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. 2025 Oct;53(5):2191-2202.
doi: 10.1007/s15010-025-02566-0. Epub 2025 Jun 2.

Global, regional, and national burden of lower respiratory infections and chronic obstructive pulmonary disease, 1990-2021: a systematic analysis from the global burden of disease study 2021

Yi-Yuan Wang  1   2   3 , Jing Wang  1   2   3 , Zhang-Wei Lu  1   2   3 , Qian-Qian Zhou  1   2   3 , Yang-Guang Cao  1   2   3 , Yu-Jie Du  1   2   3 , Xue Jin  1   2   3 , Bao-Zhu Li  4   5   6   7
Affiliations

Global, regional, and national burden of lower respiratory infections and chronic obstructive pulmonary disease, 1990-2021: a systematic analysis from the global burden of disease study 2021

Yi-Yuan Wang et al. Infection. 2025 Oct.

Abstract

Purpose: This study evaluates the global burden of lower respiratory infections (LRIs) and chronic obstructive pulmonary disease (COPD), focusing on their combined impact across age groups and regions.

Methods: Data from 204 countries were analyzed using spatiotemporal Gaussian process regression to estimate LRI and COPD incidence, prevalence, and disability-adjusted life years (DALYs). Age-standardized ratios (ASR) and the Socio-Demographic Index (SDI) were used to compare disease burdens, with trends assessed via linear regression and restricted cubic spline models.

Results: In 2021, COPD and LRI caused 360 million cases and 5.9 million deaths, with the highest burden in low-SDI regions. COPD remained the fourth leading cause of death, while LRI dropped to seventh.

Conclusion: The bidirectional link between LRI and COPD exacerbates disease progression, disproportionately affecting low-income regions and aging populations. Addressing disparities in healthcare access, improving vaccines, and strengthening public health infrastructure are critical to reducing the global burden of these diseases.

Keywords: COPD; Chronic obstructive pulmonary disease; LRI; Lower respiratory infections.

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Conflict of interest statement

Declarations. Ethical approval: All data was downloaded on September 24, 2024 from the GBD 2021 database. As this study is based on the GBD 2021 database, which is open to the public. Therefore the Institutional Ethics Committee granted an exemption for this study as it did not require approval. The study adhered to the guidelines for accurate and transparent reporting of health assessments and information that could identify individual participants was not available. Competing interests: The authors declare no competing interests.

References

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