Abstract
SummaryBackgroundLower respiratory infections are a leading cause of morbidity and mortality around the world. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, provides an up-to-date analysis of the burden of lower respiratory infections in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 26 years and shows how the burden of lower respiratory infection has changed in people of all ages.MethodsWe used three separate modelling strategies for lower respiratory infections in GBD 2016: a Bayesian hierarchical ensemble modelling platform (Cause of Death Ensemble model), which uses vital registration, verbal autopsy data, and surveillance system data to predict mortality due to lower respiratory infections; a compartmental meta-regression tool (DisMod-MR), which uses scientific literature, population representative surveys, and health-care data to predict incidence, prevalence, and mortality; and modelling of counterfactual estimates of the population attributable fraction of lower respiratory infection episodes due to Streptococcus pneumoniae, Haemophilus influenzae type b, influenza, and respiratory syncytial virus. We calculated each modelled estimate for each age, sex, year, and location. We modelled the exposure level in a population for a given risk factor using DisMod-MR and a spatio-temporal Gaussian process regression, and assessed the effectiveness of targeted interventions for each risk factor in children younger than 5 years. We also did a decomposition analysis of the change in LRI deaths from 2000–16 using the risk factors associated with LRI in GBD 2016.FindingsIn 2016, lower respiratory infections caused 652 572 deaths (95% uncertainty interval [UI] 586 475–720 612) in children younger than 5 years (under-5s), 1 080 958 deaths (943 749–1 170 638) in adults older than 70 years, and 2 377 697 deaths (2 145 584–2 512 809) in people of all ages, worldwide. Streptococcus pneumoniae was the leading cause of lower respiratory infection morbidity and mortality globally, contributing to more deaths than all other aetiologies combined in 2016 (1 189 937 deaths, 95% UI 690 445–1 770 660). Childhood wasting remains the leading risk factor for lower respiratory infection mortality among children younger than 5 years, responsible for 61·4% of lower respiratory infection deaths in 2016 (95% UI 45·7–69·6). Interventions to improve wasting, household air pollution, ambient particulate matter pollution, and expanded antibiotic use could avert one under-5 death due to lower respiratory infection for every 4000 children treated in the countries with the highest lower respiratory infection burden.InterpretationOur findings show substantial progress in the reduction of lower respiratory infection burden, but this progress has not been equal across locations, has been driven by decreases in several primary risk factors, and might require more effort among elderly adults. By highlighting regions and populations with the highest burden, and the risk factors that could have the greatest effect, funders, policy makers, and programme implementers can more effectively reduce lower respiratory infections among the world's most susceptible populations.FundingBill & Melinda Gates Foundation.
Highlights
Lower respiratory tract infections, defined in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) as pneumonia or bronchiolitis, are a leading cause of mortality and morbidity worldwide
Other studies have attempted to quantify respiratory pathogens, such as Streptococcus pneumoniae or influenza, and have found a wide range of results depending on modelling assumptions and input data
This paper presents the results of GBD 2016 for lower respiratory infections and four high-burden aetiologies (Haemophilus influenza type b [Hib], Streptococcus pneumoniae, influenza, and respiratory syncytial virus [RSV]), including deaths, episodes, disability-adjusted life-years (DALYs), and risk factors, the relationship between lower respiratory infections and social development, and intervention strategies for 195 countries, from 1990 to 2016, by age, for men and women
Summary
Lower respiratory tract infections, defined in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) as pneumonia or bronchiolitis, are a leading cause of mortality and morbidity worldwide. Evidence before this study Lower respiratory infections are responsible for a substantial number of deaths, among children younger than 5 years (under-5). Most other studies that have attempted to quantify the burden of lower respiratory infections have focused on children younger than 5 years or on subpopulations, such as immunocompromised children and adults. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2015, showed lower respiratory infections being responsible for over 2·74 million deaths (95% uncertainty interval [UI] 2·50–2·86) in 2015, and the third leading cause of under-5 mortality worldwide. An estimated 291·8 million episodes (276·3–307·0) of lower respiratory infections occurred in 2015, and were the second leading cause of disability-adjusted life-years (103 million DALYs; 95% UI 96·1–109·1)
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