Abstract: Objective To analyze the trends in rabies incidence and mortality in China from 1990 to 2019 across different temporal points, as well as by age, period, and cohort, to provide evidence for optimizing rabies prevention and control strategies. Methods Data from the Global Burden of Disease Study 2019 (GBD 2019) were utilized. A Joinpoint regression model was employed to analyze the trends in the age-standardized incidence and mortality rates of rabies in China from 1990 to 2019 at various nodes. An Age-Period-Cohort (APC) model was used to assess the effects of age, period, and cohort on these standardized rates. Results The Joinpoint regression analysis indicated that from 1990 to 2019, the age-standardized incidence rate of rabies in the total population of China decreased by an average of 2.994% annually, and the age-standardized mortality rate decreased by an average of 3.029% annually. The APC model results revealed that the age-standardized incidence and mortality rates of rabies in China exhibited a bimodal trend with increasing age, first decreasing and subsequently increasing. The age-standardized incidence rate for the total population reached its initial peak in the 5-9 age group (0.197 per 1 000 000) and a second peak in the 70-74 age group (0.162 per 1 000 000). The age-standardized mortality rate for the total population showed its first peak in the<5 age group (0.195 per 1 000 000) and a secondary peak in the 70-74 age group (0.185 per 1 000 000). For the period effect, using 2000-2004 as the reference group (RR=1), the risk of incidence and mortality was lower in 1990-1999 and peaked in 2005-2009. For the cohort effect, with the 1960-1964 birth cohort as the reference group (RR=1), the risk increased for birth cohorts from 1905 to 1994. The incidence and mortality risk for the 2015-2019 birth cohort was the lowest (RR=0.395、0.458). Conclusion Although the overall age-standardized incidence and mortality rates of rabies in China demonstrated a downward trend from 1990 to 2019, children and the elderly remain at high risk, with males exhibiting a higher risk than females. It is recommended that comprehensive intervention measures, including canine immunization, activity management, and sterilization, be strengthened. Targeted health education should be conducted for high-risk groups such as children, the elderly, and males to increase awareness of post-exposure prophylaxis.

Key words: Rabies, Incidence, Mortality, Joinpoint regression model, Age-period-cohort model