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

Rose Bender(University of Washington), Sarah Brooke Sirota(University of Washington), Lucien R Swetschinski(University of Washington), Regina-Mae Villanueva Dominguez(University of Washington), Amanda Novotney(University of Washington), Eve E Wool(University of Washington), Kevin S Ikuta(University of Washington), Avina Vongpradith(University of Washington), Emma L B Rogowski(University of Washington), Matthew C Doxey(University of Washington), Christopher Troeger(University of Washington), Samuel B Albertson(University of Washington), Jianing Ma(University of Washington), Jiawei He(University of Washington), Kelsey Lynn Maass(University of Washington), Eric A. F. Simões(University of Washington), Meriem Abdoun(University of Washington), Jeza Muhamad Abdul Aziz(University of Washington), Deldar Morad Abdulah(University of Washington), Samir Abu‐Rumeileh(University of Washington), Hasan Abualruz(University of Washington), Salahdein Aburuz(University of Washington), Victor Abiola Adepoju(University of Washington), Rishan Adha(University of Washington), Wirawan Adikusuma(University of Washington), Saryia Adra(University of Washington), Ali Afraz(University of Washington), Shahin Aghamiri(University of Washington), Antonella Agodi(University of Washington), Amir Mahmoud Ahmadzade(University of Washington), Haroon Ahmed(University of Washington), Ayman Ahmed(University of Washington), Karolina Akinosoglou(University of Washington), Tareq Mohammed Ali AL-Ahdal(University of Washington), Rasmieh Al‐Amer(University of Washington), Mohammed ALBashtawy(University of Washington), Mohammad T AlBataineh(University of Washington), Hediyeh Alemi(University of Washington), Adel Al‐Gheethi(University of Washington), Abid Ali(University of Washington), Syed Shujait Ali(University of Washington), Jaber S. Alqahtani(University of Washington), Mohammad Alqudah(University of Washington), Jaffar A. Al‐Tawfiq(University of Washington), Yaser Mohammed Al‐Worafi(University of Washington), Karem H. Alzoubi(University of Washington), Reza Amani(University of Washington), Prince M. Amegbor(University of Washington), Edward Kwabena Ameyaw(University of Washington), John Amuasi(University of Washington), Abhishek Anil(University of Washington), P.E. Anyanwu(University of Washington), Mosab Arafat(University of Washington), Damelash Areda(University of Washington), Reza Arefnezhad(University of Washington), Kendalem Asmare Atalell(University of Washington), Firayad Ayele(University of Washington), Ahmed Y. Azzam(University of Washington), Hassan Babamohamadi(University of Washington), François-Xavier Babin(University of Washington), Yogesh Bahurupi(University of Washington), Stephen Baker(University of Washington), Biswajit Banik(University of Washington), Martina Barchitta(University of Washington), Hiba Jawdat Barqawi(University of Washington), Zarrin Basharat(University of Washington), Pritish Baskaran(University of Washington), Kavita Batra(University of Washington), Ravi Batra(University of Washington), Nebiyou Simegnew Bayileyegn(University of Washington), Apostolos Beloukas(University of Washington), James A. Berkley(University of Washington), Kebede Beyene(University of Washington), Ashish Bhargava(University of Washington), Priyadarshini Bhattacharjee(University of Washington), Julia Bielicki(University of Washington), Mariah Malak Bilalaga(University of Washington), Veera Raghavulu Bitra(University of Washington), Colin Brown(University of Washington), Katrin Burkart(University of Washington), Yasser Bustanji(University of Washington), Sinclair Carr(University of Washington), Yaacoub Chahine(University of Washington), Vijay Kumar Chattu(University of Washington), Fatemeh Chichagi(University of Washington), Hitesh Chopra(University of Washington), Isaac Sunday Chukwu(University of Washington), Eunice Chung(University of Washington), Sriharsha Dadana(University of Washington), Xiaochen Dai(University of Washington), Lalit Dandona(University of Washington), Rakhi Dandona(University of Washington), Isaac Darban(University of Washington), Nihar Ranjan Dash(University of Washington), Mohsen Dashti(University of Washington), Mohadese Dashtkoohi(University of Washington), Denise Dekker(University of Washington), Iván Delgado‐Enciso(University of Washington), Vinoth Gnana Chellaiyan Devanbu(University of Washington), Kuldeep Dhama(University of Washington), Nancy Diao(University of Washington), Thao Huynh Phuong(University of Washington), Клара Докова(University of Washington), Christiane Dolecek(University of Washington), Arkadiusz Dziedzic(University of Washington), Tim Eckmanns(University of