TY  - JOUR
T1  - 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
AU  - GBD 2021 Lower Respiratory Infections and Antimicrobial Resistance Collaborators
AU  - Bender, Rose Grace
AU  - Sirota, Sarah Brooke
AU  - Swetschinski, Lucien R.
AU  - Villanueva Dominguez, Regina-Mae
AU  - Novotney, Amanda
AU  - Wool, Eve E.
AU  - Ikuta, Kevin S.
AU  - Vongpradith, Avina
AU  - Best Rogowski, Emma Lynn
AU  - Doxey, Matthew
AU  - Troeger, Christopher E.
AU  - Albertson, Samuel B.
AU  - Ma, Jianing
AU  - He, Jiawei
AU  - Maass, Kelsey Lynn
AU  - Simões, Eric A. F.
AU  - Abdoun, Meriem
AU  - Abdul Aziz, Jeza Muhamad
AU  - Abdulah, Deldar Morad
AU  - Abu Rumeileh, Samir
AU  - Abualruz, Hasan
AU  - Aburuz, Salahdein
AU  - Adepoju, Abiola Victor
AU  - Adha, Rishan
AU  - Adikusuma, Wirawan
AU  - Adra, Saryia
AU  - Afraz, Ali
AU  - Aghamiri, Shahin
AU  - Agodi, Antonella
AU  - Ahmadzade, Amir Mahmoud
AU  - Ahmed, Haroon
AU  - Ahmed, Ayman
AU  - Akinosoglou, Karolina
AU  - AL-Ahdal, Tareq Mohammed Ali
AU  - Al-amer, Rasmieh Mustafa
AU  - Albashtawy, Mohammed
AU  - AlBataineh, Mohammad T.
AU  - Alemi, Hediyeh
AU  - Al-Gheethi, Adel Ali Saeed
AU  - Ali, Abid
AU  - Shujait Ali, Syed Shujait
AU  - Alqahtani, Jaber S.
AU  - AlQudah, Mohammad
AU  - Al-Tawfiq, Jaffar A.
AU  - Al-Worafi, Yaser Mohammed
AU  - Alzoubi, Karem H.
AU  - Amani, Reza
AU  - Amegbor, Prince M.
AU  - Ameyaw, Edward Kwabena
AU  - Amuasi, John H.
AU  - Anil, Abhishek
AU  - Anyanwu, Philip Emeka
AU  - Arafat, Mosab
AU  - Areda, Damelash
AU  - Arefnezhad, Reza
AU  - Atalell, Kendalem Asmare
AU  - Ayele, Firayad
AU  - Azzam, Ahmed Y.
AU  - Babamohamadi, Hassan
AU  - Babin, François-Xavier
AU  - Bahurupi, Yogesh
AU  - Baker, Stephen
AU  - Banik, Biswajit
AU  - Barchitta, Martina
AU  - Barqawi, Hiba Jawdat
AU  - Basharat, Zarrin
AU  - Baskaran, Pritish
AU  - Batra, Kavita
AU  - Batra, Ravi
AU  - Bayileyegn, Nebiyou Simegnew
AU  - Beloukas, Apostolos
AU  - Berkley, James A.
AU  - Beyene, Kebede A.
AU  - Bhargava, Ashish
AU  - Bhattacharjee, Priyadarshini
AU  - Bielicki, Julia A.
AU  - Bilalaga, Mariah Malak
AU  - Bitra, Veera R.
AU  - Brown, Colin Stewart
AU  - Burkart, Katrin
AU  - Bustanji, Yasser
AU  - Carr, Sinclair
AU  - Chahine, Yaacoub
AU  - Chattu, Vijay Kumar
AU  - Chichagi, Fatemeh
AU  - Chopra, Hitesh
AU  - Chukwu, Isaac Sunday
AU  - Chung, Eunice
AU  - Dadana, Sriharsha
AU  - Dai, Xiaochen
AU  - Dandona, Lalit
AU  - Dandona, Rakhi
AU  - Darban, Isaac
AU  - Dash, Nihar Ranjan
AU  - Dashti, Mohsen
AU  - Dashtkoohi, Mohadese
AU  - Dekker, Denise Myriam
AU  - Delgado-Enciso, Ivan
AU  - Devanbu, Vinoth Gnana Chellaiyan
AU  - Dhama, Kuldeep
AU  - Diao, Nancy
AU  - Do, Thao Huynh Phuong
AU  - Dokova, Klara Georgieva
AU  - Dolecek, Christiane
AU  - Dziedzic, Arkadiusz Marian
AU  - Eckmanns, Tim
AU  - Ed-Dra, Abdelaziz
AU  - Efendi, Ferry
AU  - Eftekharimehrabad, Aziz
AU  - Eyre, David William
AU  - Fahim, Ayesha
AU  - Feizkhah, Alireza
AU  - Felton, Timothy William
AU  - Ferreira, Nuno
AU  - Flor, Luisa S.
AU  - Gaihre, Santosh
AU  - Gebregergis, Miglas W.
