Diversifying deaths: the shifting spectrum of childhood respiratory infectious mortality, 1990-2023: a systematic analysis of the Global Burden of Disease Study 2023
- 1National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
Abstract
BackgroundChildhood respiratory infectious deaths are partitioned across four Global Burden of Disease cause modules--26 etiological attributions within lower respiratory infections, tuberculosis, COVID-19, and whooping cough--never jointly reported. Whether the structure of this combined mortality spectrum has changed over time, and with what implications for intervention design, has not been quantified. We assembled and analyzed the integrated spectrum for children and adolescents aged 0-19 years, 1990-2023.
MethodsWe integrated Global Burden of Disease Study 2023 (release v8352) estimates into a 29-node spectrum--26 lower respiratory infection etiologies plus tuberculosis, COVID-19, and pertussis--globally and across seven super-regions, with uncertainty propagated by summing bounds. We computed Shannon diversity, Herfindahl concentration, and effective cause counts; phenotyped pandemic-window collapse and rebound per cause; linked pathogen shares to WHO/UNICEF vaccine coverage; and mapped geographic concentration in sub-Saharan Africa and South Asia. Reporting follows GATHER.
ResultsIn 2023 the 29 causes jointly accounted for 965,330 deaths (95% uncertainty interval [UI] 680,096-1,342,437). Shannon diversity rose from 2.336 to 2.711 (+16.1%) between 1990 and 2023; the effective number of causes nearly doubled (5.57 to 9.94), inversely coupled to total deaths (Spearman {rho} = -0.997). Whooping cough ranked second (112,954 deaths; 95% UI 64,576-185,708; 11.7%) and showed the spectrums only rebound above 100% (-57.4% collapse, +111.0% rebound). Tuberculosis ranked third (87,764; 57,779-124,912; 9.1%) with the highest concentration in sub-Saharan Africa and South Asia (87.1%). COVID-19 entered at rank five (52,899; 47,275-59,183; 5.5%). Nineteen of 29 causes exceeded the poverty-lock threshold (>80.59% of deaths in sub-Saharan Africa plus South Asia).
ConclusionsChildhood respiratory infectious mortality has become more diverse and more concentrated in poverty as it has declined. Single-pathogen interventions now address a shrinking share; the spectrums structure argues for platform interventions--oxygen, antimicrobial access, referral--tailored jointly by age and geography, implying that pathogen-specific strategies alone cannot finish the remaining mortality agenda.
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BibTeX
@misc{li2026diversifying,
title = {{Diversifying deaths: the shifting spectrum of childhood respiratory infectious mortality, 1990-2023: a systematic analysis of the Global Burden of Disease Study 2023}},
author = {D. Li and H. Chen and Y. Miao and Y. Zhang and X. Wang and C. Shen},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.01.26361937},
url = {https://www.medrxiv.org/content/10.64898/2026.09.01.26361937v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Diversifying deaths: the shifting spectrum of childhood respiratory infectious mortality, 1990-2023: a systematic analysis of the Global Burden of Disease Study 2023
AU - D. Li
AU - H. Chen
AU - Y. Miao
AU - Y. Zhang
AU - X. Wang
AU - C. Shen
PY - 2026
DA - 2026/09/01
PB - medRxiv
DO - 10.64898/2026.09.01.26361937
UR - https://www.medrxiv.org/content/10.64898/2026.09.01.26361937v1
AB - BackgroundChildhood respiratory infectious deaths are partitioned across four Global Burden of Disease cause modules--26 etiological attributions within lower respiratory infections, tuberculosis, COVID-19, and whooping cough--never jointly reported. Whether the structure of this combined mortality spectrum has changed over time, and with what implications for intervention design, has not been quantified. We assembled and analyzed the integrated spectrum for children and adolescents aged 0-19 years, 1990-2023. MethodsWe integrated Global Burden of Disease Study 2023 (release v8352) estimates into a 29-node spectrum--26 lower respiratory infection etiologies plus tuberculosis, COVID-19, and pertussis--globally and across seven super-regions, with uncertainty propagated by summing bounds. We computed Shannon diversity, Herfindahl concentration, and effective cause counts; phenotyped pandemic-window collapse and rebound per cause; linked pathogen shares to WHO/UNICEF vaccine coverage; and mapped geographic concentration in sub-Saharan Africa and South Asia. Reporting follows GATHER. ResultsIn 2023 the 29 causes jointly accounted for 965,330 deaths (95% uncertainty interval [UI] 680,096-1,342,437). Shannon diversity rose from 2.336 to 2.711 (+16.1%) between 1990 and 2023; the effective number of causes nearly doubled (5.57 to 9.94), inversely coupled to total deaths (Spearman {rho} = -0.997). Whooping cough ranked second (112,954 deaths; 95% UI 64,576-185,708; 11.7%) and showed the spectrums only rebound above 100% (-57.4% collapse, +111.0% rebound). Tuberculosis ranked third (87,764; 57,779-124,912; 9.1%) with the highest concentration in sub-Saharan Africa and South Asia (87.1%). COVID-19 entered at rank five (52,899; 47,275-59,183; 5.5%). Nineteen of 29 causes exceeded the poverty-lock threshold (>80.59% of deaths in sub-Saharan Africa plus South Asia). ConclusionsChildhood respiratory infectious mortality has become more diverse and more concentrated in poverty as it has declined. Single-pathogen interventions now address a shrinking share; the spectrums structure argues for platform interventions--oxygen, antimicrobial access, referral--tailored jointly by age and geography, implying that pathogen-specific strategies alone cannot finish the remaining mortality agenda.
ER -