALYs and deaths, meaning that the SDI value had an impact
a higher at the high-middle SDI level. on temporal trends related to DALYs and deaths of
In the 45 GBD regions, except for four regions, namely burns (Fig. 8A, B, C).
East Asia, Western Pacific Region, East Asia & Pacific Achieving universal health coverage (UHC) involves
– WB, Oceania, the EAPCs of incidence were nega- all individuals receiving the health services they need, of
tive (Fig. 6A); except for one region, namely Oceania, high quality, without experiencing financial difficulty and
the EAPC of DALYs and deaths were negative, suggest- the UHC effective coverage index provides the under-
ing that the incidence, DALYs and deaths of burns was standing of whether health services are aligned with
decreasing over time in most of the GBD regions (Sup- countries’ health profiles and are of sufficient quality
plemental Figure S 4A, B). to produce health gains for populations [21]. To better
At the national level, most of EAPCs were negative, understand the distribution of burns based on health-
the highest positive EAPCs of incidence, DALYs, and care system performances of countries, we examined
deaths were observed in Cuba, Lesotho, and Leso- the relationship between EAPCs in burns incidence,
tho, respectively; whereas the highest negative EAPCs DALYs, and deaths with the UHC index by Pearson cor-
of incidence, DALYs, and deaths were observed in relation analysis. The SDI was negatively correlated

Deaths_Rate( per 100,000)

Fig. 5 The map of mortality rate in 2019. A the map of ASDR in 2019 among 204 countries and territories
Yakupu et al. BMC Public Health (2022) 22:1596 Page 11 of 16

Cuba
Oceania Bermuda
Western Sub−Saharan Africa Lesotho
China
World Bank Low Income Tokelau
Southern Sub−Saharan Africa Viet Nam
Mongolia
Sub−Saharan Africa − WB
Guam
African Region American Samoa

Eastern Sub−Saharan Africa Cook Islands

South Africa
Central Sub−Saharan Africa Lao People's
Africa Latvia
Turkmenistan
Commonwealth Middle Income
Greenland
South Asia Estonia
Italy
South Asia − WB
Taiwan (Province of China)

South−East Asia Region Brazil

Commonwealth Low Income Mauritius
−3 −2 −1 0 1
World Bank Lower Middle Income EACP
Caribbean Lesotho
Zimbabwe
Southeast Asia
Bermuda
Eastern Europe Eswatini
Asia San Marino
Papua New Guinea
Southern Latin America Kuwait
Eastern Mediterranean Region Guam
Vanuatu
Europe
Northern Mariana Islands
European Region Equatorial Guinea
Kyrgyzstan
Europe & Central Asia − WB
Latvia
North Africa and Middle East Maldives
Middle East & North Africa − WB Turkmenistan
Mauritius
Central Europe Iran
East Asia & Pacific − WB Estonia
Armenia
World Bank High Income
Taiwan (Province of China)
Region of the Americas −6 −4 −2 0
America EACP
Lesotho
North America
Zimbabwe
High−income North America Eswatini
World Bank Upper Middle Income Kuwait
0
Papua New Guinea
Latin America & Caribbean − WB Mongolia
Western Pacific Region Chad
Guinea
Western Europe Cabo Verde
Central Latin America Gambia
Republic of Korea
Andean Latin America
Lithuania
Central Asia Ireland
High−income Asia Pacific Turkmenistan
Colombia
East Asia Kyrgyzstan
Tropical Latin America Mauritius
Estonia
Commonwealth High Income Taiwan (Province of China)
Australasia Armenia
−5.0 −2.5 0.0
−4 −3 −2 −1 EACP
EACP
Changes Decreased Increased
Changes Decreased Increased

Fig. 6 Temporal Trends of burns. A the EAPC of death in 45 GBD regions. B the top positive and negative EAPC of incidence among 204 countries
and territories. C the top positive and negative EAPC of DALYs among 204 countries and territories. D the top positive and negative EAPC of Deaths
among 204 countries and territories. GBD, Global Burden of Disease; EAPC, estimated annual percentage change

with all EAPC measurements (incidence, R =  − 0.055, UHC index has a vital impact on temporal trends related
p = 0.43; DALYs, R =  − 0.16, p = 0.027; deaths, R =  − 0.5, to DALYs and deaths of burns (Fig. 8D, E, F).
p = 0.000000000000025). These results suggest that the Spending on healthcare varied within and across
income groups and geographical regions, which is
Yakupu et al. BMC Public Health (2022) 22:1596 Page 12 of 16

