Cystic echinococcosis (CE) is a chronic zoonotic disease caused by the larval stages of the Echinococcus granulosus tapeworm and is recognized by the World Health Organization (WHO) as one of 17 neglected tropical diseases (NTDs) (1). According to the latest estimates, approximately 188,000 new cases of CE are reported globally each year, resulting in approximately 184,000 disability-adjusted life years (DALYs), averaging approximately 0.98 DALYs per case (2). In regions with limited medical resources, the mortality rate can reach 2–4% (3). CE is widespread globally, particularly in regions such as Argentina, Peru, East Africa, Central Asia, and China (4, 5). Notably, the disease burden is particularly severe in Central Asia due to its unique geographical and climatic conditions (6, 7), wherein a significant number of population are exposed to high-risk environments, particularly herders and farmers (8). Understanding the epidemiological characteristics of CE and its trend in high-burden region is critical to formulate effective regional public health policies and contributes to global control of CE (9). However, study on CE burden in Central Asia was scarce.

Despite significant progress in implementing CE prevention and control programs, achieving ambitious targets for the disease in the WHO 2021–2030 roadmap for NTDs poses multiple challenges (10). Estimates of the disease burden due to CE and analysis of its long-term trend may facilitate the progress toward eliminations. Recent studies had analyzed long-term trends in CE incidence, mortality, and DALYs globally and regionally (9, 11). However, these studies analyzed CE trends using the Global Burden of Disease (GBD) 2019 data, which only extends the GBD data to 2019. Recently, the GBD 2021 data was published, which made substantial updates to the GBD 2019 data, including incorporating 19,189 additional high-quality data sources (e.g., disease registries, hospital records, health surveys) and improvements to the DisMod-MR model, enabling better handling of data sparsity issues (12). Furthermore, detailed analysis on incidence, mortality and DALYs of CE in Central Asia overall and specific countries was not given in this study, although the CE burden in this region was the highest globally. Additionally, these studies did not apply alternative analytical approaches, such as joinpoint regression or age-period-cohort (APC) models, which help identify significant trend shifts and reveal complex age, period, and cohort effects, offering a more detailed understanding of CE’s epidemiological patterns. In this study, we used the GBD 2021 data and analyzed the detailed trends of CE in Central Asia over the past 30 years by age, gender, and country, and compared them with the global trends, which were critical for developing more targeted public health strategies in this high-burden region and might contribute to global efforts in controlling CE.

To our knowledge, this is the first study to use the latest GBD 2021 data to conduct a thorough analysis of CE trends in the past 30 years in Central Asia. We found both the number of CE cases and ASIR in Central Asia increased in 1992–2021, while the number of CE deaths and DALYs, ASMR and ASDR decreased, which was similar to the CE trends globally. However, the reductions in mortality and DALYs in Central Asia were substantially slower compared to global levels, highlighting the region’s persistent burden of CE. These findings highlighted the unique challenges faced by Central Asia, which included limited healthcare access, socioeconomic disparities, climate change and traditional livestock practices (6–8, 20, 21).

From 1992 to 2010, CE incidence in Central Asia increased consistently, with the most rapid growth observed between 2001 and 2005. This rise could be attributed to a substantial restructuring of the livestock industry, the unregulated slaughtering of animals, inadequate veterinary control of slaughtering, lack of veterinary public health and increasing number of dog population in both rural and urban areas after 1990s (7, 8). In contrast, between 2010 and 2015, CE incidence significantly declined, reflecting enhanced global and regional public health initiatives (22). In 2009, the WHO Informal Working Group on Echinococcosis (WHO-IWGE) published a consensus on the diagnosis and treatment of cystic and alveolar echinococcosis, providing updated guidelines for diagnosis and treatment (23). The FAO-OIE-WHO Tripartite Agreement, initiated in 2010, fostered collaborations to address zoonotic diseases, including echinococcosis, and may have indirectly contributed to improved disease control efforts in Central Asia (24). However, a moderate rebound in incidence from 2015 to 2021 suggests that the previously observed gains may not have been fully sustained. This trend may reflect persisting gaps in healthcare infrastructure and inconsistent educational campaigns. At the same time, it could also be partially attributed to improved diagnostic capabilities and increased awareness of the disease among the local population and medical community (25). Additionally, the recent expansion of livestock commerce driven by economic initiatives could have contributed to the gradual rise in incidence (26). These findings underscore the need for sustained, long-term interventions to mitigate these challenges effectively.

