Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan;25(1):36-51.
doi: 10.1016/S1473-3099(24)00430-4. Epub 2024 Sep 9.

Global, regional, and national burden of upper respiratory infections and otitis media, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021

GBD 2021 Upper Respiratory Infections Otitis Media Collaborators
Collaborators

Global, regional, and national burden of upper respiratory infections and otitis media, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021

GBD 2021 Upper Respiratory Infections Otitis Media Collaborators. Lancet Infect Dis. 2025 Jan.

Erratum in

Abstract

Background: Upper respiratory infections (URIs) are the leading cause of acute disease incidence worldwide and contribute to a substantial health-care burden. Although acute otitis media is a common complication of URIs, the combined global burden of URIs and otitis media has not been studied comprehensively. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to explore the fatal and non-fatal burden of the two diseases across all age groups, including a granular analysis of children younger than 5 years, in 204 countries and territories from 1990 to 2021.

Methods: Mortality due to URIs and otitis media was estimated with use of vital registration and sample-based vital registration data, which are used as inputs to the Cause of Death Ensemble model to separately model URIs and otitis media mortality by age and sex. Morbidity was modelled with a Bayesian meta-regression tool using data from published studies identified via systematic reviews, population-based survey data, and cause-specific URI and otitis media mortality estimates. Additionally, we assessed and compared the burden of otitis media as it relates to URIs and examined the collective burden and contributing risk factors of both diseases.

Findings: The global number of new episodes of URIs was 12·8 billion (95% uncertainty interval 11·4 to 14·5) for all ages across males and females in 2021. The global all-age incidence rate of URIs decreased by 10·1% (-12·0 to -8·1) from 1990 to 2019. From 2019 to 2021, the global all-age incidence rate fell by 0·5% (-0·8 to -0·1). Globally, the incidence rate of URIs was 162 484·8 per 100 000 population (144 834·0 to 183 289·4) in 2021, a decrease of 10·5% (-12·4 to -8·4) from 1990, when the incidence rate was 181 552·5 per 100 000 population (160 827·4 to 206 214·7). The highest incidence rates of URIs were seen in children younger than 2 years in 2021, and the largest number of episodes was in children aged 5-9 years. The number of new episodes of otitis media globally for all ages was 391 million (292 to 525) in 2021. The global incidence rate of otitis media was 4958·9 per 100 000 (3705·4 to 6658·6) in 2021, a decrease of 16·3% (-18·1 to -14·0) from 1990, when the incidence rate was 5925·5 per 100 000 (4371·8 to 8097·9). The incidence rate of otitis media in 2021 was highest in children younger than 2 years, and the largest number of episodes was in children aged 2-4 years. The mortality rate of URIs in 2021 was 0·2 per 100 000 (0·1 to 0·5), a decrease of 64·2% (-84·6 to -43·4) from 1990, when the mortality rate was 0·7 per 100 000 (0·2 to 1·1). In both 1990 and 2021, the mortality rate of otitis media was less than 0·1 per 100 000. Together, the combined burden accounted for by URIs and otitis media in 2021 was 6·86 million (4·24 to 10·4) years lived with disability and 8·16 million (4·99 to 12·0) disability-adjusted life-years (DALYs) for all ages across males and females. Globally, the all-age DALY rate of URIs and otitis media combined in 2021 was 103 per 100 000 (63 to 152). Infants aged 1-5 months had the highest combined DALY rate in 2021 (647 per 100 000 [189 to 1412]), followed by early neonates (aged 0-6 days; 582 per 100 000 [176 to 1297]) and late neonates (aged 7-24 days; 482 per 100 000 [161 to 1052]).

Interpretation: The findings of this study highlight the widespread burden posed by URIs and otitis media across all age groups and both sexes. There is a continued need for surveillance, prevention, and management to better understand and reduce the burden associated with URIs and otitis media, and research is needed to assess their impacts on individuals, communities, economies, and health-care systems worldwide.