Washington), Abdelaziz Ed‐Dra(University of Washington), Ferry Efendi(University of Washington), Aziz Eftekharimehrabad(University of Washington), David W. Eyre(University of Washington), Ayesha Fahim(University of Washington), Alireza Feizkhah(University of Washington), Timothy Felton(University of Washington), Nuno Ferreira(University of Washington), Luísa Sório Flor(University of Washington), Santosh Gaihre(University of Washington), Miglas Welay Gebregergis(University of Washington), Mesfin Gebrehiwot(University of Washington), Christine Geffers(University of Washington), Urge Gerema(University of Washington), Kazem Ghaffari(University of Washington), Mohamad Goldust(University of Washington), Pouya Goleij(University of Washington), Shi‐Yang Guan(University of Washington), Mesay Dechasa Gudeta(University of Washington), Cui Guo(University of Washington), Veer Bala Gupta(University of Washington), Ishita Gupta(University of Washington), Farrokh Habibzadeh(University of Washington), Najah R Hadi(University of Washington), Emily Haeuser(University of Washington), Wase Benti Hailu(University of Washington), Ramtin Hajibeygi(University of Washington), Arvin Haj‐Mirzaian(University of Washington), Sebastian Haller(University of Washington), Mohammad Hamiduzzaman(University of Washington), Nasrin Hanifi(University of Washington), Jan Hansel(University of Washington), Md Saquib Hasnain(University of Washington), Johannes Haubold(University of Washington), Nguyen Quoc Hoan(University of Washington), Hong-Han Huynh(University of Washington), Kenneth Iregbu(University of Washington), Md. Rabiul Islam(University of Washington), Abdollah Jafarzadeh(University of Washington), Ammar Abdulrahman Jairoun(University of Washington), Mahsa Jalili(University of Washington), Nabi Jomehzadeh(University of Washington), Charity Ehimwenma Joshua(University of Washington), Md Awal Kabir(University of Washington), Zul Kamal(University of Washington), Kehinde Kazeem Kanmodi(University of Washington), Rami S. Kantar(University of Washington), Arman Karimi Behnagh(University of Washington), Navjot Kaur(University of Washington), Harkiran Kaur(University of Washington), Faham Khamesipour(University of Washington), Md Nuruzzaman Khan(University of Washington), Mahammed Ziauddin Khan suheb(University of Washington), Vishnu Khanal(University of Washington), Khaled Khatab(University of Washington), Mahalaqua Nazli Khatib(University of Washington), Grace Kim(University of Washington), Kwanghyun Kim(University of Washington), Aiggan Tamene Tamene Kitila(University of Washington), Somayeh Komaki(University of Washington), Kewal Krishan(University of Washington), Ralf Krumkamp(University of Washington), Md Abdul Kuddus(University of Washington), Maria Dyah Kurniasari(University of Washington), Chandrakant Lahariya(University of Washington), Kaveh Latifinaibin(University of Washington), Nhi Huu Hanh Le(University of Washington), Thao T. Le(University of Washington), Trang Diep Thanh Le(University of Washington), Seung Won Lee(University of Washington), Alain Lepape(University of Washington), Temesgen Leka Lerango(University of Washington), Ming‐Chieh Li(University of Washington), Amir Ali Mahboobipour(University of Washington), Kashish Malhotra(University of Washington), Tauqeer Hussain Mallhi(University of Washington), Anand Manoharan(University of Washington), Bernardo Alfonso Martínez-Guerra(University of Washington), Alexander G. Mathioudakis(University of Washington), Rita Mattiello(University of Washington), Jürgen May(University of Washington), Barney McManigal(University of Washington), Steven McPhail(University of Washington), Tesfahun Mekene Meto(University of Washington), Max Alberto Mendez Mendez-Lopez(University of Washington), Sultan Ayoub Meo(University of Washington), Mohsen Merati(University of Washington), Tomislav Meštrović(University of Washington), Laurette Mhlanga(University of Washington), Le Huu Nhat Minh(University of Washington), Awoke Misganaw(University of Washington), Vinaytosh Mishra(University of Washington), Arup Kumar Misra(University of Washington), Nouh Saad Mohamed(University of Washington), Esmaeil Mohammadi(University of Washington), Mesud Mohammed(University of Washington), Mustapha Mohammed(University of Washington), Ali H. Mokdad(University of Washington), Lorenzo Monasta(University of Washington), Catrin E. Moore(University of Washington), Rohith Motappa(University of Washington), Vincent Mougin(University of Washington), Parsa Mousavi(University of Washington), Francesk Mulita(University of Washington), Atsedemariam Andualem Mulu(University of Washington), Pirouz Naghavi(University of Washington), Ganesh R. Naik(University