Global, regional, and national temporal trend in burden of chronic respiratory diseases from 1990 to 2021: Findings from the Global Burden of Disease Study 2021

Abstract Background: Chronic respiratory diseases (CRDs), including chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease (ILD), and pulmonary sarcoidosis, continue to pose a significant global health challenge. This study aims to assess the global, regional, and national burden of CRDs from 1990 to 2021, using data from the Global Burden of Disease Study (GBD) 2021 to identify key trends and advise future public health strategies. Methods: Data from the GBD 2021 were used to estimate the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of CRDs and their subtypes across 21 global regions and 204 countries and regions from 1990 to 2021. The temporal trend was analyzed and the relationship between CRD burden and socio-demographic index (SDI) was examined using a smoothing spline model. A Bayesian age-period-cohort model was used to project the burden of CRDs to 2035. Results: The global age-standardized rate (ASR) of incidence, prevalence, mortality, and DALY for CRDs declined by 24%, 27%, 37%, and 38%, respectively, from 1990 to 2021. However, the absolute burden of CRDs continues to grow due to population aging and demographic changes. Asthma accounts for most of the CRD-related incidence and prevalence, particularly in high-SDI regions, while COPD accounts for most CRD-related deaths and DALYs, especially in low-middle SDI regions. The ASR of incidence, prevalence, mortality, and DALYs for ILD and pulmonary sarcoidosis increased by 21%, 9%, 50%, and 28%, respectively, from 1990 to 2021. Notably, the increase was more pronounced in high SDI regions. Although air pollution decreased globally and in high-SDI, it slightly worsened in low-SDI regions. Since 2009, tobacco use has surpassed air pollution as the leading risk factor for CRD-related deaths and DALYs in high-middle SDI regions, although both are declining. In contrast, the increase in DALYs is because high body mass index (BMI) signals a change in risk factors for CRDs. By 2035, the incidence, prevalence, and mortality rates of CRD are anticipated to decline. Conclusions: The incidence of CRDs continues to represent a significant public health challenge, with variable trends in different regions influenced by a complex interaction of risk factors. Although progress has been made in reducing mortality and DALYs, particularly in higher SDI regions, the continued high incidence in low- and middle-SDI regions underscores the need for sustained and targeted public health efforts. Therefore, it is essential to address the underlying determinants, including environmental, lifestyle, and occupational risks to mitigate the global impact of CRDs in the coming decades.