Effect of the lack of access to handwashing facilities on the global burden of lower respiratory infections, 1990-2019: A systematic analysis from the global burden of disease study 2019

Abstract

A lack of access to handwashing facilities is a significant risk factor for lower respiratory infections(LRIs). However, no studies have reported epidemiologic changes in the burden of LRIs attributed to the lack of access to handwashing facilities. We conducted an integrated assessment of the burden of LRIs attributable to the lack of handwashing facilities from 1990 to 2019 using data from the Global Burden of Disease Study 2019. In 2019, 270,000 deaths were attributed to LRIs due to a lack of access to handwashing facilities, with DALYs reaching 14.02 million. The age-standardized mortality rate (ASMR) of LRIs caused by a lack of access to handwashing facilities was approximately 3.74, while the age-standardized DALY rate (ASDR) was reported to be 203.55 in 2019. Over the past 30 years, the burden of LRIs attributed to the lack of access to handwashing facilities has shown a global decline. In 2019, this burden was most pronounced in infants under 1 year of age and in those older than 95 years, reflecting the highest DALY (5591.83) and mortality rates (79.43), respectively. The burden of LRIs caused by the lack of access to handwashing facilities was found to be more severe in males and significantly more pronounced in regions with a low sociodemographic index (SDI), such as the Sahara African region. The development of targeted strategies to address the inadequate and unequal distribution of handwashing facilities holds important value in improving the disease burden of LRIs.

Keywords: Global burden of disease; Lower respiratory infections; handwashing facilities.

Fig. 1

The global distribution of the ASDR of LRIs attributable to the lack of access to handwashing facilities in 2019, and the EAPC of ASDR from 1990 to 2019. ASDR of LRIs attributable to the lack of access to handwashing facilities in 204 countries and territories in 2019 (A). EAPC of ASDR of LRIs attributable to the lack of access to handwashing facilities from 1990 to 2019 in 204 countries and territories (B); ASDR, age-standardized disability-adjusted life years (DALYs) rate; LRIs, lower respiratory infections; EAPC, estimated annual percentage change.

Fig. 2

The DALY rates and mortality rates of LRIs attributable to the lack of handwashing facilities, in 2019, and the EAPC of the death rates and DALY rates from 1990 to 2019, vary among different age groups and genders globally. Global DALY (A) and mortality (B) rates of LRIs attributable to the lack of access to handwashing facilities in different age groups by genders in 2019. The EAPCs in the global DALY (C) and mortality (D) rates of LRIs attributable to the lack of access to handwashing facilities in different age groups by genders from 1990 to 2019. DALY, disability-adjusted life year; LRIs, lower respiratory infections; EAPC, estimated annual percentage change.

Fig. 3

The sex disparity in the burden of LRIs is attributable to the lack of access to handwashing facilities across SDI regions. The temporal trends in the ASMRs and ASDRs of LRIs attributable to the lack of access to handwashing facilities from 1990 to 2019 in different SDI regions. ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life years (DALY) rate; LRIs, lower respiratory infections; SDI, sociodemographic index.

Fig. 4

The association between ASDRs of LRIs attributable to the lack of handwashing facilities and the SDI levels in different regions from 1990 to 2019; ASDRs corresponding to SDI levels in different countries and territories in 2019. ASDRs and SDIs across all regions between 1990 and 2019 (A). ASDRs across all countries and territories in 2019 according to the SDI (B). The black line represents the expected ASDR corresponding to the SDI. ASDR, age-standardized disability-adjusted life years (DALY) rate; LRIs, lower respiratory infections; DALY, disability-adjusted life year; SDI, sociodemographic index.

Fig. 5

Decomposition analysis of the change in DALYs. Changes in the DALYs of LRIs attributable to the lack of access to handwashing facilities from 1990 to 2019 at the global level and five SDI regions decomposed by three population-level determinants: population aging, population growth and epidemiological changes. The black dots indicate the total value of change attributable to all three components. DALYs, disability-adjusted life years; LRIs, lower respiratory infections; SDI, sociodemographic index.