AU  - Gebrehiwot, Mesfin
AU  - Geffers, Christine
AU  - Gerema, Urge
AU  - Ghaffari, Kazem
AU  - Goldust, Mohamad
AU  - Goleij, Pouya
AU  - Guan, Shi-Yang
AU  - Gudeta, Mesay Dechasa
AU  - Guo, Cui
AU  - Gupta, Veer Bala
AU  - Gupta, Ishita
AU  - Habibzadeh, Farrokh
AU  - Hadi, Najah R.
AU  - Haeuser, Emily
AU  - Hailu, Wase Benti
AU  - Hajibeygi, Ramtin
AU  - Haj-Mirzaian, Arvin
AU  - Haller, Sebastian
AU  - Hamiduzzaman, Mohammad
AU  - Hanifi, Nasrin
AU  - Hansel, Jan
AU  - Hasnain, Md Saquib
AU  - Haubold, Johannes
AU  - Hoan, Nguyen Quoc
AU  - Huynh, Hong-Han
AU  - Iregbu, Kenneth Chukwuemeka
AU  - Islam, Md Rabiul
AU  - Jafarzadeh, Abdollah
AU  - Jairoun, Ammar Abdulrahman
AU  - Jalil, Mahsa
AU  - Jomehzadeh, Nabi
AU  - Joshua, Charity Ehimwenma
AU  - Kabir, Awal
AU  - Kamal, Zul
AU  - Kanmodi, Kehinde Kazeem
AU  - Kantar, Rami S.
AU  - Karimi Behnagh, Arman
AU  - Kaur, Navjot
AU  - Kaur, Harkiran
AU  - Khamesipour, Faham
AU  - Khan, M. Nuruzzaman
AU  - Khan suheb, Mahammed Ziauddin
AU  - Khanal, Vishnu
AU  - Khatab, Khaled
AU  - Khatib, Mahalaqua Nazli
AU  - Kim, Grace
AU  - Kim, Kwanghyun
AU  - Kitila, Aiggan Tamene Tamene
AU  - Komaki, Somayeh
AU  - Krishan, Kewal
AU  - Krumkamp, Ralf
AU  - Kuddus, Abdul
AU  - Kurniasari, Maria Dyah
AU  - Lahariya, Chandrakant
AU  - Latifinaibin, Kaveh
AU  - Le, Nhi Huu Hanh
AU  - Le, Thao Thi Thu
AU  - Le, Trang Diep Thanh
AU  - Lee, Seung Won
AU  - Le Pape, Alain
AU  - Lerango, Temesgen L.
AU  - Li, Ming-Chieh
AU  - Mahboobipour, Amir Ali
AU  - Malhotra, Kashish
AU  - Mallhi, Tauqeer Hussain
AU  - Manoharan, Anand
AU  - Martinez-Guerra, Bernardo Alfonso
AU  - Mathioudakis, Alexander G.
AU  - Mattiello, Rita
AU  - May, Jürgen
AU  - McManigal, Barney
AU  - McPhail, Steven M.
AU  - Meto, Tesfahun Mekene
AU  - Mendez-Lopez, Max Alberto Mendez
AU  - Meo, Sultan Ayoub
AU  - Merati, Mohsen
AU  - Mestrovic, Tomislav
AU  - Mhlanga, Laurette
AU  - Minh, Le Huu Nhat
AU  - Misganaw, Awoke
AU  - Mishra, Vinaytosh
AU  - Misra, Arup Kumar
AU  - Mohamed, Nouh Saad
AU  - Mohammadi, Esmaeil
AU  - Mohammed, Mesud
AU  - Mohammed, Mustapha
AU  - Mokdad, Ali H.
AU  - Monasta, Lorenzo
AU  - Moore, Catrin E.
AU  - Motappa, Rohith
AU  - Mougin, Vincent
AU  - Mousavi, Parsa
AU  - Mulita, Francesk
AU  - Mulu, Atsedemariam Andualem
AU  - Naghavi, Pirouz
AU  - Naik, Ganesh R.
AU  - Nainu, Firzan
AU  - Nair, Tapas Sadasivan
AU  - Nargus, Shumaila
AU  - Negaresh, Mohammad
AU  - Nguyen, Hau Thi Hien
AU  - Nguyen, Dang H.
AU  - Nguyen, Van Thanh
AU  - Nikolouzakis, Taxiarchis Konstantinos
AU  - Noman, Efaq Ali
AU  - Nri-Ezedi, Chisom Adaobi
AU  - Odetokun, Ismail A.
AU  - Okwute, Patrick Godwin
AU  - Olana, Matifan Dereje
AU  - Olanipekun, Titilope O
AU  - Olasupo, Omotola O.
AU  - Olivas-Martinez, Antonio
AU  - Ordak, Michal
AU  - Ortiz-Brizuela, Edgar
AU  - Ouyahia, Amel
AU  - Padubidri, Jagadish Rao
AU  - Pak, Anton
AU  - Pandey, Anamika
AU  - Pantazopoulos, Ioannis
AU  - Parija, Pragyan Paramita
AU  - Parikh, Romil R.