Funding: Bill & Melinda Gates Foundation.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests S Afzal reports payment for educational events and webinars from King Edward Medical University and collaborative partners including Johns Hopkins University, University of California, University of Massachusetts, University of Nebraska, Imperial College London, KEMCA-UK, KEMCAANA, and APPNA; participation on a data safety monitoring board or advisory board with National Bioethics Committee Pakistan, the King Edward Medical University Institutional Ethical Review Board, and the Fatima Jinnah Medical University and Sir Ganga Ram Hospital Ethical Review Board; leadership or fiduciary roles in other board, society, committee or advocacy groups (paid or unpaid) with the Pakistan Association of Medical Editors, Faculty of Public Health Royal Colleges UK (fellow), Society of Prevention, Advocacy and Research at King Edward Medical University, and Pakistan Society of Infectious Diseases (member); and other financial or non-financial interests with the Corona Experts Advisory Group (member), Dengue Advisory Group (member), Technical Working Group or guidelines development for COVID-19 (member), National Command and Operation Committee of the Government of Pakistan (expert opinion), Pakistan Medical & Dental Council Research and Journals Committee (member), HEC Research and Publications Committee (member), Quality Assurance Agency HEC (member), Public Health and Preventive Medicine at King Edward Medical University (Dean), Quality Enhancement Cell at King Edward Medical University (director), Annals of King Edward Medical University (chief editor), and History Book of King Edward Medical University (chief editor), all outside the submitted work. S A Meo reports grants or contracts from the Deputyship for Research and Innovation, Ministry of Education in Saudi Arabia (IFKSUOR3-4-9), outside the submitted work. A Beloukas reports grants or contracts from Gilead (research grant and sponsorship to the University of West Attica) and GSK (research sponsorship to the University of West Attica); participation on a data safety monitoring board or advisory board with Gilead and GSK, paid to the University of West Attica; supports for attending meetings or travel from Gilead and GSK, paid to the University of West Attica; and receipt of equipment, materials, drugs, medical writing, gifts, or other services from Cepheid in the form of free-of-charge reagents for a research project; all outside the submitted work. C S Brown reports other financial support from market research companies via ad-hoc, one-off market research advisories on a variety of infection topics, all anonymous, conducted with no direct communication nor any knowledge of any pharmaceutical companies or products, outside the submitted work. I M Ilic and M D Ilic report support for the present manuscript from the Ministry of Science, Technological Development and Innovation of the Republic of Serbia (project numbers 175042, 2011-2023, 451-03-47/2023-01/200111). N E Ismail reports leadership or fiduciary roles in other board, society, committee, or advocacy groups (unpaid) as the Bursar and Council Member of the Malaysian Academy of Pharmacy and is a member of the Committee of the Malaysian Pharmacists Society Education Chapter, outside the submitted work. J J Jozwiak reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Novartis, Adamed, and Amgen, outside the submitted work. K Krishan reports non-financial support from the UGC Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, Panjab University (Chandigarh, India), outside the submitted work. M-C Li reports grants or contracts from the National Science and Technology Council, Taiwan (NSTC 112-2410-H-003-031); and leadership or fiduciary roles in board, society, committee, or advocacy groups (paid or unpaid) as Technical Editor with the Journal of the American Heart Association, all outside the submitted work. L Monasta reports support from the Italian Ministry of Health (Ricerca Corrente 34/2017) and payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo, outside the submitted work. C E Moore reports participation on an advisory board for an MRC grant with Gwen Knight (unpaid), WHO Advisory Group for the WHO Medically Important Antimicrobial List, and REVIVE Advisory Group as member of the steering group; and leadership or fiduciary roles in board, society, committee, or advocacy groups (unpaid) with the Microbiology Society as Co-chair of Impact and Influence Group, all outside the submitted work. A P Okekunle reports support for the present manuscript from the National Research Foundation of Korea funded by the Ministry of Science and ICT (2020H1D3A1A04081265) and support for attending meetings or travel from the National Research Foundation of Korea (funded by the Ministry of Science and ICT; 2020H1D3A1A04081265), outside the submitted work. E Ortiz-Prado reports grants or contracts from Universidad de las Americas, outside the submitted work. L F Reyes reports grants or contracts from MSD; consulting fees from GSK, MSD, and Pfizer; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from GSK, MSD, and Pfizer; payment for expert testimony from GSK and MSD; and support for attending meetings or travel from GSK and Pfizer, outside the submitted work. O Rezahosseini reports support for attending meetings or travel from the Research Department of Nordsjælands Hospital and European Society of Clinical Microbiology and Infectious Diseases 2024, outside the submitted work. L Ronfani reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017; payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo). Y L Samodra reports a leadership or fiduciary role in a board, society, committee, or advocacy group (paid or unpaid) as co-founder of Benang Merah Research Center (bmrc.id), outside the submitted work. S Saxena reports grants or contracts and support for attending meetings or travel from the National Institute for Health and Care Research (NIHR) Senior Investigator Award, NIHR School for Public Health Research (grant number NIHR 204000), NIHR Northwest London Applied Research Collaboration; participation on a data safety monitoring board or advisory board with the BMJ International Editorial Board (advisory, unpaid) and the NIHR (Academy Chair, £7500 per annum honorarium paid to their institution); and leadership or fiduciary roles in board, society, committee, or advocacy groups (paid or unpaid) with the European Public Health Association as President of the Child and Adolescent Health Section, all outside the submitted work. B M Schaarschmidt reports research grants from Else Kröner-Fresenius Foundation, Deutsche Forschungsgemeinschaft, and PharmaCept GmbH; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AstraZeneca; and support for travel from Bayer, all outside the submitted work. A Sharifan reports leadership or fiduciary roles in other board, society, committee, or advocacy groups (unpaid) as a steering committee member of Cochrane; and receipt of equipment, materials, drugs, medical writing, gifts, or other services from Elsevier, outside the submitted work. C R Simpson reports grants from HRC (New Zealand), Ministry of Health (New Zealand), MBIE (New Zealand), Chief Scientist Office (UK), and MRC (UK); and leadership or fiduciary roles in other board, society, committee, or advocacy groups (paid or unpaid) as a Chair of the New Zealand Government Data Ethics Advisory Group, outside the submitted work. J A Singh reports consulting fees from ROMTech, Atheneum, ClearView Healthcare Partners, American College of Rheumatology, Yale, Hulio, Horizon Pharmaceuticals, DINORA, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM, Trio Health, Medscape, WebMD, Practice Point Communications, and the National Institutes of Health; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events on the speakers bureau of Simply Speaking; support for attending meetings or travel from OMERACT as a steering committee member; participation on a data safety monitoring board or advisory board with the FDA Arthritis Advisory Committee; leadership or fiduciary roles in other board, society, committee, or advocacy groups as a past steering committee member of the OMERACT (an international organisation that develops measures for clinical trials and receives arm's-length funding from 12 pharmaceutical companies; paid), as Chair of the Veterans Affairs Rheumatology Field Advisory Committee (unpaid), and as the Editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis (unpaid); stock or stock options in Atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals, Aebona Pharmaceuticals, and Charlotte's Web, and previously owned stock options in Amarin, Viking, and Moderna Pharmaceuticals, outside the submitted work. J H V Ticoalu reports leadership or fiduciary roles in board, society, committee, or advocacy groups (paid or unpaid) with Benang Merah Research Center (bmrc.id) as a co-founder, outside the submitted work. E Upadhyay reports the following published patents: a system and method of reusable filters for anti-pollution mask; a system and method for electricity generation through crop stubble by using microbial fuel cells; a system for disposed personal protection equipment into biofuel through pyrolysis and method; and a novel herbal pharmaceutical aid for formulation of gel and method thereof. E Upadhyay also reports patents filed: herbal drug formulation for treating lung tissue degenerated by particulate matter exposure; and a method to transform cow dung into the wall paint by using natural materials and composition thereof. Additionally, E Upadhyay reports leadership or fiduciary roles in other board, society, committee, or advocacy groups (paid or unpaid) as Joint Secretary of Indian Meteorological Society, Jaipur Chapter (India), and as Member-Secretary of DSTPURSE Program, outside the submitted work. M Zielińska reports other financial interests as an employee of AstraZeneca, outside the submitted work.

