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. 2025 May;13(5):425-446.
doi: 10.1016/S2213-2600(25)00003-7. Epub 2025 Mar 24.

Global, regional, and national burden of asthma and atopic dermatitis, 1990-2021, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

GBD 2021 Asthma and Allergic Diseases Collaborators
Collaborators

Global, regional, and national burden of asthma and atopic dermatitis, 1990-2021, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

GBD 2021 Asthma and Allergic Diseases Collaborators. Lancet Respir Med. 2025 May.

Abstract

Background: Asthma and atopic dermatitis are common allergic conditions that contribute to substantial health loss, economic burden, and pain across individuals of all ages worldwide. Therefore, as a component of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we present updated estimates of the prevalence, disability-adjusted life-years (DALYs), incidence, and deaths due to asthma and atopic dermatitis and the burden attributable to modifiable risk factors, with forecasted prevalence up to 2050.

Methods: Asthma and atopic dermatitis prevalence, incidence, DALYs, and mortality, with corresponding 95% uncertainty intervals (UIs), were estimated for 204 countries and territories from 1990 to 2021. A systematic review identified data from 389 sources for asthma and 316 for atopic dermatitis, which were further pooled using the Bayesian meta-regression tool. We also described the age-standardised DALY rates of asthma attributable to four modifiable risk factors: high BMI, occupational asthmagens, smoking, and nitrogen dioxide pollution. Furthermore, as a secondary analysis, prevalence was forecasted to 2050 using the Socio-demographic Index (SDI), air pollution, and smoking as predictors for asthma and atopic dermatitis. To assess trends in the burden of asthma and atopic dermatitis before (2010-19) and during (2019-21) the COVID-19 pandemic, we compared their average annual percentage changes (AAPCs).

Findings: In 2021, there were an estimated 260 million (95% UI 227-298) individuals with asthma and 129 million (124-134) individuals with atopic dermatitis worldwide. Asthma cases declined from 287 million (250-331) in 1990 to 238 million (209-272) in 2005 but increased to 260 million in 2021. Atopic dermatitis cases consistently rose from 107 million (103-112) in 1990 to 129 million (124-134) in 2021. However, age-standardised prevalence rates decreased-by 40·0% (from 5568·3 per 100 000 to 3340·1 per 100 000) for asthma and 8·3% (from 1885·4 per 100 000 to 1728·5 per 100 000) for atopic dermatitis. In 2021, there were substantial variations in the burden of asthma and atopic dermatitis across different SDI groups, with the highest age-standardised DALY rate found in south Asia for asthma (465·0 [357·2-648·9] per 100 000) and the high-income super-region for atopic dermatitis (3552·5 [3407·2-3706·1] per 100 000). During the COVID-19 pandemic, the decline in asthma prevalence had stagnated (AAPC pre-pandemic -1·39% [-2·07 to -0·71] and during the pandemic 0·47% [-1·86 to 2·79]; p=0·020); however, there was no significant difference in atopic dermatitis prevalence in the same period (pre-pandemic -0·28% [-0·33 to -0·22] and during the pandemic -0·35% [-0·78 to 0·08]; p=0·20). Modifiable risk factors were responsible for 29·9% of the global asthma DALY burden; among them, high BMI was the greatest contributor (39·4 [19·6-60·2] per 100 000), followed by occupational asthmagens (20·8 [16·7-26·5] per 100 000) across all regions. The age-standardised DALY rate of asthma attributable to high BMI was highest in high-SDI settings, whereas the contribution of occupational asthmagens was highest in low-SDI settings. According to our forecasting models, we expect 275 million (224-330) asthma cases and 148 million (140-158) atopic dermatitis cases in 2050, with population growth driving this increase. However, age-standardised prevalence rates are expected to remain stable (-23·2% [-44·4 to 5·3] for asthma and -1·4% [-9·1 to 7·0] for atopic dermatitis) from 2021 to 2050.

