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Background <p>Lower respiratory infections (LRIs) are a major global contributor to morbidity and mortality, with influenza viruses being a significant cause. Despite advances in vaccination and antiviral therapies, the burden of influenza-associated LRIs remains high, particularly in low-income regions and high-risk populations. Understanding long-term trends and regional disparities is crucial for developing effective prevention strategies.</p> Methods <p>Using data from the Global Burden of Disease (GBD) 2021 study, we analyzed age-standardized mortality rates (ASMR), and disability-adjusted life years (DALYs) for influenza-associated LRIs across 21 global regions and 204 countries and territories from 1990 to 2021. Joinpoint regression was utilized to analyze temporal trends in the disease burden of influenza-associated LRIs. The relationship between influenza-associated LRIs burden and the socio-demographic index (SDI) was examined using a smoothing spline model. Frontier analysis was employed to estimate achievable outcomes based on development levels.</p> Results <p>Globally, ASMR declined from 5.87 (95% UI: 5.33–6.40) per 100,000 population in 1990 to 1.30 (0.98–1.66) per 100,000 population in 2021, with an average annual percent change (AAPC) of -0.69% (1990–2019) and − 49.74% (2019–2021). Despite declining rates, absolute deaths increased by 0.85% annually from 1990 to 2019, reflecting population growth and aging. In 2021, Central Sub-Saharan Africa had the highest ASMR (10.84/100,000 population) and ASDR (271.71/100,000 population), while high SDI regions (e.g., High-income Asia Pacific) approached near-zero mortality. Age-specific analysis revealed bimodal burdens: children under 5 and adults ≥ 70 years faced the highest risks.</p> Conclusions <p>Influenza-associated LRIs remain a significant global health challenge, particularly in low-income and high-risk populations. While global trends indicate progress, regional disparities and the impact of demographic factors highlight the need for tailored interventions. Targeted strategies—including equitable vaccine access, healthcare system strengthening, and integrated surveillance—are critical to mitigating burden in high-risk regions and populations.</p>

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Global, regional, and national burden of influenza-associated lower respiratory infections, 1990–2021: a systematic analysis from the Global Burden of Disease Study 2021

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月7日

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  • Chenglong Shao,
  • Xing Huang,
  • Huiyong Zhang,
  • Xianwei Wu,
  • Huimin Shen,
  • Lei Qiu,
  • Shaoyan Zhang,
  • Zhenhui Lu

摘要

Background

Lower respiratory infections (LRIs) are a major global contributor to morbidity and mortality, with influenza viruses being a significant cause. Despite advances in vaccination and antiviral therapies, the burden of influenza-associated LRIs remains high, particularly in low-income regions and high-risk populations. Understanding long-term trends and regional disparities is crucial for developing effective prevention strategies.

Methods

Using data from the Global Burden of Disease (GBD) 2021 study, we analyzed age-standardized mortality rates (ASMR), and disability-adjusted life years (DALYs) for influenza-associated LRIs across 21 global regions and 204 countries and territories from 1990 to 2021. Joinpoint regression was utilized to analyze temporal trends in the disease burden of influenza-associated LRIs. The relationship between influenza-associated LRIs burden and the socio-demographic index (SDI) was examined using a smoothing spline model. Frontier analysis was employed to estimate achievable outcomes based on development levels.

Results

Globally, ASMR declined from 5.87 (95% UI: 5.33–6.40) per 100,000 population in 1990 to 1.30 (0.98–1.66) per 100,000 population in 2021, with an average annual percent change (AAPC) of -0.69% (1990–2019) and − 49.74% (2019–2021). Despite declining rates, absolute deaths increased by 0.85% annually from 1990 to 2019, reflecting population growth and aging. In 2021, Central Sub-Saharan Africa had the highest ASMR (10.84/100,000 population) and ASDR (271.71/100,000 population), while high SDI regions (e.g., High-income Asia Pacific) approached near-zero mortality. Age-specific analysis revealed bimodal burdens: children under 5 and adults ≥ 70 years faced the highest risks.

Conclusions

Influenza-associated LRIs remain a significant global health challenge, particularly in low-income and high-risk populations. While global trends indicate progress, regional disparities and the impact of demographic factors highlight the need for tailored interventions. Targeted strategies—including equitable vaccine access, healthcare system strengthening, and integrated surveillance—are critical to mitigating burden in high-risk regions and populations.