Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990–2021: a systematic analysis from the Global Burden of Disease Study 2021

Issued Date

2024-09-01

Resource Type

Article

ISSN

14733099

eISSN

14744457

DOI

10.1016/S1473-3099(24)00176-2

Scopus ID

2-s2.0-85191811208

Pubmed ID

38636536

Journal Title

The Lancet Infectious Diseases

Volume

24

Issue

9

Start Page

974

End Page

1002

Rights Holder(s)

SCOPUS

Bibliographic Citation

The Lancet Infectious Diseases Vol.24 No.9 (2024) , 974-1002

Suggested Citation

Bender R.G., Sirota S.B., Swetschinski L.R., Dominguez R.M.V., Novotney A., Wool E.E., Ikuta K.S., Vongpradith A., Rogowski E.L.B., Doxey M., Troeger C.E., Albertson S.B., Ma J., He J., Maass K.L., Simões E.A.F., Abdoun M., Aziz J.M.A., Abdulah D.M., Rumeileh S.A., Abualruz H., Aburuz S., Adepoju A.V., Adha R., Adikusuma W., Adra S., Afraz A., Aghamiri S., Agodi A., Ahmadzade A.M., Ahmed H., Ahmed A., Akinosoglou K., AL-Ahdal T.M.A., Al-Amer R.M., Albashtawy M., AlBataineh M.T., Alemi H., Al-Gheethi A.A.S., Ali A., Ali S.S.S., Alqahtani J.S., AlQudah M., Al-Tawfiq J.A., Al-Worafi Y.M., Alzoubi K.H., Amani R., Amegbor P.M., Ameyaw E.K., Amuasi J.H., Anil A., Anyanwu P.E., Arafat M., Areda D., Arefnezhad R., Atalell K.A., Ayele F., Azzam A.Y., Babamohamadi H., Babin F.X., Bahurupi Y., Baker S., Banik B., Barchitta M., Barqawi H.J., Basharat Z., Baskaran P., Batra K., Batra R., Bayileyegn N.S., Beloukas A., Berkley J.A., Beyene K.A., Bhargava A., Bhattacharjee P., Bielicki J.A., Bilalaga M.M., Bitra V.R., Brown C.S., Burkart K., Bustanji Y., Carr S., Chahine Y., Chattu V.K., Chichagi F., Chopra H., Chukwu I.S., Chung E., Dadana S., Dai X., Dandona L., Dandona R., Darban I., Dash N.R., Dashti M., Dashtkoohi M., Dekker D.M., Delgado-Enciso I., Devanbu V.G.C., Dhama K. Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990–2021: a systematic analysis from the Global Burden of Disease Study 2021. The Lancet Infectious Diseases Vol.24 No.9 (2024) , 974-1002. 1002. doi:10.1016/S1473-3099(24)00176-2 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/101480

Title

Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990–2021: a systematic analysis from the Global Burden of Disease Study 2021

Author(s)

Bender R.G.
 Sirota S.B.
 Swetschinski L.R.
 Dominguez R.M.V.
 Novotney A.
 Wool E.E.
 Ikuta K.S.
 Vongpradith A.
 Rogowski E.L.B.
 Doxey M.
 Troeger C.E.
 Albertson S.B.
 Ma J.
 He J.
 Maass K.L.
 Simões E.A.F.
 Abdoun M.
 Aziz J.M.A.
 Abdulah D.M.
 Rumeileh S.A.
 Abualruz H.
 Aburuz S.
 Adepoju A.V.
 Adha R.
 Adikusuma W.
 Adra S.
 Afraz A.
 Aghamiri S.
 Agodi A.
 Ahmadzade A.M.
 Ahmed H.
 Ahmed A.
 Akinosoglou K.
 AL-Ahdal T.M.A.
 Al-Amer R.M.
 Albashtawy M.
 AlBataineh M.T.
 Alemi H.
 Al-Gheethi A.A.S.
 Ali A.
 Ali S.S.S.
 Alqahtani J.S.
 AlQudah M.
 Al-Tawfiq J.A.
 Al-Worafi Y.M.
 Alzoubi K.H.
 Amani R.
 Amegbor P.M.
 Ameyaw E.K.
 Amuasi J.H.
 Anil A.
 Anyanwu P.E.
 Arafat M.
 Areda D.
 Arefnezhad R.
 Atalell K.A.
 Ayele F.
 Azzam A.Y.
 Babamohamadi H.
 Babin F.X.
 Bahurupi Y.
 Baker S.
 Banik B.
 Barchitta M.
 Barqawi H.J.
 Basharat Z.
 Baskaran P.
 Batra K.
 Batra R.
 Bayileyegn N.S.
 Beloukas A.
 Berkley J.A.
 Beyene K.A.
 Bhargava A.
 Bhattacharjee P.
 Bielicki J.A.
 Bilalaga M.M.
 Bitra V.R.
 Brown C.S.
 Burkart K.
 Bustanji Y.
 Carr S.
 Chahine Y.
 Chattu V.K.
 Chichagi F.
 Chopra H.
 Chukwu I.S.
 Chung E.
 Dadana S.
 Dai X.
 Dandona L.
 Dandona R.
 Darban I.
 Dash N.R.
 Dashti M.
 Dashtkoohi M.
 Dekker D.M.
 Delgado-Enciso I.
 Devanbu V.G.C.
 Dhama K.

