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
Hmwe Hmwe Kyu(University of Washington), Avina Vongpradith(University of Washington), Sarah Brooke Sirota(University of Washington), Amanda Novotney(University of Washington), Christopher Troeger(University of Washington), Matthew C Doxey(University of Washington), Rose Bender(University of Washington), Jorge R Ledesma(University of Washington), Molly H Biehl(University of Washington), Samuel B Albertson(University of Washington), Joseph Frostad(University of Washington), Katrin Burkart(University of Washington), Fiona B Bennitt(University of Washington), Jeff T Zhao(University of Washington), William M. Gardner(University of Washington), Hailey Hagins(University of Washington), Dana Bryazka(University of Washington), Regina-Mae Villanueva Dominguez(University of Washington), Semagn Mekonnen Abate(University of Washington), Michael Abdelmasseh(University of Washington), Amir Abdoli(University of Washington), Gholamreza Abdoli(University of Washington), Aidin Abedi(University of Washington), Vida Abedi(University of Washington), Tadesse Melaku Abegaz(University of Washington), Hassan Abidi(University of Washington), Richard Gyan Aboagye(University of Washington), Hassan Abolhassani(University of Washington), Yonas Derso Abtew(University of Washington), Hiwa Abubaker Ali(University of Washington), Eman Abu‐Gharbieh(University of Washington), Ahmed Abu‐Zaid(University of Washington), Kidist Adamu(University of Washington), Isaac Yeboah Addo(University of Washington), Oyelola A. Adegboye(University of Washington), Mohammad Adnan(University of Washington), Qorinah Estiningtyas Sakilah Adnani(University of Washington), Muhammad U. Afzal(University of Washington), Saira Afzal(University of Washington), Bright Opoku Ahinkorah(University of Washington), Aqeel Ahmad(University of Washington), Araz Ramazan Ahmad(University of Washington), Sajjad Ahmad(University of Washington), Ali Ahmadi(University of Washington), Sepideh Ahmadi(University of Washington), Haroon Ahmed(University of Washington), Jivan Qasim Ahmed(University of Washington), Tarik A. Rashid(University of Washington), Mostafa Akbarzadeh-Khiavi(University of Washington), Hanadi Al Hamad(University of Washington), Luciana Albano(University of Washington), Mamoon A. Aldeyab(University of Washington), Bezatu Mengistie Alemu(University of Washington), Kefyalew Addis Alene(University of Washington), Abdelazeem M. Algammal(University of Washington), Fadwa Alhalaiqa(University of Washington), Robert Kaba Alhassan(University of Washington), Beriwan Abdulqadir Ali(University of Washington), Liaqat Ali(University of Washington), Musa Mohammed Ali(University of Washington), Syed Shujait Ali(University of Washington), Yousef Alimohamadi(University of Washington), Vahid Alipour(University of Washington), Adel Al-Jumaily(University of Washington), Syed Mohamed Aljunid(University of Washington), Sami Almustanyir(University of Washington), Rajaa Al‐Raddadi(University of Washington), Rami H Hani Al-Rifai(University of Washington), Saif Aldeen AlRyalat(University of Washington), Nelson Alvis‐Guzmán(University of Washington), Nelson J Alvis-Zakzuk(University of Washington), Edward Kwabena Ameyaw(University of Washington), Javad Aminian-Dehkordi(University of Washington), John Amuasi(University of Washington), Dickson A Amugsi(University of Washington), Etsay Woldu Anbesu(University of Washington), Adnan Ansar(University of Washington), Anayochukwu Edward Anyasodor(University of Washington), Jalal Arabloo(University of Washington), Demelash