Interpretation: Although the increases in the total number of asthma and atopic dermatitis cases will probably continue until 2050, age-standardised prevalence rates are expected to remain stable. A considerable portion of the global burden could be managed through efforts to address modifiable risk factors. Additionally, the contribution of risk factors to the burden substantially varied by SDI, which suggests the need for tailored initiatives for specific SDI settings. The growing number of individuals expected to be affected by asthma and atopic dermatitis in the future suggests that it is essential to improve our understanding of risk factors for asthma and atopic dermatitis and collect disease prevalence data that are globally generalisable.

Funding: Gates Foundation.

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Conflict of interest statement

Declaration of interests M L Bell reports grants or contracts from US EPA, National Institutes of Health (NIH), Hutchinson Postdoctoral Fellowship, Health Effects Institute, Yale Women Faculty Forum, Robert Wood Johnson Foundation, Yale Institute for Biospheric Studies, and Wellcome Trust Foundation; consulting fees from Clinique and ToxiMap; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Colorado School of Public Health, Duke University, University of Texas, Data4Justice, Korea University, University of Pennsylvania, Brown University, Northeastern University, IOP Publishing, NIH, Health Canada, EHS, PAC-10, UKRI, AXA Research Fund Fellowship, Harvard University, University of Montana, and SciQuest; support for attending meetings or travel from Colorado School of Public Health, University of Texas, Duke University, Harvard University, American Journal of Public Health, Columbia University, Harvard University, CMAS Conference, and Nature Conference; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid with Fifth National Climate Assessment, Lancet Countdown, US EPA Clean Air Scientific Advisory Committee (CASAC), Johns Hopkins EHE Advisory Board, Harvard external advisory committee for training grant, WHO Global Air Pollution and Health Technical Advisory Group, and the National Academies Panels and Committees, outside the submitted work. T C Ekundayo reports grants or contracts from PDF Research Fellowship, University of South Africa, outside the submitted work. I M Ilic reports support for the present manuscript from the Ministry of Education, Science and Technological development, Republic of Serbia (project No 175042, 2011-2023). 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. M-C Li reports support for the present manuscript from the National Science and Technology Council, Taiwan (NSTC 113-2314-B-003-002); leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as the Technical Editor, Journal of the American Heart Association, outside the submitted work. L Monasta 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. B Oancea reports grants or contracts from PNRR/2022/C9/MCID/I8 project 760096, outside the submitted work. N E Ismail reports leadership or fiduciary role in other board, society, committee, or advocacy group, unpaid as The Bursar and Council Member of Malaysian Academy of Pharmacy (Malaysia) and as Committee Member of Malaysian Pharmacists Society Education Chapter Committee, 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 and J H V Ticoalu report a leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid as the co-founders of Benang Merah Research Center, Indonesia, outside the submitted work. J I Shin reports other financial or non-financial interests from the Yonsei Fellowship, funded by Lee Youn Jae (to J I Shin). J A Singh reports consulting fees from ROMTech, Atheneum, ClearView Healthcare Partners, American College of Rheumatology, Yale University, Hulio, Horizon Pharmaceuticals, DINORA, ANI/Exeltis USA, 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 NIH; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Simply Speaking; support for attending meetings or travel from OMERACT; participation on a Data Safety Monitoring Board or Advisory Board as a member of the FDA Arthritis Advisory Committee; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as a past steering committee member of the OMERACT; stock or stock options in atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart, Atyu BioPharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp, Aebona Pharmaceuticals, and Charlotte's Web Holdingss; and previous ownership of stock options in Amarin, Viking, and Moderna Pharmaceuticals, outside the submitted work. E Upadhyay reports patents planned, issued, or pending: 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), A novel herbal pharmaceutical aid for formulation of gel and method thereof (Published), Herbal drug formulation for treating lung tissue degenerated by particulate matter exposure (published), A method to transform cow dung into the wall paint by using natural materials and composition thereof (filed); leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as the Executive Council Member, Indian Meteorological Society, Jaipur Chapter (India) and as Member Secretary of DSTPURSE Program, outside the submitted work. M Zielińska reports other financial or non-financial interests as an Alexion employee, outside the submitted work. All other authors declare no competing interests.

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