Author's Affiliation

University of Science & Technology of Fujairah
 Faculty of Medicine
 University of Swat
 UK Health Security Agency
 University General Hospital of Patras
 Health Policy Research Center
 Public Health Foundation of India
 Jhpiego Corporation
 Hematology, Oncology and Stem Cell Transplantation Research Center
 University of Human Development
 Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR)
 Department of Medicine
 All India Institute of Medical Sciences, Bhubaneswar
 All India Institute of Medical Sciences, Rishikesh
 University of West Attica
 Chettinad Academy of Research and Education
 Saveetha Institute of Medical and Technical Sciences
 All India Institute of Medical Sciences, Jodhpur
 Abdul Wali Khan University Mardan
 Johns Hopkins Aramco Healthcare
 Al Ain University
 Khalifa University of Science and Technology
 CRC CARE Pty Ltd.
 Datta Meghe Institute of Higher Education & Research (Deemed to be University)
 Institute for Health Metrics and Evaluation
 Prince Sultan Military College of Health Sciences, Dhahran
 COMSATS University Islamabad
 University of Duhok
 University of Gondar
 Kwame Nkrumah University of Science & Technology
 Institute of Endemic Diseases Sudan
 Haramaya University
 Jimma University
 University of Sharjah
 University of Mataram
 Université Ferhat Abbas Sétif 1
 Al-Zaytoonah University of Jordan
 Wellcome Trust Research Laboratories Nairobi
 The University of Jordan
 King Hussein Cancer Center
 Jordan University of Science and Technology
 Yarmouk University
 Al Al-Bayt University
 University of Nevada, Las Vegas
 Federal Medical Centre Nigeria
 Tabriz University of Medical Sciences
 University of Patras
 St George’s, University of London
 University of Washington School of Medicine
 Tehran University of Medical Sciences
 Cheyenne Regional Medical Center
 School of Life Sciences
 Indian Council of Medical Research
 School of Clinical Medicine
 Universidad de Colima
 Semnan University of Medical Sciences and Health Services
 University of Iowa
 Universität Basel
 Shiraz University of Medical Sciences
 Indiana University School of Medicine
 New York University
 University of Toronto Faculty of Medicine
 University of Botswana
 University of Liverpool
 Bernhard Nocht Institut fur Tropenmedizin Hamburg
 Wayne State University School of Medicine
 Shahid Beheshti University of Medical Sciences
 Yale School of Medicine
 University of Ghana
 University of New England Australia
 Western Sydney University
 Kerman University of Medical Sciences
 Universität Heidelberg
 Cambridge University Hospitals NHS Foundation Trust
 University of Washington
 Imperial College London
 VA Medical Center
 Martin-Luther-Universität Halle-Wittenberg
 Lingnan University, Hong Kong
 Federation University Australia
 The University of Newcastle, Australia
 University of Colorado Denver
 Nuffield Department of Medicine
 United Arab Emirates University
 The University of Auckland
 Indian Veterinary Research Institute
 Università degli Studi di Catania, Scuola di Medicina
 The Ohio State University
 Emory University School of Medicine
 Mashhad University of Medical Sciences
 Warwick Medical School
 Coforge
 Ottawa University
 Baxshin Hospital
 University of Health Sciences and Pharmacy in St. Louis
 Alpha Genomics (Pvt) Ltd
 Azal University for Human Development
 Adolescent Friendly Research Initiative and Care
 Mérieux Foundation
 Seattle Indian Health Board

Corresponding Author(s)

Bender R.G.