Areda(University of Washington), Ayele Mamo Argaw(University of Washington), Zeleke Gebru Argaw(University of Washington), Judie Arulappan(University of Washington), Raphael Taiwo Aruleba(University of Washington), Mulusew Andualem Asemahagn(University of Washington), Seyyed Shamsadin Athari(University of Washington), Daniel Atlaw(University of Washington), Engi F. Attia(University of Washington), Sameh Attia(University of Washington), Avinash Aujayeb(University of Washington), Tewachew Awoke(University of Washington), Tegegn Mulatu Ayana(University of Washington), Martin Amogre Ayanore(University of Washington), Sina Azadnajafabad(University of Washington), Mohammadreza Azangou‐Khyavy(University of Washington), Samad Azari(University of Washington), Amirhossein Azari Jafari(University of Washington), Muhammad Badar(University of Washington), Ashish Badiye(University of Washington), Nayereh Baghcheghi(University of Washington), Sara Bagherieh(University of Washington), Atif Amin Baig(University of Washington), Maciej Banach(University of Washington), Indrajit Banerjee(University of Washington), Mainak Bardhan(University of Washington), Francesco Barone‐Adesi(University of Washington), Hiba Jawdat Barqawi(University of Washington), Amadou Barrow(University of Washington), Azadeh Bashiri(University of Washington), Quique Bassat(University of Washington), Abdul‐Monim Batiha(University of Washington), Abate Bekele Belachew(University of Washington), Melaku Ashagrie Belete(University of Washington), Uzma Belgaumi(University of Washington), Akshaya Srikanth Bhagavathula(University of Washington), Nikha Bhardwaj(University of Washington), Pankaj Bhardwaj(University of Washington), Parth Bhatt(University of Washington), Vijayalakshmi S Bhojaraja(University of Washington), Zulfiqar A Bhutta(University of Washington), Soumitra S. Bhuyan(University of Washington), Ali Bijani(University of Washington), Saeid Bitaraf(University of Washington), Belay Boda Abule Bodicha(University of Washington), Н. И. Брико(University of Washington), Danilo Buonsenso(University of Washington), Muhammad Hammad Butt(University of Washington), Jiao Cai(University of Washington), Paulo Augusto Moreira Camargos(University of Washington), Luis Alberto Cámera(University of Washington), Promit Ananyo Chakraborty(University of Washington), Muluken Genetu Chanie(University of Washington), Jaykaran Charan(University of Washington), Vijay Kumar Chattu(University of Washington), Patrick R Ching(University of Washington), Sungchul Choi(University of Washington), Yuen Yu Chong, Sonali G Choudhari(University of Washington), E. Chowdhury(University of Washington), Devasahayam J Christopher(University of Washington), Dinh‐Toi Chu(University of Washington), Natalie Cobb(University of Washington), Aaron J. Cohen(University of Washington), Natália Martins(University of Washington), Omid Dadras(University of Washington), Fentaw Teshome Dagnaw(University of Washington), Xiaochen Dai(University of Washington), Lalit Dandona(University of Washington), Rakhi Dandona(University of Washington), An Thi Minh Dao(University of Washington), Sisay Abebe Debela(University of Washington), Biniyam Demisse(University of Washington), Fitsum Wolde Demisse(University of Washington), Solomon Demissie(University of Washington), Diriba Dereje(University of Washington), Hardik Dineshbhai Desai(University of Washington), Abebaw Alemayehu Desta(University of Washington), Belay Desye(University of Washington), Sameer Dhingra(University of Washington), Nancy Diao(University of Washington), Daniel Díaz(University