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. 2024 Feb 15;23(1):20.
doi: 10.1186/s12940-024-01060-8.

Global patterns of asthma burden related to environmental risk factors during 1990-2019: an age-period-cohort analysis for global burden of disease study 2019

Siying Zhang  1   2   3 , Zongshi Gao  4 , Lihong Wu  1 , Yumei Zhong  1 , Hui Gao  5 , Fang-Biao Tao  1   2   3 , Xiulong Wu  6   7   8
Affiliations

Global patterns of asthma burden related to environmental risk factors during 1990-2019: an age-period-cohort analysis for global burden of disease study 2019

Siying Zhang et al. Environ Health. .

Abstract

Background: Change in asthma burden attributed to specific environmental risk factor has not been evaluated.

Objective: We aimed to explore the age, period, and cohort effects on asthma burden attributable to smoking and occupational asthmagens in different socio-demographic index (SDI) regions and the region and sex disparities.

Methods: Risk factor-specific asthma deaths and disability-adjusted life years (DALYs) rates were extracted from Global Burden of Disease study 2019, estimated by standard Combined Cause of Death Model and DisMod-MR 2.1 modeling tool. Age-period-cohort analysis was conducted to decompose age, period, and cohort effects on asthma burden.

Results: Smoking- and occupational asthmagens-related asthma deaths and DALYs rates dropped by > 45% during 1990-2019. In 2019, Africa, South and Southeast Asia had higher asthma burden than other regions. Male had higher asthma burden than female. Among nearly all age groups, low-middle SDI region had the highest smoking-related asthma burden, and low SDI region had the highest occupational asthmagens-related asthma burden. Inverse "V" shaped trend was observed in the above regions with increasing age. For smoking-related asthma deaths and DALYs rates, the most significant improvement of period rate ratio (RR) occurred in high SDI region, decreased from 1.67 (1.61, 1.74) to 0.34 (0.33, 0.36) and 1.61 (1.57, 1.66) to 0.59 (0.57, 0.61), respectively, as well as the cohort effect on smoking-related asthma burden. For occupational asthmagens-related asthma deaths and DALYs rates, the most sharply decrease of period and cohort RR appeared in the high and high-middle SDI regions. Low SDI region showed least progress in period and cohort RR of smoking- and occupational asthmagens-linked asthma burden.

Conclusion: Smoking- and occupational asthmagens-related asthma burden sharply decreases, but region and sex disparities exist. Policy makers from low SDI region should reinforce tobacco control and prioritize workplace protection.

Keywords: Age-period-cohort analysis; Asthma; Disability-adjusted life years; Occupational asthmagens; Smoking.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Age-standardized deaths and DALYs rates (per 100,000 population) of asthma attributed to different risk factors in 2019 stratified by country. A Age-standardized asthma deaths rates attributed to smoking; B Age-standardized asthma DALYs rates attributed to smoking; C Age-standardized asthma deaths rates attributed to occupational asthmagens; D Age-standardized asthma DALYs rates attributed to occupational asthmagens
Fig. 2
Fig. 2
Age, period, and cohort effects on asthma deaths and DALYs rates attributed to smoking. A Age-specific asthma deaths rates attributed to smoking; B Age-specific asthma DALYs rates attributed to smoking; C Period rate ratio (RR) of asthma deaths rates attributed to smoking; D Period RR of asthma DALYs rates attributed to smoking; E Cohort RR of asthma deaths rates attributed to smoking; F Cohort RR of asthma DALYs rates attributed to smoking
Fig. 3
Fig. 3
Age, period, and cohort effects on asthma deaths and DALYs rates attributed to occupational asthmagens. A Age-specific asthma deaths rates attributed to occupational asthmagens; B Age-specific asthma DALYs rates attributed to occupational asthmagens; C Period rate ratio (RR) of asthma deaths rates attributed to asthmagens; D Period RR of asthma DALYs rates attributed to occupational asthmagens; E Cohort RR of asthma deaths rates attributed to occupational asthmagens; F Cohort RR of asthma DALYs rates attributed to occupational asthmagens
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