Other Contributor(s)

Mahidol University

Abstract

Background: Lower respiratory infections (LRIs) are a major global contributor to morbidity and mortality. In 2020–21, non-pharmaceutical interventions associated with the COVID-19 pandemic reduced not only the transmission of SARS-CoV-2, but also the transmission of other LRI pathogens. Tracking LRI incidence and mortality, as well as the pathogens responsible, can guide health-system responses and funding priorities to reduce future burden. We present estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 of the burden of non-COVID-19 LRIs and corresponding aetiologies from 1990 to 2021, inclusive of pandemic effects on the incidence and mortality of select respiratory viruses, globally, regionally, and for 204 countries and territories. Methods: We estimated mortality, incidence, and aetiology attribution for LRI, defined by the GBD as pneumonia or bronchiolitis, not inclusive of COVID-19. We analysed 26 259 site-years of mortality data using the Cause of Death Ensemble model to estimate LRI mortality rates. We analysed all available age-specific and sex-specific data sources, including published literature identified by a systematic review, as well as household surveys, hospital admissions, health insurance claims, and LRI mortality estimates, to generate internally consistent estimates of incidence and prevalence using DisMod-MR 2.1. For aetiology estimation, we analysed multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature data using a network analysis model to produce the proportion of LRI deaths and episodes attributable to the following pathogens: Acinetobacter baumannii, Chlamydia spp, Enterobacter spp, Escherichia coli, fungi, group B streptococcus, Haemophilus influenzae, influenza viruses, Klebsiella pneumoniae, Legionella spp, Mycoplasma spp, polymicrobial infections, Pseudomonas aeruginosa, respiratory syncytial virus (RSV), Staphylococcus aureus, Streptococcus pneumoniae, and other viruses (ie, the aggregate of all viruses studied except influenza and RSV), as well as a residual category of other bacterial pathogens. Findings: Globally, in 2021, we estimated 344 million (95% uncertainty interval [UI] 325–364) incident episodes of LRI, or 4350 episodes (4120–4610) per 100 000 population, and 2·18 million deaths (1·98–2·36), or 27·7 deaths (25·1–29·9) per 100 000. 502 000 deaths (406 000–611 000) were in children younger than 5 years, among which 254 000 deaths (197 000–320 000) occurred in countries with a low Socio-demographic Index. Of the 18 modelled pathogen categories in 2021, S pneumoniae was responsible for the highest proportions of LRI episodes and deaths, with an estimated 97·9 million (92·1–104·0) episodes and 505 000 deaths (454 000–555 000) globally. The pathogens responsible for the second and third highest episode counts globally were other viral aetiologies (46·4 million [43·6–49·3] episodes) and Mycoplasma spp (25·3 million [23·5–27·2]), while those responsible for the second and third highest death counts were S aureus (424 000 [380 000–459 000]) and K pneumoniae (176 000 [158 000–194 000]). From 1990 to 2019, the global all-age non-COVID-19 LRI mortality rate declined by 41·7% (35·9–46·9), from 56·5 deaths (51·3–61·9) to 32·9 deaths (29·9–35·4) per 100 000. From 2019 to 2021, during the COVID-19 pandemic and implementation of associated non-pharmaceutical interventions, we estimated a 16·0% (13·1–18·6) decline in the global all-age non-COVID-19 LRI mortality rate, largely accounted for by a 71·8% (63·8–78·9) decline in the number of influenza deaths and a 66·7% (56·6–75·3) decline in the number of RSV deaths. Interpretation: Substantial progress has been made in reducing LRI mortality, but the burden remains high, especially in low-income and middle-income countries. During the COVID-19 pandemic, with its associated non-pharmaceutical interventions, global incident LRI cases and mortality attributable to influenza and RSV declined substantially. Expanding access to health-care services and vaccines, including S pneumoniae, H influenzae type B, and novel RSV vaccines, along with new low-cost interventions against S aureus, could mitigate the LRI burden and prevent transmission of LRI-causing pathogens. Funding: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care (UK).

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/101480

Collections

Scopus 2024