of Washington), Lankamo Ena Digesa(University of Washington), Linh Phuong Doan(University of Washington), Milad Dodangeh(University of Washington), Deepa Dongarwar(University of Washington), Fariba Dorostkar(University of Washington), Wendel Mombaque dos Santos, Haneil Larson Dsouza(University of Washington), Eleonora Dubljanin(University of Washington), Oyewole Christopher Durojaiye(University of Washington), Hisham Atan Edinur(University of Washington), Elham Ehsani‐Chimeh(University of Washington), Ebrahim Eini(University of Washington), Michael Ekholuenetale(University of Washington), Temitope Cyrus Ekundayo(University of Washington), Eman D. El Desouky, Iman El Sayed(University of Washington), Maysaa El Sayed Zaki(University of Washington), Muhammed Elhadi(University of Washington), Ahmed Mahmoud Rabie Elkhapery(University of Washington), Amir Emami(University of Washington), Luchuo Engelbert Bain, Ryenchindorj Erkhembayar(University of Washington), Farshid Etaee(University of Washington), Mohamad Ezati Asar(University of Washington), Adeniyi Francis Fagbamigbe(University of Washington), Shahab Falahi(University of Washington), Aida Fallahzadeh(University of Washington), Anwar Faraj(University of Washington), Emerito Jose A Faraon(University of Washington), Ali Fatehizadeh(University of Washington), Pietro Ferrara(University of Washington), Allegra Ferrari(University of Washington), Getahun Fetensa(University of Washington), Florian Fischer(University of Washington), Joanne Flavel(University of Washington), Masoud Foroutan(University of Washington), Péter Gaál, Abhay Gaidhane(University of Washington), Santosh Gaihre(University of Washington), Nasrin Galehdar(University of Washington), Alberto L. García‐Basteiro(University of Washington), Tushar Garg(University of Washington), Mesfin Gebrehiwot(University of Washington), Mathewos Alemu Gebremichael, Yibeltal Yismaw Gela(University of Washington), Belete Negese(University of Washington), Bradford D. Gessner(University of Washington), Melaku Getachew(University of Washington), Asmare Getie(University of Washington), Seyyed‐Hadi Ghamari(University of Washington), Mohammad Ghasemi Nour(University of Washington), Ahmad Ghashghaee(University of Washington), Ali Gholamrezanezhad(University of Washington), Abdolmajid Gholizadeh(University of Washington), Rakesh Ghosh(University of Washington), Sherief Ghozy(University of Washington), Pouya Goleij(University of Washington), Mohamad Golitaleb(University of Washington), Giuseppe Gorini(University of Washington), Alessandra C. Goulart(University of Washington), Girma Garedew Goyomsa(University of Washington), Habtamu Alganeh Guadie(University of Washington), Zewdie Gudisa(University of Washington), Rashid Abdi Guled(University of Washington), Sapna Gupta(University of Washington), Veer Bala Gupta(University of Washington), Vivek Gupta(University of Washington), Alemu Guta(University of Washington), Parham Habibzadeh(University of Washington), Arvin Haj‐Mirzaian(University of Washington), Rabih Halwani(University of Washington), Samer Hamidi(University of Washington), Md. Abdul Hannan(University of Washington), Mehdi Harorani(University of Washington), Ahmed I Hasaballah(University of Washington), Hamidreza Hasani(University of Washington), Abbas M. Hassan(University of Washington), Shokoufeh Hassani(University of Washington), Hossein Hassanian‐Moghaddam(University of Washington), Hadi Hassankhani(University of Washington), Khezar Hayat(University of Washington), Behzad Heibati(University of Washington), Mohammad Heidari(University of