Abstract
BACKGROUND: Infectious diseases remain a major global health challenge. However, long-term trends of acute infectious diseases in Sichuan Province, an area in southwest China with a high disease burden, are limited. This study examines trends in 23 acute infectious diseases over two decades to provide evidence for evaluating prevention strategies and informing future preparedness efforts. METHODS: We obtained disease incidence and demographic data from the China Information System for Disease Control and Prevention and the National Bureau of Statistics. We analyzed 23 notifiable acute infectious diseases in Sichuan Province from 2005 to 2024, stratifying patterns by sex, age, region, and season. We used Joinpoint regression to assess temporal trends and calculate the average annual percentage change (AAPC). We evaluated spatial trends via trend surface analysis in ArcGIS 10.7.0. Statistical analyses were performed using R 4.4.1 and the Joinpoint Regression Program 5.4.0, setting statistical significance at p < 0.05. RESULTS: From 2005 to 2024, Sichuan recorded incidence and mortality rates of 305.78 and 0.13 per 100,000 people, respectively, for the 23 acute infectious diseases. Excluding hand, foot, and mouth disease and seasonal influenza, the overall incidence rate of the remaining 21 diseases increased (AAPC: 3.4%, 95% CI: 1.75-4.51), with sharp increases occurring from 2022 to 2024. During the study period, the incidence rate increased for 8 diseases, declined for 12 diseases, and remained stable for 3 diseases. Males had a higher incidence rate than females (1.17:1), particularly for zoonotic and vector-borne diseases. The highest incidence rate was among children aged 0-9 years (1,772.04 per 100,000 people). In the first and the last decades, there was a great alteration in dynamic spatial patterns. The north-south trend shifted from a U-shaped pattern in the first decade to a linear pattern in the last decade, while the east-west pattern reversed. CONCLUSIONS: Acute infectious disease patterns in Sichuan have continuously shifted due to evolving prevention strategies and epidemiological trends. Priority diseases requiring enhanced surveillance include seasonal influenza, pertussis, infectious diarrhea, hepatitis E, brucellosis, typhus, and dengue fever. Reducing the disease burden effectively requires targeted strategies that integrate seasonal and regional patterns and intensify surveillance during high-risk periods.