Incidence_EAPC
1

−1

−2

−3

Fig. 7 The map of Incidence EAPC. A the map of Incidence EAPC among 204 countries and territories. EAPC, estimated annual percentage change

expected to rise [23]. We examined the relationship because children have a low ability to avoid risks, unable
between EAPCs in burns incidence, DALYs, and deaths to verbalize their needs, have different airway anatomy
with GDP by Pearson correlation analysis. GDP was than adults, resulting in a higher incidence of upper airway
negatively correlated with all EAPC measurements (inci- obstruction due to edema and are prone to the develop-
dence, R =  − 0.05, p = 0.48; DALYs, R =  − 0.04, p = 0.57; ment of hypothermia [37–40].
deaths, R =  − 0.37, p = 0.000000041). These results sug- Further, we analyzed the burns epidemiological indica-
gest that GDP has a vital impact on the temporal trend of tors on SDI level, the result shows that burns lead to a per-
deaths (Fig. 8G, H, Supplemental Figure S 5). sistent healthcare burden on each country, especially those
with lower SDI levels. SDI index contains per capita income,
Discussion average years of education, and total fertility rates, which
Burn injuries are under-appreciated trauma that is an increased the analysis angle of socio-demographic aspects
important cause of morbidity and mortality in many affects on burns prevalence than previous works [28, 34,
parts of the world [4, 24, 25]. To our knowledge, this 41]. In addition, the correlation of EAPCs with SDI, UHC,
study is the first to comprehensively analyze international and GDP indicates that prevention burns not only depend
burn trends in 204 countries and territories from 1990 on health spending per capita but also depend on the edu-
to 2019. The study improved our understanding of the cation level per capita and healthcare system performance,
global distribution and burden of burns. but it does not mean higher health spending corresponds to
Several previous works indicated that burn injuries are higher UHC index, which needs high efficiency of translat-
decreasing, which happens especially in high-income ing health spending into individuals health gains [21, 42].
countries, however, the prevalence of burn injuries remains There are a lot of risk factors for burns, the aspects includ-
high elsewhere with lower income, but those research ing individual, family, and society [28], we evaluated a set of
mainly operated on the national level and incomes level [5, risks for burns, and we can find that although these coun-
26–31]. First, combining the results of previous research tries with lower SDI occupied a high-level occupational risk,
and our study, we can conclude that the age-standardized it remains has great influence in many countries. what’s
rates of burn incidence, DALYs, and mortality will con- surprising is that alcohol use is a quite effective risk factor
tinuously decrease, but the number of new burn cases has for burns. At the national level, the highest ASIR highlights
an increasing tendency globally. Although the causes of the substantial societal burden and disease management
burn injuries in children and adolescents in Eastern and challenges that burns continue to pose, while a substantial
Western countries are similar [32–34], burns were more decrease in the ASIR suggests successful prevention and
prevalent in younger age groups [33–36], which is possible
Yakupu et al. BMC Public Health (2022) 22:1596 Page 13 of 16

4
R =− 0.16, p = 0.026
2019
4
R =− 0.029, p = 0.68
2019

EAPC
EAPC

−2

−2 −4

−6
0.25 0.50 0.75 1.00
0.25 0.50 0.75 1.00
SDI
SDI
High_middle_SDI High_SDI Low_middle_SDI Low_SDI Middle_SDI
High_middle_SDI High_SDI Low_middle_SDI Low_SDI Middle_SDI

