Global, regional, national burden of asthma from 1990 to 2021, with projections of incidence to 2050: a systematic analysis of the global burden of disease study 2021

Abstract

Background: Asthma is the second leading cause of mortality among chronic respiratory illnesses. This study provided a comprehensive analysis of the burden of asthma.

Methods: Data on asthma were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. We focused on the effects of age, sex, risk factors, and the socio-demographic index (SDI) on the burden of asthma and calculated the average annual percent change (AAPC) via joinpoint regression. Two-sample Mendelian randomization (MR) was adopted to estimate the causal relationships between risk factors and asthma. The Bayesian age-period-cohort (BAPC) model was used to predict incidence patterns of asthma from 2022 to 2050.

Findings: In 2021, there was an observed prevalence of asthma, with 3,340 cases per 100,000 people. Males who were below 20 years old had a greater prevalence of asthma. The incidence and prevalence correlated positively with the SDI, whereas mortality and disability-adjusted life years (DALYs) correlated negatively. The contribution of high body mass index (BMI) to asthma DALYs increased by 4.3% worldwide between 1990 and 2021. MR studies have confirmed that high BMI and smoking can increase the risk of asthma. The prediction results indicated that the global age-standardised incidence rate will remain high from 2022 to 2050.

Interpretation: The global mortality of patients with asthma is a significant concern. The analysis of the burden of asthma can help formulate public health policies, allocate resources, and prevent asthma.

Funding: This study was supported by the National Natural Science Foundation of China; Program for Young Talents of Basic Research in Universities of Heilongjiang Province; Marshal Initiative Funding; Mathematical Tianyuan Fund of the National Natural Science Foundation of China; XingLian Outstanding Talent Support Program 2024.

Keywords: Asthma; GBD 2021; Mendelian randomization; Prediction; Risk factors.

Fig. 1

The age-standardised prevalence rates of asthma and the AAPC of age-standardised prevalence rates from 204 countries and territories. Notes: (A) Age-standardised prevalence rate in 2021. (B) AAPC of age-standardised prevalence rate from 1990 to 2021. AAPC, average annual percent change.

Fig. 2

The number of DALYs and age-standardized DALY rates of asthma in 2021 by sex. Notes: DALYs, disability-adjusted life years. Dotted lines indicate 95% upper and lower uncertainty intervals, respectively.

Fig. 3

Temporal trend of age-standardised prevalence rates, age-standardised incidence rates, age-standardised disability-adjusted life years rates and age-standardised mortality rates for the burden of asthma, globally and by socio-demographic index from 1990 to 2021. The average annual percent change, globally and by socio-demographic levels, from 1990 to 2021. Notes: Five levels of socio-demographic index, high, high-middle, middle, low-middle, or low. ASPR, age-stadardised prevalence rate per 100,000 people. ASIR, age-stadardised incidence rate per 100,000 people. ASDR, age-stadardised DALY rate per 100,000 people. ASMR, age-stadardised mortality rate per 100,000 people.

Fig. 4

Association between SDI and age-standardised prevalence, incidence, DALY and mortality rates of asthma in 2021 and corresponding AAPC from 1990 to 2021. Notes: (A) ASPR and SDI. (B) ASIR and SDI. (C) ASDR and SDI. (D) ASMR and SDI. (E) AAPC of ASPR and SDI. (F) AAPC of ASIR and SDI. (G) AAPC of ASDR and SDI. (H) AAPC of ASMR and SDI. Dotted lines refer to the global level of rates. SDI, socio-demographic index. AAPC, average annual percent change. ASPR, age-stadardised prevalence rate per 100,000 people. ASIR, age-stadardised incidence rate per 100,000 people. ASDR, age-stadardised DALY rate per 100,000 people. ASMR, age-stadardised mortality rate per 100,000 people.

Fig. 5

Proportion of asthma DALYs caused by high body mass index in 1990 and 2021 from different regions and sex. Notes: DALYs, disability-adjusted life years.

Fig. 6

Forest plot of Mendelian randomization analysis. Notes: (A) The associations of body mass index with risk of asthma. (B) The associations of current pack years of smoking with risk of asthma. BMI, body mass index.

Fig. 7

The trends of age-standardized incidence rates for each age group of asthma in worldwide from 2022 to 2050 predicted by Bayesian age-period-cohort model. Notes: (A) Male. (B) Female. Blue shades are the corresponding confidence intervals.