Global, regional, and national burden of asthma from 1990 to 2021: A systematic analysis of the global burden of disease study 2021

Background: Asthma is a prevalent non-communicable disease that affects individuals of all ages and has emerged as a significant global public health concern. This study aims to conduct a comprehensive assessment of the burden of asthma worldwide, as well as at regional and national levels, utilizing the Global Burden of Diseases (GBD) 2021 database for the years 1990 to 2021. Methods: This study utilized the GBD 2021 database to report the prevalent cases and incident cases of asthma, alongside age-standardized prevalence rates (ASPR), age-standardized incidence rate (ASIR), the number of disability-adjusted life years (DALYs), age-standardized DALY rates (ASDR), the number of deaths, and age-standardized mortality rates (ASMR) at global, regional, and national levels for the year 2021. Additionally, it computed the estimated annual percentage change (EAPC) for these asthma burden indicators from 1990 to 2021. This study further analyzed the levels of the above indicators in different gender and age groups, and investigated the association between asthma ASDR/ASMR levels and socio-demographic index (SDI). It also provided an analysis of the contribution of four risk factors to the overall asthma burden. Results: From 1990 to 2021, the global EAPC for asthma ASIR was -1.04 (95 % confidence interval [CI]:-1.18 to -0.89), the EAPC for ASPR was -1.59 (95 % CI:-1.74 to -1.43), the EAPC for ASDR was -1.91 (95 % CI:-1.98 to -1.84), and the EAPC for ASMR was -2.03 (95 % CI:-2.09 to -1.98). In 2021, the prevalent cases of asthma remained alarmingly high at 260.48 million (95 % UI: 227.21 million to 297.97 million). Developed countries, exemplified by the United States, exhibited elevated asthma ASPR. However, the burden of asthma-related mortality and DALYs predominantly afflicted low- and middle-income nations. In China, there has been a significant decline in ASIR, ASPR, ASDR and ASMR for asthma. In most age groups, the burden of asthma among women was markedly higher than that among men, particularly evident in prevalence and DALYs. Children and the elderly bore a heavier burden of asthma. In 2021, ASDR and ASMR levels varied across countries, generally exhibiting a negative correlation with SDI levels. A high body-mass index continued to be a primary risk factor for asthma on a global scale. Decomposition analysis reveals that population growth plays a significant role in exacerbating the burden of asthma-related deaths and DALYs. Conclusions: From 1990 to 2021, the burden of asthma as measured by age-standardized rate (ASR) has shown a declining trend. However, the overall burden of asthma remains significantly high. Moreover, there is a notable inequality in the burden of asthma across different regions and populations worldwide. This highlights the urgent need for countries to prioritize asthma management and control strategies to address these disparities and improve health outcomes for affected individuals.