2019
R =− 0.49, p = 0.00000000000016 R =− 0.055, p = 0.43
1

2.5

0.0

EAPC
−1
EAPC

−2.5

−2

−5.0

−3

20 40 60 80 100
0.25 0.50 0.75 1.00
SDI
UHC

High_middle_SDI High_SDI Low_middle_SDI Low_SDI Middle_SDI

Incidence EAPC <−1 −1~0

R =− 0.16, p = 0.027 R =− 0.5, p = 0.000000000000025

0 0.0
EAPC

EAPC

−2 −2.5

−4
−5.0

−6

20 40 60 80 100 20 40 60 80 100

UHC UHC

DALYs EAPC <−1 −1~0 Deaths EAPC −9~−4 −4~1

R =− 0.04, p = 0.57
R =− 0.05, p = 0.48
1

0
EAPC

−2
EAPC

−1

−2 −4

−3
−6

0 50000 100000 150000 0 50000 100000 150000

GDP GDP

Incidence EAPC <−1 −1~0 DALYs EAPC <−1 −1~0

Fig. 8 Relationship of EAPCs in burns incidence, DALYs, and death with SDI, UHC, and GDP. A correlation analysis of the EAPC of ASIR with SDI.
B correlation analysis of the EAPC of ASDAR with SDI. C correlation analysis of the EAPC of ASDR with SDI. D correlation analysis of the EAPC
of ASIR with UHC. E correlation analysis of the EAPC of ASDAR with UHC. F correlation analysis of the EAPC of ASDR with UHC. G correlation
analysis of the EAPC of ASIR with GDP. H correlation analysis of the EAPC of ASDAR with GDP. EAPC, estimated annual percentage change; DALYs,
disability-adjusted life years; SDI, sociodemographic index; UHC, universal health coverage; GDP, gross domestic product; ASIR, age-standardized
incidence rate; ASDAR, age-standardized DALYs rate
Yakupu et al. BMC Public Health (2022) 22:1596 Page 14 of 16

healthcare policies that could be used as a reference point 1990 in 45 GBD regions. K, the map of ASIR in 2019 among 204 countries
for establishing new policies elsewhere. and territories. SDI, sociodemographic index; ASIR, age-standardized
incidence rate; GBD, Global Burden of Disease.
Limitations Additional file 2: Supplemental Figure S2. DALYs of burns. A, the global
This study suffers from the general limitations of GBD changing trend in the number of ASDAR by sex from 1990 to 2019. B, a
comparison of the ASDAR between 1990 and 2019 at global and different
studies. First, the accuracy of GBD estimation depends SDI levels. C, distribution of DALYs rate among different age categories in
largely on the quality and quantity of data used since 2019. D, distribution of DALYs rate among different age categories in 1990.
there are under-reporting and under-diagnosis during E, the range of change in DALYs by sex in 2019 compared to 1990 in 45
GBD regions. F, the range of change in ASDAR by sex in 2019 compared
burns registration. Second, death certification accuracy to 1990 in 45 GBD regions. G, the top increased or decreased in DALYs by
has international variability and the co-morbidities that sex in 2019 compared with 1990 among 204 countries and territories. H,
are often associated with burns can add further ambi- the top increased or decreased in ASDAR by sex in 2019 compared with
1990 among 204 countries and territories. I, distribution of DALYs among
guity when identifying the true cause of death. Third, different age categories in 1990. J, the map of DALYs in 2019 among 204
the data could not be explored further to extract infor- countries and territories. K, the map of ASDAR in 2019 among 204 coun-
mation related to severity, and treatments, as such tries and territories. DALYs, disability-adjusted life years; SDI, sociodemo-
graphic index; ASDAR, age-standardized DALYs rate; GBD, Global Burden
information was not provided in the GHDx. Therefore, of Disease.