Our analysis also revealed significant gender and age-specific disparities in CE trends. Males exhibited higher ASIR and ASDR compared to females, contrasting with the global pattern (11). This disparity is likely due to men’s engagement in high-risk occupations such as herding, animal husbandry, and slaughtering, which involve close contact with livestock and dogs, including practices like feeding infected livestock to dogs and working in slaughterhouses with inadequate safety protocols (27–29). Such occupational exposures have been identified as key risk factors in other zoonotic diseases (28). The socio-cultural context in Central Asia, where men predominantly participate in livestock-related activities, may further amplify their risk of exposure (28). Incidence rates exhibited a dual peak among children (10–14 years) and middle-aged adults (50–54 years), reflecting distinct exposure and susceptibility profiles. Children are primarily exposed through environmental contamination, such as contact with Echinococcus eggs in soil near infected dogs, especially in rural areas with inadequate sanitation (25, 30). For middle-aged adults, occupational exposure in high-risk industries such as livestock farming and slaughterhouses remains a significant driver of infection (27, 28). Reductions in DALYs among younger populations, particularly children under 5 years, could indicate the benefits of public health interventions and improved healthcare access.

Significant disparities in CE burden trends were observed across Central Asian countries. For instance, Kazakhstan experienced the largest increase in ASIR, while Mongolia demonstrated the most substantial declines in DALY rates. These disparities likely result from variations in public health infrastructure, policy implementation, and socioeconomic development, which influence healthcare accessibility and disease management (7, 31, 32). Adopting successful strategies from low-burden countries, such as modernized livestock practices and improved meat inspection, could help reduce the CE burden in high-incidence regions. For example, pilot programs in China have demonstrated the effectiveness of enhanced meat inspection and waste management in significantly reducing CE incidence in targeted rural areas. Similarly, collaborative initiatives in Central Asia that draw on livestock management policies from Mongolia have shown promise in mitigating the upward trend of infection rates (29). Regional collaboration and resource-sharing initiatives remain critical for fostering sustainable and effective interventions.

This study is the first to use GBD 2021 data to analyze CE trends in Central Asia, providing a comprehensive analysis of long-term trends and offering critical insights for developing effective disease prevention and control strategies in this high-burden region. Compared to previous studies, this research incorporates several notable advancements. First, it leverages the updated GBD 2021 database, which features a broader range of data sources and a comprehensive update of historical data across all years (14, 33). Additionally, the use of a more advanced DisMod-MR model ensures greater consistency and reliability in estimates, further strengthening the accuracy of trend analysis (14). Second, while earlier studies predominantly focused on global or macro-regional trends, this study provides a detailed examination of Central Asia, stratifying trends by age, gender, and country, and uncovering unique epidemiological characteristics in the region. Finally, the application of Joinpoint and APC models offers a novel analytical perspective, enabling the identification of significant trend shifts and the assessment of age-period-cohort effects. These methodological approaches allow policymakers to prioritize high-risk groups, pinpoint key intervention periods, and develop actionable, targeted public health strategies to address the burden of CE.

Our study has some limitations. First, while the GBD database offers extensive, peer-reviewed data, underreporting and incomplete data, particularly in remote areas with limited healthcare infrastructure, may underestimate the actual burden of CE. In rural and economically disadvantaged regions of Central Asia, limited surveillance systems and healthcare access further exacerbate this challenge, emphasizing the need for more robust data collection (8). Second, the reliance on retrospective data introduces potential biases, as improvements in diagnostic methods over time may reflect increased case detection rather than a true rise in incidence. Third, the COVID-19 pandemic significantly disrupted healthcare systems in Central Asia, delaying the diagnosis and treatment of chronic diseases like CE (34, 35). The reallocation of medical and veterinary resources during the pandemic, coupled with interruptions in routine public health campaigns, likely exacerbated gaps in disease prevention and control efforts, particularly in rural areas with higher zoonotic transmission risks. Additionally, socioeconomic disruptions may have intensified reliance on informal livestock practices, further complicating CE control (13, 33, 36). While broader factors such as climate change and traditional agricultural practices may influence CE epidemiology, these aspects were beyond the scope of our analysis. Future research could explore these factors to provide a more comprehensive understanding of CE transmission dynamics and refine public health strategies.

These findings emphasize the need for tailored public health interventions in Central Asia, particularly improving healthcare access in rural areas, strengthening disease surveillance systems, and implementing educational campaigns targeting high-risk groups, including males, children, and younger cohorts. Additionally, addressing gender-specific occupational risks and promoting safe livestock practices are crucial for reducing exposure. Sustained investment in regional collaboration and public health infrastructure is essential for mitigating the CE burden effectively and ensuring the long-term success of these interventions.

This study provides a comprehensive analysis of cystic echinococcosis (CE) trends in Central Asia over the past 30 years using the latest GBD 2021 data. The findings indicate that, despite some improvements, CE remains a significant public health challenge in Central Asia, with men experiencing significantly higher incidence rates than women. These results underscore the need for gender-specific prevention strategies and highlight substantial disparities among Central Asian countries in disease burden and management effectiveness. Public health policies should be tailored to consider gender, age, and national specifics to enhance their impact. Continued monitoring of CE trends and the development of targeted prevention strategies within diverse socioeconomic contexts are essential to reduce the disease burden in this high-risk region.