Objective To analyze the long-term trend, recent change of the disease burden by infectious diarrhea from 1990 to 2023 and predict its short-term trend in China, and provide evidence for the more precise prevention and control of infectious diarrhea.

Methods The incidence, mortality, and disability-adjusted life year (DALY) of infectious diarrhea in China, the world and five regions with different socio-demographic index (SDI) from 1990 to 2023 were obtained from the Global Burden of Disease Study 2023 (GBD 2023). Temporal trends in the age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and age-standardized DALY rate were evaluated by using Joinpoint regression model, and the average annual percentage change (AAPC) and annual percentage change (APC) were calculated. Stratified analyses by sex and age were conducted to describe differences in the disease burden in China. Autoregressive integrated moving average (ARIMA) model was used to predict the changes in disease burden from 2024 to 2030. In addition, supplementary prediction analyses were performed to compare results derived from different modeling and evaluate the influence of end-year fluctuations on short-term prediction.

Results From 1990 to 2023, the overall level of disease burden by infectious diarrhea in China, indicated by incidence, mortality, and DALY, showed a marked downward trend. During the study period, the ASIR, ASDR, and age-standardized DALY rate in China remained lower than the global level and all SDI region levels. The AAPCs indicated that the annual ASIR, ASDR, and age-standardized DALY rate decreased by 2.71%, 11.02%, and 9.06%, respectively. Despite this long-term decline, a notable increase occurred again in recent years. From 2021 to 2023, the ASIR and age-standardized DALY rate rebounded significantly, with APCs of 34.96% and 25.54%, respectively. Age-specific analyses showed that the incidence peak shifted from the age group 0-4-year in 1990 to the age group 5-14-year in 2023, suggesting a change in the age distribution of morbidity. In contrast, the mortality remained severe in old adults. ARIMA models suggested that by 2030 the ASIR might continue to increase, whereas the ASDR might continue to decline, and the age-standardized DALY rate might show an upward trend. Supplementary prediction analyses indicated that the incidence prediction was sensitive to the fluctuations of end-year data, and the main model prediction results should be interpreted with caution.

Conclusion From 1990 to 2023, the overall level of disease burden by infectious diarrhea in China declined markedly, however, close attention should be paid to the rebounds of the incidence and DALY rates during 2021–2023. Because pathogen-specific data were not available, the rebound cannot be directly attributed to any single pathogen. Surveillance of key populations and high-risk settings should be strengthened, and the influence of end-year fluctuations on short-term prediction should be interpreted with caution.