we could not generate a detailed etiological under- Additional file 3: Supplemental Figure S3. Mortality of burns. A, the
standing of global changes in burn patterns. Lastly, global changing trend of the ASDR by sex from 1990 to 2019. B, a com-
due to the observational nature of this analysis, there parison of ASDR between 1990 and 2019 at global and between different
SDI levels. C, distribution of death rate among different age categories in
are likely to be a number of unmeasured confounding 2019. D, distribution of the number of death cases among different age
factors not discussed and causal statements about the categories in 1990. E, a comparison of the number of death cases by sex at
trends observed cannot be made. global and different SDI levels in 1990. F, a comparison of ASDR by sex at
global and between different SDI levels in 2019. G, the range of change in
the number of death cases by sex in 2019 compared with 1990 in 45 GBD
regions. H, the range of change in ASDR by sex in 2019 compared with
Conclusions 1990 in 45 GBD regions. I, the top increased or decreased in the number
of death cases by sex in 2019 compared with 1990 among 204 countries
Globally, the age-standardized rates of burn incidence, and territories. J, the top increased or decreased in ASDR by sex in 2019
DALYs, and mortality, as well as the number of burn compared with 1990 among 204 countries and territories. K, the map of
DALYs and death cases will continuously decrease, but death cases number in 2019 among 204 countries and territories. SDI,
sociodemographic index; ASDR, age-standardized death rate; GBD, Global
the number of new burn cases has an increasing ten- Burden of Disease.
dency globally. In addition, the EAPCs of burns in inci- Additional file 4: Supplemental Figure S4. Temporal Trends of burns.
dence, DALYs, and deaths indicated that the burden of A, the EAPC of incidence in 45 GBD regions. B, the EAPC of deaths in 45
burns was considered to be decreasing in most of the GBD regions. C, the map of deaths EAPC in 2019 among 204 countries and
territories. D, the map of DALYs EAPC in 2019 among 204 countries and
regions. And from the relationship of EAPCs with SDI, territories. EAPC, estimated annual percentage change; DALYs, disability-
UHC index, and GDP, indicate that prevention burns adjusted life years; GBD, Global Burden of Disease.
not only depend on health spending per capita but also Additional file 5: Supplemental Figure S5. Relationship of EAPCs in
depend on the education level per capita and health- burns incidence, DALYs, and death with SDI, UHC, and GDP. A, correlation
analysis of the EAPC of ASDR with GDP. EAPC, estimated annual percent-
care system performance, but it does not mean higher
age change; DALYs, disability-adjusted life years; SDI, sociodemographic
health spending corresponds to higher UHC index, index; UHC, universal health coverage; GDP, gross domestic product;
which needs high efficiency of translating health spend- ASDR, age-standardized death rate.
ing into individuals health gains. Additional file 6: Table S3. GBD location hierarchy with levels (Table
from:Diseases, G.B.D. and C. Injuries, Global burden of 369 diseases and injuries
in 204 countries and territories, 1990-2019: a systematic analysis for the Global
Supplementary Information Burden of Disease Study 2019. Lancet (London, England), 2020. 396(10258): p.
The online version contains supplementary material available at https://​doi.​ 1204-1222. ).
org/​10.​1186/​s12889-​022-​13887-2.

