TY - JOUR
T1 - Age–sex differences in the global burden of lower respiratory infections and risk factors, 1990–2019
T2 - results from the Global Burden of Disease Study 2019
AU - GBD 2019 LRI Collaborators
AU - Kyu, Hmwe Hmwe
AU - Vongpradith, Avina
AU - Sirota, Sarah Brooke
AU - Novotney, Amanda
AU - Troeger, Christopher E.
AU - Doxey, Matthew C.
AU - Bender, Rose G.
AU - Ledesma, Jorge R.
AU - Biehl, Molly H.
AU - Albertson, Samuel B.
AU - Frostad, Joseph Jon
AU - Burkart, Katrin
AU - Bennitt, Fiona B.
AU - Zhao, Jeff T.
AU - Gardner, William M.
AU - Hagins, Hailey
AU - Bryazka, Dana
AU - Dominguez, Regina Mae Villanueva
AU - Abate, Semagn Mekonnen
AU - Abdelmasseh, Michael
AU - Abdoli, Amir
AU - Abdoli, Gholamreza
AU - Abedi, Aidin
AU - Abedi, Vida
AU - Abegaz, Tadesse M.
AU - Abidi, Hassan
AU - Aboagye, Richard Gyan
AU - Abolhassani, Hassan
AU - Abtew, Yonas Derso
AU - Abubaker Ali, Hiwa
AU - Abu-Gharbieh, Eman
AU - Abu-Zaid, Ahmed
AU - Adamu, Kidist
AU - Addo, Isaac Yeboah
AU - Adegboye, Oyelola A.
AU - Adnan, Mohammad
AU - Adnani, Qorinah Estiningtyas Sakilah
AU - Afzal, Muhammad Sohail
AU - Afzal, Saira
AU - Ahinkorah, Bright Opoku
AU - Ahmad, Aqeel
AU - Ahmad, Araz Ramazan
AU - Ahmad, Sajjad
AU - Ahmadi, Ali
AU - Ahmadi, Sepideh
AU - Ahmed, Haroon
AU - Ahmed, Jivan Qasim
AU - Ahmed Rashid, Tarik
AU - Akbarzadeh-Khiavi, Mostafa
AU - Al Hamad, Hanadi
AU - Albano, Luciana
AU - Aldeyab, Mamoon A.
AU - Alemu, Bezatu Mengistie
AU - Alene, Kefyalew Addis
AU - Algammal, Abdelazeem M.
AU - Alhalaiqa, Fadwa Alhalaiqa Naji
AU - Alhassan, Robert Kaba
AU - Ali, Beriwan Abdulqadir
AU - Ali, Liaqat
AU - Ali, Musa Mohammed
AU - Ali, Syed Shujait
AU - Alimohamadi, Yousef
AU - Alipour, Vahid
AU - Al-Jumaily, Adel
AU - Aljunid, Syed Mohamed
AU - Almustanyir, Sami
AU - Al-Raddadi, Rajaa M.
AU - Al-Rifai, Rami H.Hani
AU - AlRyalat, Saif Aldeen S.
AU - Alvis-Guzman, Nelson
AU - Alvis-Zakzuk, Nelson J.
AU - Ameyaw, Edward Kwabena
AU - Aminian Dehkordi, Javad Javad
AU - Amuasi, John H.
AU - Amugsi, Dickson A.
AU - Anbesu, Etsay Woldu
AU - Ansar, Adnan
AU - Anyasodor, Anayochukwu Edward
AU - Arabloo, Jalal
AU - Areda, Demelash
AU - Argaw, Ayele Mamo
AU - Argaw, Zeleke Gebru
AU - Arulappan, Judie
AU - Aruleba, Raphael Taiwo
AU - Asemahagn, Mulusew A.
AU - Athari, Seyyed Shamsadin
AU - Atlaw, Daniel
AU - Attia, Engi F.
AU - Attia, Sameh
AU - Aujayeb, Avinash
AU - Awoke, Tewachew
AU - Ayana, Tegegn Mulatu
AU - Ayanore, Martin Amogre
AU - Azadnajafabad, Sina
AU - Azangou-Khyavy, Mohammadreza
AU - Azari, Samad
AU - Azari Jafari, Amirhossein
AU - Badar, Muhammad
AU - Badiye, Ashish D.
AU - Baghcheghi, Nayereh
AU - Bagherieh, Sara
AU - Baig, Atif Amin
AU - Banach, Maciej
AU - Banerjee, Indrajit
AU - Bardhan, Mainak
AU - Barone-Adesi, Francesco
AU - Barqawi, Hiba Jawdat
AU - Barrow, Amadou
AU - Bashiri, Azadeh
AU - Bassat, Quique
AU - Batiha, Abdul Monim Mohammad
AU - Belachew, Abate Bekele
AU - Belete, Melaku Ashagrie
AU - Belgaumi, Uzma Iqbal
AU - Bhagavathula, Akshaya Srikanth
AU - Bhardwaj, Nikha
AU - Bhardwaj, Pankaj
AU - Bhatt, Parth
AU - Bhojaraja, Vijayalakshmi S.
AU - Bhutta, Zulfiqar A.
AU - Bhuyan, Soumitra S.
AU - Bijani, Ali
AU - Bitaraf, Saeid
AU - Bodicha, Belay Boda Abule
AU - Briko, Nikolay Ivanovich
AU - Buonsenso, Danilo
AU - Butt, Muhammad Hammad
AU - Cai, Jiao
AU - Camargos, Paulo
AU - Cámera, Luis Alberto
AU - Chakraborty, Promit Ananyo
AU - Chanie, Muluken Genetu
AU - Charan, Jaykaran
AU - Chattu, Vijay Kumar
AU - Ching, Patrick R.
