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 Apr 2:13:1554694.
doi: 10.3389/fpubh.2025.1554694. eCollection 2025.

Spatiotemporal analysis of the burden of lower respiratory infections in the older adult population due to air pollution: trends from 1990 to 2021 and predictions for the next 30 years

Zheng Lei  1 , Ziguo Sun  2 , Huiyu Li  1 , Ji Luo  1 , Li Zhang  1 , Yuanjun Zhang  1
Affiliations

Spatiotemporal analysis of the burden of lower respiratory infections in the older adult population due to air pollution: trends from 1990 to 2021 and predictions for the next 30 years

Zheng Lei et al. Front Public Health. .

Abstract

Background: Lower respiratory infections (LRI), caused by various pathogens, have significant impacts on global health. Air pollution is a major environmental factor in the development of LRI, and with ongoing urbanization and industrialization, it has become a critical public health concern. The older adult population, with declining immune function and physiological capabilities, exhibits reduced resistance to air pollution, making them a high-risk group for LRI. However, the spatiotemporal trends of LRI burden in the older adult and their association with air pollution remain understudied. This study analyzes the trends in LRI burden from 1990 to 2021 in relation to air pollution and predicts future trends from 2022 to 2050.

Methods: Using data from the Global Burden of Disease (GBD 2021) database, this study examines mortality rates and disability-adjusted life years (DALY) at global, regional, and national levels from 1990 to 2021. Age-standardized rates (ASR) and estimated annual percentage changes (EAPC) were used to compare burdens across regions and time periods. A Bayesian age-period-cohort (BAPC) model was applied to predict future trends. Data analysis was conducted using R programming to explore differences in burden across genders, age groups, and socioeconomic levels.

Results: From 1990 to 2021, the global burden of LRI due to air pollution generally declined, with the largest reduction in household air pollution from solid fuels. Regional differences were observed, with Asia and Africa showing increasing LRI burden from ambient particulate matter, especially in regions with lower socioeconomic development. Gender and age-specific analysis revealed that men and older populations face a higher burden, with the gap widening with age. The burden was negatively correlated with socioeconomic development. Predictions indicate a continued decrease in LRI burden due to secondhand smoke, while the LRI burden caused by ambient particulate matter and household air pollution may experience a rebound around 2035.

Conclusion: While the global burden of air pollution-related LRI in older adults has decreased, regions with lower economic development, particularly in parts of Asia and Africa, continue to face high and rising burdens. Efforts should focus on strengthening the resilience of high-risk groups and implementing targeted interventions.

