The evolving global burden of asthma among children and adolescents, 1990–2040: trends, disparities, and future projections based on Global Burden of Disease (GBD) 2021

Background: Asthma is a significant contributor to the global disease burden and is the most common chronic disease in children and adolescents. This study provides estimates of the prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) burden of asthma among children and adolescents from 1990 to 2021. Methods: Using Global Burden of Disease (GBD) 2021 data, we analyzed age-standardized prevalence (ASPR), incidence (ASIR), mortality (ASMR), and DALYs (ASDR) rates of asthma among children and adolescents from 1990 to 2021. Estimated annual percentage changes (EAPC) were calculated to evaluate temporal trends. Data were stratified by sex, age, 204 nations/territories, 21 GBD regions, and five socio-demographic index (SDI) quintiles. The Bayesian age-period-cohort (BAPC) models were applied to predict asthma burden up to 2040. Results: In 2021, there were approximately 126 million prevalent cases and 27 million incidence cases among children and adolescents worldwide. From 1990 to 2021, ASPR (EAPC -1.00) and ASIR (EAPC -0.77) declined moderately, while ASMR (EAPC -3.01) and ASDR (EAPC -1.54) decreased substantially. High SDI regions had the highest prevalence, incidence, and DALYs, whereas low SDI regions bore greater mortality. Males exhibited higher prevalence, whereas females experienced higher mortality. Prevalence peaked at ages 5-9 years, while incidence, deaths, and DALYs were highest in children younger than 5 years. High body mass index (BMI) was a leading contributor to asthma burden. During the coronavirus disease 2019 (COVID-19) pandemic (2019-2021), global asthma burden in children and adolescents decreased, particularly in deaths, while prevalence slightly increased. BAPC projections indicate that the ASPR and ASIR will remain stable through 2040, while ASMR and ASDR will continue to decline. Conclusions: The global burden of asthma among children and adolescents has declined, but regional, sex, and age disparities persist. These findings highlight the need for targeted healthcare strategies and policies that address age, gender, and regional differences.