Figures

Figure 1
Figure 1
URI and otitis media incidence rates (A) and DALY rates (B) per 100 000 population, by super-region, in 1990 and 2021 Shaded areas are 95% uncertainty intervals. DALY=disability-adjusted life-year. URI=upper respiratory infection.
Figure 2
Figure 2
Global URI episodes in millions (A) and incidence rates per 100 000 population (B), by age, in 1990 and 2021 URI=upper respiratory infection.
Figure 3
Figure 3
Global otitis media episodes in millions (A) and incidence rates per 100 000 population (B), by age, in 1990 and 2021
Figure 4
Figure 4
Combined YLD rates of URIs and otitis media globally, by age, in 2021 URIs=upper respiratory infections. YLD=years lived with disability.
Figure 5
Figure 5
Maps of combined YLD rates (A) and DALY rates (B) for upper respiratory infections and otitis media in 2021 DALY=disability-adjusted life-year. YLD=years lived with disability.
See this image and copyright information in PMC

References

    1. Global Burden of Disease Study 2013 Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:743–800. - PMC - PubMed
    1. Fendrick AM, Monto AS, Nightengale B, Sarnes M. The economic burden of non-influenza-related viral respiratory tract infection in the United States. Arch Intern Med. 2003;163:487–494. - PubMed
    1. Duan KI, Birger M, Au DH, Spece LJ, Feemster LC, Dieleman JL. Health care spending on respiratory diseases in the United States, 1996–2016. Am J Respir Crit Care Med. 2023;207:183–192. - PMC - PubMed
    1. Dixon RE. Economic costs of respiratory tract infections in the United States. Am J Med. 1985;78:45–51. - PubMed
    1. Klein JO. The burden of otitis media. Vaccine. 2000;19(suppl 1):S2–S8. - PubMed