Washington), Demisu Zenbaba Heyi(University of Washington), Kamal Hezam(University of Washington), Ramesh Holla(University of Washington), Sung Hwi Hong(University of Washington), Nobuyuki Horita(University of Washington), Mohammad‐Salar Hosseini(University of Washington), Mehdi Hosseinzadeh(University of Washington), Mihaela Hostiuc(University of Washington), Mowafa Househ(University of Washington), Soodabeh Hoveidamanesh(University of Washington), Junjie Huang(University of Washington), Nawfal R Hussein(University of Washington), Ivo Iavicoli(University of Washington), Segun Emmanuel Ibitoye(University of Washington), Kevin S Ikuta, Olayinka Stephen Ilesanmi(University of Washington), Irena Ilić(University of Washington), Milena Ilić(University of Washington), Mustapha Immurana, Nahlah Elkudssiah Ismail(University of Washington), Masao Iwagami(University of Washington), Jalil Jaafari(University of Washington), Elham Jamshidi(University of Washington), Sung‐In Jang(University of Washington), Amirreza Javadi Mamaghani(University of Washington), Tahereh Javaheri(University of Washington), Fatemeh Javanmardi(University of Washington), Javad Javidnia(University of Washington), Sathish Kumar Jayapal(University of Washington), Umesh Jayarajah(University of Washington), Shubha Jayaram(University of Washington), Alelign Tasew Jema(University of Washington), Wonjeong Jeong(University of Washington), Jost B. Jonas(University of Washington), Nitin Joseph(University of Washington), Farahnaz Joukar(University of Washington), Jacek Jerzy Jozwiak(University of Washington), K Vaishali(University of Washington), Zubair Kabir(University of Washington), Salah Eddine Oussama Kacimi(University of Washington), Vidya Kadashetti(University of Washington), Laleh R. Kalankesh(University of Washington), Rohollah Kalhor(University of Washington), Ashwin Kamath(University of Washington), Bhushan Dattatray Kamble(University of Washington), Himal Kandel(University of Washington), Tesfaye K Kanko(University of Washington), Ibraheem M. Karaye(University of Washington), André Karch(University of Washington), Samad Karkhah(University of Washington), Bekalu Getnet Kassa(University of Washington), Patrick DMC Katoto(University of Washington), Harkiran Kaur(University of Washington), Rimple Jeet Kaur(University of Washington), Leila Keikavoosi-Arani(University of Washington), Mohammad Keykhaei(University of Washington), Yousef Khader(University of Washington), Himanshu Khajuria(University of Washington), Ejaz Ahmad Khan(University of Washington), Gulfaraz Khan(University of Washington), Imteyaz Ahmad Khan(University of Washington), Maseer Khan(University of Washington), Md Nuruzzaman Khan(University of Washington), Moien AB Khan(University of Washington), Yusra Habib Khan(University of Washington), Moawiah Khatatbeh(University of Washington), Mina Khosravifar(University of Washington), Jagdish Khubchandani(University of Washington), Min Seo Kim(University of Washington), Ruth W Kimokoti(University of Washington), Adnan Kısa(University of Washington), Sezer Kısa(University of Washington), Niranjan Kissoon(University of Washington), Luke D. Knibbs(University of Washington), Sonali Kochhar(University of Washington), Farzad Kompani(University of Washington), Hamid Reza Koohestani(University of Washington), Vladimir Andreevich Korshunov(University of Washington), Soewarta Kosen(University of Washington), Parvaiz A Koul(University of Washington), Ai Koyanagi(University of Washington), Kewal Krishan(University of Washington), Barthélémy Kuate Defo(University of Washington), G