Trends in Meningitis Burden and Projections to 2040: A Secondary Analysis of the Global Burden of Disease Study 2023

ABSTRACT Background and Aims Meningitis remains a global health challenge, characterized by substantial regional and etiologic disparities. This study aimed to analyze recent trends, forecast future burden, and examine the influence of development status on meningitis outcomes. Methods We used Global Burden of Disease 2023 data to assess trends in age‐standardized incidence rate (ASIR), age‐standardized disability‐adjusted life‐year (DALY) rate (ASDR), and age‐standardized mortality rate (ASMR) for meningitis from 1990 to 2023 across regions and major etiologies. Temporal trends were assessed using joinpoint regression. Future projections through 2040 were generated using a hybrid time‐series model. Development‐related disparities were explored using multilevel regression based on the Human Development Index (HDI), and spatial clustering was analyzed. Results From 1990 to 2023, global meningitis burden declined markedly, with ASIR, ASDR, and ASMR decreasing by roughly half. Despite these improvements, Sub‐Saharan Africa remained the most affected region in 2023, showing the highest ASIR, ASDR, and ASMR and the smallest proportional declines. Etiology‐specific analyses demonstrated substantial heterogeneity. Among bacterial causes, Streptococcus pneumoniae and Neisseria meningitidis remain the leading global contributors, while Haemophilus influenzae showed the steepest long‐term reductions. Viral meningitis was primarily driven by non‐polio enteroviruses, whereas Candida spp. represented the main fungal contributor. HDI‐based analyses revealed that although all development groups experienced declining trends, countries with higher HDI had consistently faster reductions across all three measures. Spatial clustering identified persistent high‐burden hotspots across the African meningitis belt. Projections to 2040 indicated continued global declines across all major etiologies, with S. pneumoniae expected to remain the predominant contributor and N. meningitidis showing the largest relative reductions. Conclusion Despite substantial global declines, meningitis remains unevenly distributed, especially in Sub‐Saharan Africa, where incidence, DALY burden, and mortality remain highest. Projections show continued improvement, although Streptococcus pneumoniae is expected to remain the leading cause.