AU - Choi, Sungchul
AU - Chong, Yuen Yu
AU - Choudhari, Sonali Gajanan
AU - Chowdhury, Enayet Karim
AU - Christopher, Devasahayam J.
AU - Chu, Dinh Toi
AU - Cobb, Natalie L.
AU - Cohen, Aaron J.
AU - Cruz-Martins, Natália
AU - Dadras, Omid
AU - Dagnaw, Fentaw Teshome
AU - Dai, Xiaochen
AU - Dandona, Lalit
AU - Dandona, Rakhi
AU - Dao, An Thi Minh
AU - Debela, Sisay Abebe
AU - Demisse, Biniyam
AU - Demisse, Fitsum Wolde
AU - Demissie, Solomon
AU - Dereje, Diriba
AU - Desai, Hardik Dineshbhai
AU - Desta, Abebaw Alemayehu
AU - Desye, Belay
AU - Dhingra, Sameer
AU - Diao, Nancy
AU - Diaz, Daniel
AU - Digesa, Lankamo Ena
AU - Doan, Linh Phuong
AU - Dodangeh, Milad
AU - Dongarwar, Deepa
AU - Dorostkar, Fariba
AU - dos Santos, Wendel Mombaque
AU - Dsouza, Haneil Larson
AU - Dubljanin, Eleonora
AU - Durojaiye, Oyewole Christopher
AU - Edinur, Hisham Atan
AU - Ehsani-Chimeh, Elham
AU - Eini, Ebrahim
AU - Ekholuenetale, Michael
AU - Ekundayo, Temitope Cyrus
AU - El Desouky, Eman D.
AU - El Sayed, Iman
AU - El Sayed Zaki, Maysaa
AU - Elhadi, Muhammed
AU - Elkhapery, Ahmed Mahmoud Rabie
AU - Emami, Amir
AU - Engelbert Bain, Luchuo
AU - Erkhembayar, Ryenchindorj
AU - Etaee, Farshid
AU - Ezati Asar, Mohamad
AU - Fagbamigbe, Adeniyi Francis
AU - Falahi, Shahab
AU - Fallahzadeh, Aida
AU - Faraj, Anwar
AU - Faraon, Emerito Jose A.
AU - Fatehizadeh, Ali
AU - Ferrara, Pietro
AU - Ferrari, Allegra Allegra
AU - Fetensa, Getahun
AU - Fischer, Florian
AU - Flavel, Joanne
AU - Foroutan, Masoud
AU - Gaal, Peter Andras
AU - Gaidhane, Abhay Motiramji
AU - Gaihre, Santosh
AU - Galehdar, Nasrin
AU - Garcia-Basteiro, Alberto L.
AU - Garg, Tushar
AU - Gebrehiwot, Mesfin Damtew
AU - Gebremichael, Mathewos Alemu
AU - Gela, Yibeltal Yismaw
AU - Gemeda, Belete Negese Belete
AU - Gessner, Bradford D.
AU - Getachew, Melaku
AU - Getie, Asmare
AU - Ghamari, Seyyed Hadi
AU - Ghasemi Nour, Mohammad
AU - Ghashghaee, Ahmad
AU - Gholamrezanezhad, Ali
AU - Gholizadeh, Abdolmajid
AU - Ghosh, Rakesh
AU - Ghozy, Sherief
AU - Goleij, Pouya
AU - Golitaleb, Mohamad
AU - Gorini, Giuseppe
AU - Goulart, Alessandra C.
AU - Goyomsa, Girma Garedew
AU - Guadie, Habtamu Alganeh
AU - Gudisa, Zewdie
AU - Guled, Rashid Abdi
AU - Gupta, Sapna
AU - Gupta, Veer Bala
AU - Gupta, Vivek Kumar
AU - Guta, Alemu
AU - Habibzadeh, Parham
AU - Haj-Mirzaian, Arvin
AU - Halwani, Rabih
AU - Hamidi, Samer
AU - Hannan, Md Abdul
AU - Harorani, Mehdi
AU - Hasaballah, Ahmed I.
AU - Hasani, Hamidreza
AU - Hassan, Abbas M.
AU - Hassani, Shokoufeh
AU - Hassanian-Moghaddam, Hossein
AU - Hassankhani, Hadi
AU - Hayat, Khezar
AU - Heibati, Behzad
AU - Heidari, Mohammad
AU - Heyi, Demisu Zenbaba
AU - Hezam, Kamal
AU - Holla, Ramesh
AU - Hong, Sung Hwi
AU - Horita, Nobuyuki
AU - Kandel, Himal
PY - 2022/11
Y1 - 2022/11
N2 - Background: The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. Methods: In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7, and 487–489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4, and U04–U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age–sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age–sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors.Findings: Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240–275) LRI incident episodes in males and 232 million (217–248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (–70·7% [–77·2 to –61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) of LRI deaths.Interpretation: The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities. Funding: Bill & Melinda Gates Foundation.
AB - Background: The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. Methods: In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7, and 487–489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4, and U04–U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age–sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age–sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors.Findings: Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240–275) LRI incident episodes in males and 232 million (217–248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (–70·7% [–77·2 to –61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) of LRI deaths.Interpretation: The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities. Funding: Bill & Melinda Gates Foundation.
KW - Global Burden of Disease
KW - Respiratory disease
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=85136647628&partnerID=8YFLogxK
U2 - 10.1016/S1473-3099(22)00510-2
DO - 10.1016/S1473-3099(22)00510-2
M3 - Article
C2 - 35964613
AN - SCOPUS:85136647628
SN - 1473-3099
VL - 22
SP - 1626
EP - 1647
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 11
ER -