Anil Kumar(University of Washington), Om Kurmi(University of Washington), Ambily Kuttikkattu(University of Washington), Dharmesh Kumar Lal(University of Washington), Judit Lám(University of Washington), Iván Landires(University of Washington), Caterina Ledda, Sang-woong Lee, Miriam Levi, Sonia Lewycka, Gang Liu, Wei Liu, Rakesh Lodha(University of Washington), László Lorenzovici, Mojgan Lotfi, Joana A. Loureiro, Farzan Madadizadeh, Ata Mahmoodpoor(University of Washington), Razzagh Mahmoudi, Marzieh Mahmoudimanesh, Jamal Majidpoor, Alaa Makki, Elaheh Malakan Rad, Ahmad Azam Malik, Tauqeer Hussain Mallhi, Yosef Manla, Clara N Matei, Alexander G. Mathioudakis, Richard J. Maude, Entezar Mehrabi Nasab, Addisu Melese, Ziad A. Memish, Oliver Mendoza‐Cano, Alexios‐Fotios A. Mentis, Tuomo J Meretoja, Mehari Woldemariam Merid, Tomislav Meštrović, Ana Carolina Micheletti Gomide Nogueira de Sá, Gelana Fekadu Worku Mijena, Le Huu Nhat Minh(University of Washington), Shabir Ahmad Mir(University of Washington), Reza Mirfakhraie(University of Washington), Seyyedmohammadsadeq Mirmoeeni, Agha Zeeshan Mirza(University of Washington), Moonis Mirza(University of Washington), Mohammad Mirza‐Aghazadeh‐Attari(University of Washington), Abay Sisay Misganaw, Awoke Temesgen Misganaw, Esmaeil Mohammadi, Mokhtar Mohammadi, Arif Ahmed Mohammed(University of Washington), Shafiu Mohammed(University of Washington), Syam Mohan, Mohammad Mohseni(University of Washington), Nagabhishek Moka, Ali H. Mokdad, Sara Momtazmanesh(University of Washington), Lorenzo Monasta, Md. Moniruzzaman(University of Washington), Fateme Montazeri(University of Washington), Catrin E. Moore, Abdolvahab Moradi, Lídia Morawska, Jonathan F Mosser, Ebrahim Mostafavi(University of Washington), Majid Motaghinejad(University of Washington), Haleh Mousavi Isfahani, Seyed Ali Mousavi‐Aghdas, Sumaira Mubarik, Efrén Murillo‐Zamora, Ghulam Mustafa, Sanjeev Nair, Tapas Sadasivan Nair, Houshang Najafi, Atta Abbas Naqvi, Sreenivas Narasimha Swamy, Zuhair S. Natto, Biswa Prakash Nayak, Seyed Aria Nejadghaderi, Nguyễn Văn Huy, Robina Khan Niazi, Antonio Tolentino Nogueira de Sá, Hasti Nouraei, Ali Nowroozi(University of Washington), Virginia Núñez-Samudio, Chimezie Igwegbe Nzoputam, Ogochukwu Janet Nzoputam, Bogdan Oancea, Chimedsuren Оchir, Oluwakemi Ololade Odukoya, Hassan Okati‐Aliabad(University of Washington), Akinkunmi Paul Okekunle, Osaretin Christabel Okonji, Andrew T Olagunju, Isaac Iyinoluwa Olufadewa, Ahmed Omar Bali(University of Washington), Emad Omer, Eyal Oren, Erika Ota(University of Washington), Nikita Otstavnov, Abderrahim Oulhaj, P A Mahesh(University of Washington), Jagadish Rao Padubidri, Keyvan Pakshir, Reza Pakzad(University of Washington), Tamás Palicz, Anamika Pandey, Suman Pant, Shahina Pardhan, Eun‐Cheol Park, Eun‐Kee Park, Fatemeh Pashazadeh Kan(University of Washington), Rajan Paudel, Shrikant Pawar, Minjin Peng, Gavin Pereira, Simone Perna, Navaraj Perumalsamy, Ionela-Roxana Petcu, David M. Pigott, Zahra Zahid Piracha, Vivek Podder(University of Washington), Р. В. Полибин, Maarten J. Postma, Hamid Pourasghari(University of Washington), Naeimeh Pourtaheri, Mirza Muhammad Fahd Qadir, Mathieu Raad, Mohammad Rabiee(University of Washington), Navid Rabiee, Saber Raeghi, Alireza Rafiei, Fakher Rahim(University of Washington), Mehran Rahimi, Vafa Rahimi‐Movaghar, Azizur Rahman, Obaidur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Amir M. Rahmani, Vahid Rahmanian(University of Washington), Pradhum Ram(University of Washington), Kiana Ramezanzadeh, Juwel Rana, Priyanga Ranasinghe, Usha