AU  - Park, Seoyeon
AU  - Parthasarathi, Ashwaghosha
AU  - Pashaei, Ava
AU  - Peprah, Prince
AU  - Pham, Hoang Tran
AU  - Poddighe, Dimitri
AU  - Pollard, Andrew
AU  - Ponce-De-Leon, Alfredo
AU  - Prakash, Peralam Yegneswaran
AU  - Prates, Elton Junio Sady
AU  - Quan, Nguyen Khoi
AU  - Raee, Pourya
AU  - Rahim, Fakher
AU  - Rahman, Mosiur
AU  - Rahmati, Masoud
AU  - Ramasamy, Shakthi Kumaran
AU  - Ranjan, Shubham
AU  - Rao, Indu Ramachandra
AU  - Rashid, Ahmed Mustafa
AU  - Rattanavong, Sayaphet
AU  - Ravikumar, Nakul
AU  - Reddy, Murali Mohan Rama Krishna
AU  - Redwan, Elrashdy Moustafa Mohamed
AU  - Reiner Jr., Robert C.
AU  - Reyes, Luis Felipe
AU  - Roberts, Tamalee
AU  - Rodrigues, Mónica
AU  - Rosenthal, Victor Daniel
AU  - Roy, Priyanka
AU  - Runghien, Tilleye
AU  - Saeed, Umar
AU  - Saghazadeh, Amene
AU  - Sharif-Askari, Narjes Saheb
AU  - Sharif-Askari, Fatemeh Saheb
AU  - Sahoo, Soumya Swaroop
AU  - Sahu, Monalisha
AU  - Sakshaug, Joseph W.
AU  - Salami, Afeez Abolarinwa
AU  - Saleh, Mohamed A.
AU  - Salehi omran, Hossein
AU  - Sallam, Malik
AU  - Samadzadeh, Sara
AU  - Samodra, Yoseph Leonardo
AU  - Sanjeev, Rama Krishna
AU  - Sarasmita, Made Ary
AU  - Saravanan, Aswini
AU  - Sartorius, Benn
AU  - Saulam, Jennifer
AU  - Schumacher, Austin E.
AU  - Seyedi, Seyed Arsalan
AU  - Shafie, Mahan
AU  - Shahid, Samiah
AU  - Sham, Sunder
AU  - Shamim, Muhammad Aaqib
AU  - Shamshirgaran, Mohammad Ali
AU  - Shastry, Rajesh P.
AU  - Sherchan, Samendra P.
AU  - Shiferaw, Desalegn
AU  - Shittu, Aminu
AU  - Siddig, Emmanuel Edwar
AU  - Sinto, Robert
AU  - Sood, Aayushi
AU  - Sorensen, Reed J. D.
AU  - Stergachis, Andy
AU  - Stoeva, Temenuga Zhekova
AU  - Swain, Chandan Kumar
AU  - Szarpak, Lukasz
AU  - Tamuzi, Jacques Lukenze
AU  - Temsah, Mohamad-Hani
AU  - Tessema, Melkamu B Tessema
AU  - Thangaraju, Pugazhenthan
AU  - Tran, Nghia Minh
AU  - Tran, Ngoc-Ha
AU  - Tumurkhuu, Munkhtuya
AU  - Ty, Sree Sudha
AU  - Udoakang, Aniefiok John
AU  - Ulhaq, Inam
AU  - Umar, Tungki Pratama
AU  - Umer, Abdurezak Adem
AU  - Vahabi, Seyed Mohammad
AU  - Vaithinathan, Asokan Govindaraj
AU  - Van den Eynde, Jef
AU  - Walson, Judd L.
AU  - Waqas, Muhammad
AU  - Xing, Yuhan
AU  - Yadav, Mukesh Kumar
AU  - Yahya, Galal
AU  - Yon, Dong Keon
AU  - Zahedi Bialvaei, Abed
AU  - Zakham, Fathiah
AU  - Zeleke, Abyalew Mamuye
AU  - Zhai, Chunxia
AU  - Zhang, Zhaofeng
AU  - Zhang, Haijun
AU  - Zielińska, Magdalena
AU  - Zheng, Peng
AU  - Aravkin, Aleksandr Y.
AU  - Vos, Theo
AU  - Hay, Simon I.
AU  - Mosser, Jonathan F.
AU  - Lim, Stephen S.
AU  - Naghavi, Mohsen
AU  - Murray, Christopher J. L.
AU  - Kyu, Hmwe Hmwe
AB  - 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).
KW  - Adolescents
KW  - Adult
KW  - Aged
KW  - Aged, 80 and over
KW  - Child
KW  - Child, Preschool
KW  - Female
KW  - Global Burden of Disease
KW  - Global Health / statistics & numerical data
KW  - Humans
KW  - Incidence
KW  - Infant
KW  - Infant, Newborn
KW  - Male
KW  - Middle Aged
KW  - Respiratory Tract Infections / epidemiology
KW  - Respiratory Tract Infections / microbiology
KW  - Respiratory Tract Infections / mortality
KW  - Young Adult
KW  - 610 Medizin und Gesundheit
PY  - 2024
LA  - eng
PB  - Robert Koch-Institut
JO  - The Lancet Infectious Diseases
SP  - 974
EP  - 1002
DO  - 10.1016/S1473-3099(24)00176-2
ER  -