Acknowledgements
Additional file 1: Supplemental Figure S1. Incidence of burns. A, the
We thank the countless individuals who have contributed to the GEO data-
global changing trend in ASIR by sex from 1990 to 2019. B, a comparison
base in various capacities.
of the number of new cases between 1990 and 2019 at global and differ-
ent SDI levels. C, distribution of new cases among different age categories
Authors’ contributions
in 1990. D, distribution of incidence rate among different age categories
AY, JZ analyzed and visualized the data. AY, SLL was a major contributor in writ-
in 2019. E, distribution of incidence rate among different age categories
ing the manuscript. All authors read and approved the final manuscript.
in 1990. F, a comparison of the number of new cases by sex globally and
at different SDI levels in 2019. G, a comparison of the number of new
Funding
cases by sex at global and different SDI levels in 1990. H, a comparison of
National Natural Science Foundation of China, Grant/Award Numbers:
the ASIR by sex at global and different SDI levels in 1990. I, the range of
81671916.
change in the number of new cases by sex in 2019 compared with 1990 in
45 GBD regions. J, the rangeability in ASIR by sex in 2019 compared with
Yakupu et al. BMC Public Health (2022) 22:1596 Page 15 of 16

Availability of data and materials for the Global Burden of Disease Study 2017. Lancet (London, England),
The datasets generated and/or analyzed during the current study are available 2018;392(10159):1789-858.
in the GBD 2019 repository, which is freely available on http://​ghdx.​healt​hdata.​ 14. Gao S, et al. Declining rates of hepatocellular carcinoma in urban Shang-
org/​gbd-​resul​ts-​tool. hai: incidence trends in 1976-2005. Euro J Epidemiol. 2012;27(1):39-46.
15. Trends and risk factors of mortality and disability adjusted life years for
chronic respiratory diseases from 1990 to 2017: systematic analysis for
Declarations the Global Burden of Disease Study 2017. BMJ. 2020;370:m3150.
16. Yang X, et al. Temporal trends of the lung cancer mortality attributable to
Ethics approval and consent to participate smoking from 1990 to 2017: a global, regional and national analysis. Lung
Ethics approval was exempted by the Ethics Committee of Ruijin Hospital, Cancer (Amsterdam, Netherlands). 2021;152:49–57.
Shanghai JiaoTong University School of Medicine because the GBD 2019 study 17. Liu Z, et al. The trends in incidence of primary liver cancer caused by
is a publicly available database and all data were anonymous. All methods specific etiologies: results from the global burden of disease study 2016
were performed following the relevant guidelines and regulations. and implications for liver cancer prevention. J Hepatol. 2019;70(4):674–83.
18. Yang X, et al. Global, regional and national burden of anxiety disorders
Consent for publication from 1990 to 2019: results from the global burden of disease study 2019.
Not applicable. Epidemiol Psychiatr Sci. 2021;30:e36.
19. Yang X, et al. Global, regional, and national burden of blindness and
Competing interests vision loss due to common eye diseases along with its attributable risk
The authors declare that they have no competing interests. factors from 1990 to 2019: a systematic analysis from the global burden
of disease study 2019. Aging (Albany NY). 2021;13(15):19614–42.
Author details 20. Zhai Z, et al. Assessment of global trends in the diagnosis of mesothe-
1
Wound Healing Center, Ruijin Hospital, Shanghai Jiao Tong University School lioma from 1990 to 2017. JAMA Netw Open. 2021;4(8): e2120360.
of Medicine, Shanghai, China. 2 Department of Burn, Ruijin Hospital, Shanghai 21. Measuring universal health coverage based on an index of effective
Jiao Tong University School of Medicine, Shanghai, China. 3 Shanghai Burn coverage of health services in 204 countries and territories, 1990–2019: a
Institute, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, No. systematic analysis for the Global Burden of Disease Study 2019. Lancet
197 Ruijin Er Road, Shanghai 200025, China. (London, England). 2020;396(10258):1250–84.
22. Cai W, et al. Trends analysis of non-hodgkin lymphoma at the national,
Received: 27 January 2022 Accepted: 18 July 2022 regional, and global level, 1990–2019: results from the global burden of
disease study 2019. Front Med (Lausanne). 2021;8:738693.
23. Tracking development assistance for health and for COVID-19: a review of
development assistance, government, out-of-pocket, and other private
spending on health for 204 countries and territories, 1990–2050. Lancet
References (London, England). 2021;398(10308):1317–43.
1. Diseases, G.B.D. and C. Injuries, Global burden of 369 diseases and injuries 24. Finnerty CC, et al. Hypertrophic scarring: the greatest unmet challenge
in 204 countries and territories, 1990-2019: a systematic analysis for after burn injury. Lancet. 2016;388(10052):1427–36.
the Global Burden of Disease Study 2019. Lancet (London, England). 25. Greenhalgh DG. Management of Burns. N Engl J Med.
2020;396(10258):1204-22. 2019;380(24):2349–59.
2. Enns J, et al. Mental and physical health outcomes in parents of children 26. Kai-Yang L, et al. Epidemiology of pediatric burns requiring hospitaliza-