Rani(University of Washington), Sowmya J Rao(University of Washington), Sina Rashedi(University of Washington), Mohammad‐Mahdi Rashidi, Azad Rasul(University of Washington), Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Reza Rawassizadeh(University of Washington), Mohammad Sadegh Razeghinia, Elrashdy M. Redwan, Marissa B Reitsma, André M. N. Renzaho, Mohsen Rezaeian, Abanoub Riad, Reza Rikhtegar(University of Washington), Jefferson Antonio Buendía, Emma L B Rogowski, Luca Ronfani, Kristina E. Rudd, Basema Saddik, Erfan Sadeghi, Umar Saeed(University of Washington), Azam Safary, Sher Zaman Safi, Maryam Sahebazzamani, Amirhossein Sahebkar(University of Washington), Sateesh Sakhamuri, Sana Salehi(University of Washington), Muhammad Salman(University of Washington), Hossein Samadi Kafil(University of Washington), Abdallah M Samy, Milena M Santric-Milicevic, Bruno Piassi Sâo José, Maryam Sarkhosh, Brijesh Sathian, Monika Sawhney, Ganesh Kumar Saya, Abdul-Aziz Seidu, Allen Seylani, Amira Shaheen(University of Washington), Masood Ali Shaikh, Elaheh Shaker, Hina Shamshad, Mequannent Melaku Sharew Sharew, Asaad Sharhani, Azam Sharifi, Purva Sharma, Ali Sheidaei(University of Washington), Suchitra Shenoy, Jeevan K. Shetty, Damtew Solomon Shiferaw, Mika Shigematsu, Jae Il Shin, Hesamaddin Shirzad‐Aski, K. M. Shivakumar, Siddharudha Shivalli, Parnian Shobeiri, Wudneh Simegn, Colin R Simpson, Harpreet Singh, Ambrish Singh, Paramdeep Singh, Samarjeet Singh Siwal, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Mohammad Sadegh Soltani‐Zangbar, Suhang Song, Yimeng Song, Prashant Sood(University of Washington), Chandrashekhar T Sreeramareddy, Paschalis Steiropoulos, Muhammad Suleman(University of Washington), Seyed‐Amir Tabatabaeizadeh, Alireza Tahamtan, Majid Taheri(University of Washington), Moslem Taheri Soodejani, Elahe Taki, Iman M. Talaat, Mircea Tampa, Sarmila Tandukar, Nathan Y Tat(University of Washington), Vivian Y Tat(University of Washington), Yibekal Manaye Tefera, Gebremaryam Temesgen, Mohamad‐Hani Temsah, Azene Tesfaye(University of Washington), Degefa Gomora Tesfaye(University of Washington), Belay Tessema(University of Washington), Rekha Thapar, Jansje Henny Vera Ticoalu, Amir Tiyuri(University of Washington), Imad M. Tleyjeh, Munkhsaikhan Togtmol, Marcos Roberto Tovani‐Palone, Derara Girma Tufa, Irfan Ullah, Era Upadhyay(University of Washington), Sahel Valadan Tahbaz, Pascual Valdéz, Rohollah Valizadeh(University of Washington), Constantine Vardavas, Tommi Vasankari, Bay Vo(University of Washington), Linh Gia Vu, Birhanu Wagaye, Yasir Waheed, Yu Wang(University of Washington), Abdul Waris(University of Washington), T. Eoin West, Nuwan Darshana Wickramasinghe, Xiaoyue Xu, Sajad Yaghoubi, Gahin Abdulraheem Tayib Yahya Yahya, Seyed Hossein Yahyazadeh Jabbari, Dong Keon Yon(University of Washington), Naohiro Yonemoto, Burhan Abdullah Zaman(University of Washington), Alireza Zandifar, Moein Zangiabadian, Heather J. Zar(University of Washington), Iman Zare(University of Washington), Zahra Zareshahrabadi, Armin Zarrintan, Михаил Сергеевич Застрожин, Wu Zeng(University of Washington), Mengxi Zhang, Zhi-Jiang Zhang, Chenwen Zhong, Mohammad Zoladl(University of Washington), Alimuddin Zumla, Stephen S Lim(University of Washington), Theo Vos, Mohsen Naghavi, Michael Bräuer(University of Washington), Simon I Hay(University of Washington), Christopher Murray
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Abstract
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.
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