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. 2023 May:59:101936.
doi: 10.1016/j.eclinm.2023.101936.

Global burden of chronic respiratory diseases and risk factors, 1990-2019: an update from the Global Burden of Disease Study 2019

GBD 2019 Chronic Respiratory Diseases Collaborators
Collaborators, Affiliations

Global burden of chronic respiratory diseases and risk factors, 1990-2019: an update from the Global Burden of Disease Study 2019

GBD 2019 Chronic Respiratory Diseases Collaborators. EClinicalMedicine. 2023 May.

Abstract

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019.

Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input.

Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6-4.3) with a prevalence of 454.6 million cases (417.4-499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4-225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9-3.6) deaths. With 262.4 million (224.1-309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively.

Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries.

Keywords: Asthma; Chronic obstructive pulmonary disease; Epidemiology; Interstitial lung disease; Lung disease; Morbidity; Mortality; Pneumoconiosis; Pulmonary emphysema.

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Conflict of interest statement

Declaration of interests R Ancuceanu reports consulting fees from Abbvie; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Abbvie, B. Braun, Sandoz, and Laropharm all outside the submitted work. NS Bayileyegn reports participation on a Data Safety Monitoring Board or Advisory Board with Jimma University; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Jimma University as part of the disaster response team all outside the submitted work. S Das reports grants or contracts from the Department of Science and Technology, government of India all outside the submitted work. TC Ekundayo other support from the African-German Network of Excellence in Science, the Federal Ministry of Education and Research, and the Alexander von Humboldt Foundation all outside the submitted work. R Erkhembayar reports grants or contracts from World Health Organization, Country Office in Mongolia for disease burden estimates and utilizations, training and capacity building at CHD, MoH, Mongolia all outside the submitted work. A Faro reports support for the present manuscript from CNPq - National Council for Scientific and Technological Development, Brazil all outside the submitted work. I Filip reports other support from Avicenna Medical and Research Institute all outside the submitted work. R Franklin reports grants or contracts for Heatwaves in Queensland Arc Flash, Human Factors from Queensland Government; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from World Safety Conference 2022; support for attending meetings and/or travel from ACTM - Tropical Medicine and Travel Medicine Conference 2022; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Kidsafe as a Director, with Auschem as a Director, with ISASH as part of the Governance Committee, with Farmsafe as a Director, and with PHAA Injury Prevention SIG Convenor all outside the submitted work. C Herteliu reports grants or contracts from Romanian Ministry of Research Innovation and Digitalization, MCID for project number ID-585-CTR-42-PFE-2021 research grant (Jan 2022-Jun 2023) “Enhancing institutional performance through development of infrastructure and transdisciplinary research ecosystem within socio-economic domain - PERFECTIS ” all outside the submitted work. NE Ismail reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Malaysian Academy of Pharmacy as a Council Member. J Jozwiak reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis and Adamed all outside the submitted work. K Krishan reports other support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India all outside the submitted work. AFA Mentis reports grants or contracts from `MilkSafe: A novel pipeline to enrich formula milk using omics technologies,’ a research co financed by the European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH - CREATE - INNOVATE (project code: T2EDK-02222), as well as from ELIDEK (Hellenic Foundation for Research and Innovation, MIMS-860); payment for expert testimony having served as external peer-reviewer for Fondazione Car-iplo, Italy; participation on a Data Safety Monitoring Board or Advisory Board serving as Editorial Board Member for “Systematic Reviews” journal, for “Annals of Epidemiology” journal, and as Associate Editor for “Translational Psychiatry;” stock or stock options in a family winery; and other support from BGI Group as a scientific officer all outside the submitted work. N Moka reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Kentucky Society of Clinical Oncology as Treasurer. MJ Postma reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with JCVI (UK) as an unpaid Member; stock or stock options in HealthEcore (Zeist, NL) and PAG BV (Groningen, NL) all outside the submitted work. A Radfar reports other support from Avicenna Medical and Research Institute all outside the submitted work. J Singh reports consulting fees Crealta/Horizon, Medisys, Fidia, PK Med, Two labs Inc., Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, and Practice Point communications; and the National Institutes of Health and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Simply Speaking on the speaker’s bureau; support for attending meetings and/or travel from the steering committee of OMERACT; participation on a Data Safety Monitoring Board or Advisory Board with FDA Arthritis Advisory Committee; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with OMERACT as a steering committee member, Veterans Affairs Rheumatology Field Advisory Committee as Chair, and UAB Cochrane Muskuloskelatal Group Satellite Center on Network Meta-analysis as editor and Director; stock or stock options in TPT Global Tech, Vaxart pharmaceuticals, Atyu biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics Inc., Seres Therapeutics, Tonix Pharmaceuticals and Charlotte’s Web Holdings, Inc all outside the submitted work. E Upadhyay reports patents planned, issued or pending for “A system and method of reusable filters for anti-pollution mask” (published), “A system and method for electricity generation through crop stubble by using microbial fuel cells” (published), “A system for disposed personal protection equipment (PPE) into biofuel through pyrolysis and method” (published), and “A novel herbal pharmaceutical aid for formulation of gel and method thereof” (filed) all outside the submitted work. M Wei reports support for the present manuscript from NIH National Institute on Aging K23 career development award; grants or contract from NIH National Institute on Aging K23 career development award; support for attending meetings and/or travel from NIH National Institute on Aging K23 career development award to attend national meetings (SGIM, AGS) to present results; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Society of General Internal Medicine (SGIM) as Chair of the Research Committee all outside the submitted work.

Figures

Fig. 1
Fig. 1
Global age-standardised rates of incidence, prevalence, deaths, and DALYs of chronic respiratory diseases in men, women, and in both sexes combined, 1990–2019. DALYs = Disability-Adjusted Life Years.
Fig. 2
Fig. 2
Global age-standardised rates of incidence, prevalence, deaths, and DALYs of chronic respiratory diseases in both sexes combined in each SDI quintile. DALYs = Disability-Adjusted Life Years, SDI = Socio-demographic Index.
Fig. 3
Fig. 3
Global age-standardised rate of deaths and DALYs from chronic respiratory diseases in 2019 and their percent change from 1990 in both sexes combined. DALYs = Disability-Adjusted Life Years.
Fig. 4
Fig. 4
Ranked contribution of risk factors to the age-standardised rate of DALYs from chronic respiratory diseases by region, 2019, for both sexes combined, females, and males. Risk factors are ranked from 1 (the leading risk factor for age-standardised Disability-Adjusted Life Years (DALYs); dark red) to 11 (the lowest risk factor for age-standardised DALYs; dark green). The numbers inside each box indicate the ranking.
Fig. 5
Fig. 5
Absolute rate of DALYs from chronic respiratory diseases by age in men and women in 1990 and 2019 with age-standardised rate. DALYs = Disability-Adjusted Life Years.
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