Keywords: air pollution; epidemiology; global disease burden; lower respiratory infections; older adult population; trend predict.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Time trends of age-standardized mortality rate (per 100,000) (A) and age-standardized DALY rate (per 100,000) (B) for older adult populations with Lower Respiratory Infections due to air pollution from 1990 to 2021, globally and across five SDI regions. DALY, Disability-Adjusted Life Years; SDI, Socio-Demographic Index. The shaded area represents the 95% uncertainty interval.
Figure 2
Figure 2
Time trends of age-standardized mortality rate (per 100,000) for older adult populations with Lower Respiratory Infections due to air pollution from 1990 to 2021 in the 21 GBD regions. The shaded area represents the 95% uncertainty interval.
Figure 3
Figure 3
Time trends of age-standardized DALY rate (per 100,000) for older adult populations with Lower Respiratory Infections due to air pollution from 1990 to 2021 in the 21 GBD regions. DALYs, Disability-Adjusted Life Years. The shaded area represents the 95% uncertainty interval.
Figure 4
Figure 4
EAPC values of ASMR and ASDR (per 100,000) for older adult populations with Lower Respiratory Infections due to air pollution in the 27 GBD regions (1990–2021). (A) EAPC of ASMR by region for ambient particulate matter pollution. (B) EAPC of ASMR by region for household air pollution from solid fuels. (C) EAPC of ASMR by region for secondhand smoke. (D) EAPC of ASDR by region for ambient particulate matter pollution. (E) EAPC of ASDR by region for household air pollution from solid fuels. (F) EAPC of ASDR by region for secondhand smoke. EAPC, Estimated Annual Percentage Change; ASMR, Age-Standardized Mortality Rate; ASDR, Age-Standardized DALY Rate; DALY, Disability-Adjusted Life Years.
Figure 5
Figure 5
Spatial distribution of ASMR (per 100,000) and EAPC for older adult populations with Lower Respiratory Infections due to air pollution in 2021. (A) ASMR by region for ambient particulate matter pollution. (B) ASMR by region for household air pollution from solid fuels. (C) ASMR by region for secondhand smoke. (D) EAPC of ASMR by region for ambient particulate matter pollution. (E) EAPC of ASMR by region for household air pollution from solid fuels. (F) EAPC of ASMR by region for secondhand smoke. ASMR, Age-Standardized Mortality Rate; EAPC, Estimated Annual Percentage Change.
Figure 6
Figure 6
Spatial distribution of ASDR (per 100,000) and EAPC for older adult populations with Lower Respiratory Infections due to air pollution in 2021. (A) ASDR by region for ambient particulate matter pollution. (B) EAPC of ASDR by region for ambient particulate matter pollution. (C) ASDR by region for household air pollution from solid fuels. (D) EAPC of ASDR by region for household air pollution from solid fuels. (E) ASDR by region for secondhand smoke. (F) EAPC of ASDR by region for secondhand smoke. ASDR, Age-Standardized DALY Rate; DALY, Disability-Adjusted Life Years; EAPC, Estimated Annual Percentage Change.
Figure 7
Figure 7
Age and sex trends of the burden of Lower Respiratory Infections due to air pollution in older adult populations in 1990 and 2021. Panels (A–C) show the mortality rate (per 100,000). Panels (D–F) show the DALY rate (per 100,000). Panels (G–I) show the EAPC of mortality rate. Panels (J–L) show the EAPC of DALY rate. Yellow bars represent females, while blue bars represent males. DALY, Disability-Adjusted Life Years; EAPC, Estimated Annual Percentage Change.
Figure 8
Figure 8
The proportion of mortality and DALY rates of Lower Respiratory Infections in 27 GBD regions in 1990 and 2021 attributable to various air pollution exposures. (A) Proportion of deaths attributable to ambient particulate matter pollution, household air pollution from solid fuels, and secondhand smoke. (B) Proportion of DALYs attributable to ambient particulate matter pollution, household air pollution from solid fuels, and secondhand smoke. DALY, Disability-Adjusted Life Years.
Figure 9
Figure 9
From 1990 to 2021, the age-standardized mortality rate and DALY rate of Lower Respiratory Infections caused by air pollution in 21 GBD regions, classified by the Social Demographic Index (SDI). The expected values based on SDI and burden indicators for all locations are represented by black lines. Statistical test results are shown at the top left of each subplot. (A) ASMR for ambient particulate matter pollution. (B) ASMR for household air pollution from solid fuels. (C) ASMR for secondhand smoke. (D) ASDR for ambient particulate matter pollution. (E) ASDR for household air pollution from solid fuels. (F) ASDR for secondhand smoke. ASMR, Age-Standardized Mortality Rate; ASDR, Age-Standardized DALY Rate; DALY, Disability-Adjusted Life Years.
Figure 10
Figure 10
In 2021, age-standardized mortality rate and DALY rate of Lower Respiratory Infections caused by air pollution in 204 GBD countries and regions, classified by SDI. The expected values based on SDI and burden indicators for all locations are represented by black lines. Statistical test results are shown at the top left of each subplot. (A) ASMR for ambient particulate matter pollution. (B) ASMR for household air pollution from solid fuels. (C) ASMR for secondhand smoke. (D) ASDR for ambient particulate matter pollution. (E) ASDR for household air pollution from solid fuels. (F) ASDR for secondhand smoke. (G) EAPC of ASMR for ambient particulate matter pollution. (H) EAPC of ASMR for household air pollution from solid fuels. (I) EAPC of ASMR for secondhand smoke. (J) EAPC of ASDR for ambient particulate matter pollution. (K) EAPC of ASDR for household air pollution from solid fuels. (L) EAPC of ASDR for secondhand smoke. SDI, Social Demographic Index, ASMR, Age-Standardized Mortality Rate; ASDR, Age-Standardized DALY Rate; DALY, Disability-Adjusted Life Years. EAPC, Estimated Annual Percentage Change.
Figure 11
Figure 11
The projected trends of age-standardized mortality rate (per 100,000 people) (A) and age-standardized DALY rate (per 100,000 people) (B) for Lower Respiratory Infections attributable to air pollution in the older adult population. DALY, Disability-Adjusted Life Year.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the global burden of disease study 2021. Lancet. (2024) 403:2133–61. doi: 10.1016/S0140-6736(24)00757-8 - DOI - PMC - PubMed
    1. GBD 2021 Forecasting Collaborators. Burden of disease scenarios for 204 countries and territories, 2022-2050: a forecasting analysis for the global burden of disease study 2021. Lancet. (2024) 403:1961–3. doi: 10.1016/S0140-6736(24)00932-2 - DOI - PMC - PubMed
    1. GBD 2019 Lower Respiratory Infections Collaborators. Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019: results from the global burden of disease study 2019. Lancet Infect Dis. (2022) 22:1626–47. doi: 10.1016/S1473-3099(22)00510-2, PMID: - DOI - PMC - PubMed
    1. Falagas ME, Mourtzoukou EG, Vardakas KZ. Sex differences in the incidence and severity of respiratory tract infections. Respir Med. (2007) 101:1845–63. doi: 10.1016/j.rmed.2007.04.011, PMID: - DOI - PubMed
    1. Ursin RL, Klein SL. Sex differences in respiratory viral pathogenesis and treatments. Ann Rev Virol. (2021) 8:393–414. doi: 10.1146/annurev-virology-091919-092720, PMID: - DOI - PubMed

LinkOut - more resources