Global burden of respiratory infections and tuberculosis and risk factors, 1990-2021: a systematic analysis of the Global Burden of Disease Study 2021.
- 1State Key Laboratory of Molecular Oncology, Beijing Key Laboratory, CAMS Key Laboratory of Translational Research on Lung Cancer, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Abstract
Respiratory infections and tuberculosis (RIT) remain major contributors to global morbidity and mortality, with pronounced geographic and socioeconomic disparities. The emergence of coronavirus disease 2019 (COVID-19) has further disrupted existing control efforts, highlighting the need to reassess temporal trends, socioeconomic disparities, and risk-factor changes. This study aimed to quantify temporal trends, characterize geographic and socioeconomic disparities, and assess changes in risk-factor-attributable burden of RIT from 1990 to 2021. Using Global Burden of Disease (GBD) 2021 data, we quantified incidence, prevalence, deaths, and disability-adjusted life years (DALYs) of RIT across 204 countries/regions from 1990 to 2021. Temporal trends were assessed using average annual percentage change (AAPC) and joinpoint regression. Associations with the Socio-demographic Index (SDI) were examined using Pearson correlation and generalized additive models (GAMs). Risk factor-attributable burdens were estimated using comparative risk assessment (CRA) methodology. In 2021, RIT caused 11.25 million deaths and 349.68 million DALYs worldwide, accounting for 16.59% of total deaths and 12.15% of total DALYs. COVID-19 became the leading cause of RIT mortality (7.89 million deaths), followed by lower RIT. We identified four distinct regional burden trajectories, which reflected differences in health-system capacity and pandemic impact. SDI showed strong negative associations with age-standardized DALYs, deaths, and prevalence, but showed no significant association with incidence. From 1990 to 2021, environmental and behavioral risk factor burdens declined substantially, whereas metabolic risks rose, particularly in high-SDI regions. Despite declining age-standardized rates (ASRs), the absolute global burden of RIT continues to rise due to demographic transitions and the COVID-19 pandemic. Persistent socioeconomic disparities call for integrated strategies that combine vaccination, tuberculosis control, risk-factor reduction, and health-system strengthening to improve respiratory health equity.
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BibTeX
@article{wang2026global,
title = {{Global burden of respiratory infections and tuberculosis and risk factors, 1990-2021: a systematic analysis of the Global Burden of Disease Study 2021.}},
author = {Jiaxu Wang and Jianchun Duan},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-1654},
url = {https://europepmc.org/article/MED/42996967},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Global burden of respiratory infections and tuberculosis and risk factors, 1990-2021: a systematic analysis of the Global Burden of Disease Study 2021.
AU - Jiaxu Wang
AU - Jianchun Duan
PY - 2026
DA - 2026/09/28
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-1654
UR - https://europepmc.org/article/MED/42996967
AB - Respiratory infections and tuberculosis (RIT) remain major contributors to global morbidity and mortality, with pronounced geographic and socioeconomic disparities. The emergence of coronavirus disease 2019 (COVID-19) has further disrupted existing control efforts, highlighting the need to reassess temporal trends, socioeconomic disparities, and risk-factor changes. This study aimed to quantify temporal trends, characterize geographic and socioeconomic disparities, and assess changes in risk-factor-attributable burden of RIT from 1990 to 2021. Using Global Burden of Disease (GBD) 2021 data, we quantified incidence, prevalence, deaths, and disability-adjusted life years (DALYs) of RIT across 204 countries/regions from 1990 to 2021. Temporal trends were assessed using average annual percentage change (AAPC) and joinpoint regression. Associations with the Socio-demographic Index (SDI) were examined using Pearson correlation and generalized additive models (GAMs). Risk factor-attributable burdens were estimated using comparative risk assessment (CRA) methodology. In 2021, RIT caused 11.25 million deaths and 349.68 million DALYs worldwide, accounting for 16.59% of total deaths and 12.15% of total DALYs. COVID-19 became the leading cause of RIT mortality (7.89 million deaths), followed by lower RIT. We identified four distinct regional burden trajectories, which reflected differences in health-system capacity and pandemic impact. SDI showed strong negative associations with age-standardized DALYs, deaths, and prevalence, but showed no significant association with incidence. From 1990 to 2021, environmental and behavioral risk factor burdens declined substantially, whereas metabolic risks rose, particularly in high-SDI regions. Despite declining age-standardized rates (ASRs), the absolute global burden of RIT continues to rise due to demographic transitions and the COVID-19 pandemic. Persistent socioeconomic disparities call for integrated strategies that combine vaccination, tuberculosis control, risk-factor reduction, and health-system strengthening to improve respiratory health equity.
SN - 2072-1439
SN - 2077-6624
ER -