Global burden of lower respiratory infections during the last three decades

Abstract

Background: Lower respiratory infections (LRIs) cause a substantial mortality, morbidity and economic burden. The present study reported the global, regional and national burden of LRIs and their attributable risk factors in 204 countries and territories, between 1990 and 2019, by age, sex, etiology, and Socio-demographic Index (SDI).

Methods: Using publicly available data from the Global Burden of Disease (GBD) study 2019, we reported the incidence, deaths and disability-adjusted life-years (DALYs), due to LRIs. Estimates were presented as counts and age-standardized rates per 100,000 population with their associated uncertainty intervals (UIs).

Results: Globally, in 2019 there were 488.9 million (95% UI: 457.6 to 522.6) incident cases and 2.4 million (2.3-2.7) deaths due to LRIs. The global age-standardized incidence and death rates for LRIs were 6,295 (5,887.4-6,737.3) and 34.3 (31.1-37.9) per 100,000 in 2019, which represents a 23.9% (22.5-25.4) and 48.5% (42.9-54.0) decrease, respectively since 1990. In 2019, Guinea [12,390.4 (11,495.5-13,332.8)], Chad [12,208.1 (11,289.3-13,202.5)] and India [11,862.1 (11,087.0-12,749.0)] had the three highest age-standardized incidence rates of LRI. Equatorial Guinea [-52.7% (95% UI: -55.8 to -49.3)], Chile [-50.2% (95% UI: -53.4 to -47.0)] and Albania [-48.6% (95% UI: -51.7 to -45.3)] showed the largest decreases from 1990 to 2019. In 2019, a decrease in the incidence rate of LRI was observed at the global level up to the 25-29 age group, then the incidence rates increased with age. The burden of LRIs decreased with increasing SDI at both the regional and national levels. Globally, child wasting (33.1%), household air pollution from solid fuels (24.9%) and a lack of access to handwashing facilities (14.4%) made the largest contributions to the LRI burden in 2019.

Conclusions: Although the burden of LRIs decreased over the period 1990-2019, LRIs still contribute to a large number of incident cases, deaths and DALYs. Preventative programs with a focus on reducing exposure to attributable risk factors should be implemented, especially in less developed countries.

Keywords: epidemiology; incidence; lower respiratory infection; mortality; respiratory infection; risk factor.

Figure 1

Age-standardized incidence rate of lower respiratory infections (per 100,000 population) in 2019, by country (generated from data available from http://ghdx.healthdata.org/gbd-results-tool).

Figure 2

Age-standardized death rate from lower respiratory infections (per 100,000) population in 2019, by country (generated from data available from http://ghdx.healthdata.org/gbd-results-tool).

Figure 3

Global number of incident cases and incidence rate of lower respiratory infections (per 100,000 population) by age and sex in 2019; Dotted and dashed lines indicate 95% upper and lower uncertainty intervals, respectively (generated from data available from http://ghdx.healthdata.org/gbd-results-tool).

Figure 4

Age-standardized DALY rates of lower respiratory infections for the 21 Global Burden of Disease regions by Socio-demographic Index, 1990–2019; Expected values based on Socio-demographic Index and disease rates in all locations are shown as the black line. Thirty points are plotted for each GBD region and show the observed age-standardized DALY rates from 1990 to 2019 for that region. DALY, disability adjusted life years (generated from data available from http://ghdx.healthdata.org/gbd-results-tool).

Figure 5

Global number of deaths and death rate due to lower respiratory infections (per 100,000 population) by etiology and age in 2019 (generated from data available from http://ghdx.healthdata.org/gbd-results-tool).

Figure 6

Percentage of DALYs due to lower respiratory infections attributable to risk factors for 21 GBD regions in 2019. DALY, disability adjusted life years (generated from data available from http://ghdx.healthdata.org/gbd-results-tool).