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 Jun 26;10(7):180.
doi: 10.3390/tropicalmed10070180.

Global Trends and Attributable Risk Factors in the Disease Burden of Lower Respiratory Infections

E Yu  1 , Chunhui Li  1
Affiliations

Global Trends and Attributable Risk Factors in the Disease Burden of Lower Respiratory Infections

E Yu et al. Trop Med Infect Dis. .

Abstract

Background: Lower respiratory infections (LRIs) are the leading cause of the global disease burden, accounting for millions of deaths each year.

Methods: Data on LRIs, including deaths, disability-adjusted life years (DALYs), and incidence, were obtained from the Global Burden of Disease Study 2021. Joinpoint regression was employed to assess temporal trends in the LRIs' burden, while the age-period-cohort model was used to evaluate age, period, and cohort effects. Pearson's correlation coefficients were calculated to examine the relationship between DALYs attributable to risk factors and the socio-demographic index (SDI).

Results: Over recent decades, the average annual percentage change in age-standardized mortality rate, age-standardized DALYs rate, and age-standardized incidence rate of LRIs globally were -2.4%, -3.5%, and -1.3%, respectively. Notably, the LRIs' burden dropped considerably from 2019 to 2021. The disease burden was higher among children under five and individuals over 60 compared to other age groups. In terms of gender, males had a higher burden. The age-standardized DALYs rate of LRIs was strongly and negatively correlated with SDI (r = -0.84; p < 0.05). Streptococcus pneumoniae remained the leading pathogen, followed by Staphylococcus aureus, and Klebsiella pneumoniae.

Conclusions: In recent years, the global burden of LRIs has declined, but regional, gender, and age disparities persist. Targeted measures are needed to address high-risk populations and major risk factors.

Keywords: age–period–cohort model; lower respiratory infections; risk factors; variation trend; worldwide disease burden.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Global burden and temporal trends of lower respiratory infections in countries and territories. (a) ASMR in 2021; (b) AAPC of ASMR from 1980 to 2021; (c) ASDR in 2021; (d) AAPC of ASDR from 1990 to 2021; (e) ASIR in 2021; (f) AAPC of ASIR from 1990 to 2021. ASMR, age-standardized mortality rate; AAPC, average annual percentage change; ASDR, age-standardized disability-adjusted life years rate; ASIR, age-standardized incidence rate.
Figure 2
Figure 2
Global burden of lower respiratory infections by age and sex in 2021. (a) Deaths; (b) DALYs; (c) incidence. DALYs, disability-adjusted life years.
Figure 3
Figure 3
Age–period–cohort model analysis of deaths (1980–2021), d DALYs (1990–2021) and incidence (1990–2021) rates of lower respiratory infections globally by sex. DALYs, disability-adjusted life years.
Figure 4
Figure 4
Percentage of DALYs due to lower respiratory infections attributable to risk factors by sex and age globally in 2021. (a) Sex; (b) age. DALYs, disability-adjusted life years.
Figure 5
Figure 5
AAPC of lower respiratory infections DALYs attributable to risk factors by sex and age globally from 1990 to 2021. (a) Sex; (b) age. AAPC, average annual percentage change; DALYs, disability-adjusted life years.
Figure 6
Figure 6
Etiology distribution of global lower respiratory infections ASMR and ASDR by sex in 2021. (a) ASMR; (b) ASDR. ASMR, age-standardized mortality rate; ASDR, age-standardized disability-adjusted life years rate.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kyu H.H., Vongpradith A., Sirota S.B., Novotney A., Troeger C.E., Doxey M.C., Bender R.G., Ledesma J.R., Biehl M.H., Albertson S.B., et al. 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;22:1626–1647. doi: 10.1016/S1473-3099(22)00510-2. - DOI - PMC - PubMed
    1. Ruan Z.L., Qi J.L., Qian Z.M., Zhou M.G., Yang Y., Zhang S.Y., Vaughn M.G., LeBaige M.H., Yin P., Lin H.L. Disease burden and attributable risk factors of respiratory infections in China from 1990 to 2019. Lancet Reg. Health. 2021;11:100153. doi: 10.1016/j.lanwpc.2021.100153. - DOI - PMC - PubMed
    1. Naghavi M., Ong K.L., Aali A., Ababneh H.S., Abate Y.H., Abbafati C., Abbasgholizadeh R., Abbasian M., Abbasi-Kangevari M., Abbastabar H., et al. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: A systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403:2100–2132. doi: 10.1016/S0140-6736(24)00367-2. - DOI - PMC - PubMed
    1. Li J., Xu L., Zuo A.F., Xu P., Xu K. The global burden of Klebsiella pneumoniae-associated lower respiratory infection in 204 countries and territories, 1990–2021: Findings from the global burden of disease study 2021. PLoS ONE. 2025;20:e0324151. doi: 10.1371/journal.pone.0324151. - DOI - PMC - PubMed
    1. Asseri A.A. Respiratory Syncytial Virus: A Narrative Review of Updates and Recent Advances in Epidemiology, Pathogenesis, Diagnosis, Management and Prevention. J. Clin. Med. 2025;14:3880. doi: 10.3390/jcm14113880. - DOI - PMC - PubMed

LinkOut - more resources