Jiang Qing-Qing, Zhang Xiao-Yu, Yu Xiao, Liu You-De, Pan Wei, Xue Jian
Qishan Hospital of Yantai, Department of Hospital Infection Management, Shandong Province, The People's Republic of China.
Department of Laboratory Medicine, Yantai Center for Disease Control and Prevention, Shandong Province, The People's Republic of China.
Medicine (Baltimore). 2025 Sep 12;104(37):e44280. doi: 10.1097/MD.0000000000044280.
This study analyzed the disease burden of lower respiratory infections (LRIs) and associated health inequalities globally, regionally, and nationally from 1990 to 2021, aiming to provide evidence-based insights for optimizing public health policies. Leveraging data from the 2021 global burden of diseases (BODs), injuries, and risk factors study (global burden of diseases (GBD) 2021), we comprehensively analyzed the disease burden and health inequality levels. Using frontier analysis, we aimed to elucidate the impact of national and regional development. Decomposition analysis was employed to dissect the contributions of epidemiological changes, aging, and population growth, while age-period-cohort (APC) modeling was adopted to explore temporal trends. Compared to 1990, the global burden of LRIs in 2021 exhibited a downward trend; however, significant disparities persisted across socio-demographic index (SDI) strata. In 2021, low-SDI regions recorded the highest age-standardized disability-adjusted life year (DALY) rates, with the most pronounced disease burden observed in sub-Saharan Africa. After adjusting for population size, the top 5 countries with the highest absolute disease burden were India, Nigeria, China, Pakistan, and Ethiopia, collectively accounting for 45.1% of the global burden. From 1990 to 2021, health inequalities narrowed with increasing SDI. Among all regions, China exhibited the most significant improvement, whereas the 15 countries with the largest improvement gaps were predominantly concentrated in low- and low-middle-SDI regions. Globally, reductions were primarily driven by epidemiological transitions. However, in Asia and sub-Saharan Africa, population growth substantially offset these gains. Children under 5 and adults over 65 represented the highest-burden groups. Globally, pre-2005 improvements were predominantly driven by high-SDI regions; however, post-2005, while global trends stabilized, middle-high-SDI regions exhibited a significant decline. Prior to 1947, changes were largely influenced by high-SDI regions. In contrast, over the past 3 decades (since 1987), the most significant improvements were observed in middle-high-SDI and middle-SDI regions, reflecting substantial advancements in these populations. Health inequalities related to LRIs are significantly influenced by geographic and national factors. Although epidemiological improvements have improved LRI-related health outcomes globally, these gains are offset by challenges such as population aging and growth. Targeted interventions are urgently needed to address the underlying drivers of health inequality.
本研究分析了1990年至2021年全球、区域和国家层面下呼吸道感染（LRI）的疾病负担及相关健康不平等现象，旨在为优化公共卫生政策提供循证见解。利用2021年全球疾病、伤害及风险因素负担研究（GBD 2021）的数据，我们全面分析了疾病负担和健康不平等水平。通过前沿分析，我们旨在阐明国家和区域发展的影响。采用分解分析来剖析流行病学变化、老龄化和人口增长的贡献，同时采用年龄-时期-队列（APC）模型来探索时间趋势。与1990年相比，2021年全球LRI负担呈下降趋势；然而，社会人口指数（SDI）各阶层之间仍存在显著差异。2021年，低SDI地区的年龄标准化残疾调整生命年（DALY）率最高，撒哈拉以南非洲地区的疾病负担最为明显。在调整人口规模后，疾病负担绝对值最高的前5个国家是印度、尼日利亚、中国、巴基斯坦和埃塞俄比亚，它们合计占全球负担的45.1%。从1990年到2021年，随着SDI的增加，健康不平等有所缩小。在所有地区中，中国的改善最为显著，而改善差距最大的15个国家主要集中在低和中低SDI地区。在全球范围内，减少主要由流行病学转变驱动。然而，在亚洲和撒哈拉以南非洲，人口增长大幅抵消了这些成果。5岁以下儿童和65岁以上成年人是负担最重的群体。在全球范围内，2005年前的改善主要由高SDI地区推动；然而，2005年后，虽然全球趋势稳定，但中高SDI地区出现了显著下降。1947年之前，变化主要受高SDI地区影响。相比之下，在过去30年（自1987年以来），中高SDI和中SDI地区取得了最显著的改善，反映出这些人群取得了实质性进步。与LRI相关的健康不平等受到地理和国家因素的显著影响。尽管流行病学方面的改善在全球范围内改善了与LRI相关的健康结果，但这些成果被人口老龄化和增长等挑战所抵消。迫切需要有针对性的干预措施来解决健康不平等的根本驱动因素。