of Washington), Firzan Nainu(University of Washington), Tapas Sadasivan Nair(University of Washington), Shumaila Nargus(University of Washington), Mohammad Negaresh(University of Washington), Hau Thi Hien Nguyen(University of Washington), Dang Nguyen(University of Washington), Văn Thành Nguyễn(University of Washington), Τaxiarchis Κonstantinos Νikolouzakis(University of Washington), Efaq Ali Noman(University of Washington), Chisom Adaobi Nri-Ezedi(University of Washington), Ismail Ayoade Odetokun(University of Washington), Patrick Godwin Okwute(University of Washington), Matifan Dereje Olana(University of Washington), Titilope Olanipekun(University of Washington), Omotola O Olasupo(University of Washington), Antonio Olivas‐Martínez(University of Washington), Michał Ordak(University of Washington), Edgar Ortíz‐Brizuela(University of Washington), Amel Ouyahia(University of Washington), Jagadish Rao Padubidri(University of Washington), Anton Pak(University of Washington), Anamika Pandey(University of Washington), Ioannis Pantazopoulos(University of Washington), Pragyan Paramita Parija(University of Washington), Romil R Parikh(University of Washington), Seoyeon Park(University of Washington), Ashwaghosha Parthasarathi(University of Washington), Ava Pashaei(University of Washington), Prince Peprah(University of Washington), Hoang Tran Pham(University of Washington), Dimitri Poddighe(University of Washington), Andrew J. Pollard(University of Washington), Alfredo Ponce‐de‐León(University of Washington), Peralam Yegneswaran Prakash(University of Washington), Elton Junio Sady Prates(University of Washington), Nguyen Khoi Quan(University of Washington), Pourya Raee(University of Washington), Fakher Rahim(University of Washington), Mosiur Rahman(University of Washington), Masoud Rahmati(University of Washington), Shakthi Kumaran Ramasamy(University of Washington), Shubham Ranjan(University of Washington), Indu Ramachandra Rao(University of Washington), Ahmed Mustafa Rashid(University of Washington), Sayaphet Rattanavong(University of Washington), Nakul Ravikumar(University of Washington), Murali Mohan Rama Krishna Reddy(University of Washington), Elrashdy M. Redwan(University of Washington), Robert C. Reiner(University of Washington), Luis Felipe Reyes(University of Washington), Tamalee Roberts(University of Washington), Mónica Rodrigues(University of Washington), Víctor Rosenthal(University of Washington), Priyanka Roy(University of Washington), Tilleye Runghien(University of Washington), Umar Saeed(University of Washington), Amene Saghazadeh(University of Washington), Narjes Saheb Sharif‐Askari(University of Washington), Fatemeh Saheb Sharif‐Askari(University of Washington), Soumya Swaroop Sahoo(University of Washington), Monalisha Sahu(University of Washington), Joseph W. Sakshaug(University of Washington), Afeez Abolarinwa Salami(University of Washington), Mohamed A. Saleh(University of Washington), Hossein Salehi Omran(University of Washington), Malik Sallam(University of Washington), Sara Samadzadeh(University of Washington), Yoseph Leonardo Samodra, Rama Krishna Sanjeev, Made Ary Sarasmita, Aswini Saravanan, Benn Sartorius, Jennifer Saulam, Austin E Schumacher, Seyed Arsalan Seyedi, Mahan Shafie, Samiah Shahid, Sunder Sham, Muhammad Aaqib Shamim, Mohammad Ali Shamshirgaran, Rajesh P. Shastry, Samendra P. Sherchan, Desalegn Shiferaw, Aminu Shittu, Emmanuel Edwar Siddig, Robert Sinto(University of Washington), Aayushi Sood, Reed J D Sorensen, Andy Stergachis, Temenuga Stoeva, Chandan Kumar Swain, Łukasz Szarpak, Jacques Lukenze Tamuzi, Mohamad‐Hani Temsah, Melkamu B Tessema Tessema, Pugazhenthan Thangaraju, Nghia Minh Tran(University of Washington), Ngoc-Ha Tran(University of Washington), Munkhtuya Tumurkhuu, Sree Sudha T Y(University of Washington), Aniefiok John Udoakang, Inam Ul Haq(University of Washington), Tungki Pratama Umar(University of Washington), Abdurezak Umer, Seyed Mohammad Vahabi, Asokan Govindaraj Vaithinathan, Jef Van den Eynde, Judd L. Walson, Muhammad Waqas, Yuhan Xing, Mukesh Yadav, Galal Yahya, Dong Keon Yon, Abed Zahedi Bialvaei, Fathiah Zakham, Abyalew Mamuye Zeleke, Chunxia Zhai, Zhaofeng Zhang, Haijun Zhang, Magdalena Zielińska, Peng Zheng, Aleksandr Y. Aravkin, Theo Vos, Simon I Hay, Jonathan F Mosser, Stephen S Lim(University of Washington), Mohsen Naghavi(University of Washington), Christopher J L Murray, Hmwe Hmwe Kyu(University of Washington)
The Lancet Infectious Diseases
April 15, 2024
10.1016/s1473-3099(24)00176-2
Cited by 471Open Access
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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).

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