with burn injuries as compared with matched controls. J Burn Care Res. tion in China: a literature review of retrospective studies. Pediatrics.
2016;37(1):e18–26. 2008;122(1):132–42.
3. Logsetty S, et al. Mental health outcomes of burn: A longitudinal 27. Smolle C, et al. Recent trends in burn epidemiology worldwide: a system-
population-based study of adults hospitalized for burns. Burns. atic review. Burns. 2017;43(2):249–57.
2016;42(4):738–44. 28. Forjuoh SN. Burns in low- and middle-income countries: a review of avail-
4. Jeschke MG, et al. Burn injury. Nat Rev Dis Primers. 2020;6(1):11. able literature on descriptive epidemiology, risk factors, treatment, and
5. Rybarczyk MM, et al. A systematic review of burn injuries in low- and prevention. Burns. 2006;32(5):529–37.
middle-income countries: epidemiology in the WHO-defined African 29. Sethi J, et al. the relationship between income and burn incidence in
Region. Afr J Emerg Med. 2017;7(1):30–7. Winnipeg, Manitoba, Canada: a population health study. J Burn Care Res.
6. Bayuo J, et al. Epidemiology and outcomes of burn injury among older 2018;39(5):645–51.
adults in a Ghanaian tertiary hospital. Burns Open. 2018;2(2):98–103. 30. Stylianou N, Buchan I, Dunn KW. A review of the international Burn Injury
7. Ready FL, et al. Epidemiologic shifts for burn injury in Ethiopia from 2001 to Database (iBID) for England and Wales: descriptive analysis of burn inju-
2016: implications for public health measures. Burns. 2018;44(7):1839–43. ries 2003–2011. BMJ Open. 2015;5(2): e006184.
8. Mitchell M, et al. Children younger than 18 years treated for non- 31. Peck M, Pressman MA. The correlation between burn mortality rates from
fatal burns in US Emergency departments. Clin Pediatr (Phila). fire and flame and economic status of countries. Burns. 2013;39(6):1054–9.
2020;59(1):34–44. 32. Sakallioğlu AE, et al. Burns in Turkish children and adolescents: nine years
9. Santiso L, et al. The epidemiology of burns in children in Guatemala: a of experience. Burns. 2007;33(1):46–51.
single center report. J Burn Care Res. 2020;41(2):248–53. 33. Peck MD. Epidemiology of burns throughout the World. part II: inten-
10. Collaborators GBDRF. Global burden of 87 risk factors in 204 countries tional burns in adults. Burns. 2012;38(5):630–7.
and territories, 1990-2019: a systematic analysis for the Global Burden of 34. Tegtmeyer LC, et al. Retrospective analysis on thermal injuries in children-demo-
Disease Study 2019. Lancet (London, England). 2020;396(10258):1223-49. graphic, etiological and clinical data of German and Austrian pediatric hospitals
11. Fitzmaurice C, et al. Global, Regional, and National Cancer Incidence, Mor- 2006–2015-Approaching the new German burn registry. Burns. 2018;44(1):150–7.
tality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted 35. Hutchings H, et al. Burns in young children: a retrospective matched
Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for cohort study of health and developmental outcomes. Child Care Health
the Global Burden of Disease Study. JAMA Oncol. 2019;5(12):1749-68. Dev. 2010;36(6):787–94.
12. Global, regional, and national disability-adjusted life-years (DALYs) for 333 36. Stone J, et al. Outcomes in Adult Survivors of Childhood Burn Injuries as
diseases and injuries and healthy life expectancy (HALE) for 195 countries and Compared with Matched Controls. J Burn Care Res. 2016;37(2):e166–73.
territories, 1990–2016: a systematic analysis for the Global Burden of Disease 37. Palmieri TL. Pediatric Burn Resuscitation. Crit Care Clin. 2016;32(4):547–59.
Study 2016. Lancet (London, England). 2017;390(10100):1260–344. 38. Jeschke MG, Herndon DN. Burns in children: standard and new treat-
13. Disease GBD, I. Injury, and C. Prevalence, Global, regional, and national ments. Lancet (London, England). 2014;383(9923):1168–78.
incidence, prevalence, and years lived with disability for 354 diseases and 39. Loos MHJ, et al. Incidence and characteristics of non-accidental burns in
injuries for 195 countries and territories, 1990-2017: a systematic analysis children: a systematic review. Burns. 2020;46(6):1243–53.
Yakupu et al. BMC Public Health (2022) 22:1596 Page 16 of 16

40. Kallinen O, et al. Multiple organ failure as a cause of death in patients with
severe burns. J Burn Care Res. 2012;33(2):206–11.
41. Dissanaike S, Rahimi M. Epidemiology of burn injuries: highlight-
ing cultural and socio-demographic aspects. Int Rev Psychiatry.
2009;21(6):505–11.
42. Atiyeh BS, Costagliola M, Hayek SN. Burn prevention mechanisms and
outcomes: pitfalls, failures and successes. Burns. 2009;35(2):181–93.

Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in pub-
lished maps and institutional affiliations.

Ready to submit your research ? Choose BMC and benefit from:

• fast, convenient online submission

• thorough peer review by experienced researchers in your field
• rapid publication on acceptance
• support for research data, including large and complex data types
• gold Open Access which fosters wider collaboration and increased citations
• maximum visibility for your research: over 100M website views per year

At BMC, research is always in progress.

Learn more biomedcentral.com/submissions