Global burden, trends and projections analysis of interstitial lung disease and pulmonary sarcoidosis in elderly adults (aged 55+ Years) based on GBD 2021.

Particulate matter pollution (PM2.5) is a leading global health risk factor. We analyzed the spatiotemporal trends of diseases attributable to PM2.5 at global, regional, and national levels from 1990 to 2021. Using data from the Global Burden of Disease (GBD) 2021 study, we assessed global, regional, and national deaths and disability-adjusted life years (DALYs) due to PM2.5, along with age-standardized mortality rates (ASMR) and age-standardized DALY rates (ASDR), categorized by age, sex, year, location, and disease type. We used average annual percentage change (AAPC) to illustrate trends from 1990 to 2021. Spearman correlation analysis was conducted to examine the relationship between the socio-demographic index (SDI) and age-standardized rates (ASRs) across 204 countries. Bayesian age-period-cohort (BAPC) analysis was used to project trends for 2022-2036. In 2021, PM2.5 exposure contributed to 7.83 million deaths and 231.51 million DALYs globally. The age-standardized rates decreased to 95.69 per 100,000 for deaths (AAPC = -2.12) and 2984.47 per 100,000 for DALYs (AAPC = -2.22), compared to 1990. Disease burdens related to PM2.5, as reflected by ASMR and ASDR, declined across SDI quintiles and GBD super regions from 1990 to 2021. The low SDI quintile had the highest disease burden (ASMR: 211.39, ASDR: 6,114.26). Correlation analysis revealed a significant negative relationship between ASRs and SDI. South Asia and sub-Saharan Africa experienced the highest disease burdens. Males had higher disease burdens than females globally and in all regions. The burden was particularly severe for children under five and older adults. Ischemic heart disease and stroke were the leading causes of PM2.5-related deaths and DALYs. Diabetes mellitus saw an increase in both deaths and DALYs. The BAPC model predicts continued declines in PM2.5-related ASDR and ASMR over the next 15 years. With population growth and an aging demographic, the public health burden associated with PM2.5 exposure remains a major concern. It is imperative to develop targeted and proactive strategies that account for the unique circumstances and challenges of different regions.

Peptic ulcer disease (PUD) is a chronic gastrointestinal disorder that may present acutely due to complications and poses significant clinical and economic challenges. Understanding the global burden of PUD and its contributing risk factors is essential for developing targeted prevention strategies. Therefore, our research aimed to comprehensively evaluate the epidemiological characteristics and associated risk factors of PUD, thereby providing evidence to support policymakers in formulating appropriate health policies. The data on PUD were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Incidence, prevalence, deaths and disability-adjusted life years (DALYs) were metrics used to measure PUD burden. The population attributable fractions (PAFs) were used to calculate the percentage contributions of primary potential risk factors to PUD deaths and DALYs. The global incidence and prevalence cases of PUD increased by 11.1% and 8.8%, respectively, between 1990 and 2021. In contrast, the number of deaths and DALYs decreased by 15.94% and 27.8%, respectively, during the same period. The global age-standardized rates (ASRs) for incidence, prevalence, deaths and DALYs associated with PUD decreased by 40.3%, 41.1%, 61.5%, and 63.1%, respectively, between 1990 and 2021. Men exhibited higher numbers and ASRs of incidence, prevalence, deaths, and DALYs associated with PUD than women across most age cohorts in 2021.The average annual percentage change (AAPC) in age-standardized incidence (ASIR), prevalence (ASPR), deaths (ASMR), and DALYs (ASDR) rates for PUD were -1.65 (95% confidence interval (CI): -1.69, -1.61), -1.69 (95% CI: -1.74, -1.63), -3.02 (95% CI: -3.13, -2.91) and -3.17 (95% CI: -3.24,-3.10), respectively, from 1990 to 2021 on a global scale. In 2021, negative associations were observed globally among the ASIR, ASPR, ASMR, ASDR and the Socio-Demographic Index (SDI). Based on the ARIMA model, we projected that the global ASIR, ASPR, ASMR, and ASDR for PUD will exhibit decreasing trends from 2022 to 2040 for both sexes. We also identified smoking as the primary risk factor associated with PUD-related DALYs and deaths in both sexes in 1990 and 2021. Significant advancements have been noted in reducing the global burden of PUD. Nonetheless, significant geographical and gender disparities exist in PUD numbers and ASRs, suggesting that a substantial portion of the population still lacks access to quality healthcare or experiences variations in risk factors for PUD. Thus, precise prevention strategies are essential to mitigate the disease burden of PUD.

This study aims to analyze global trends in cancer deaths and disability-adjusted life years (DALYs) attributable to smoking from 1990 to 2021 using the Global Burden of Disease (GBD) database, and to predict trends over the next 20 years. This study utilized the 2021 GBD database to extract annual mortality, DALYs, and age-standardized rates for cancer attributable to smoking across 204 countries from 1990 to 2021. Joinpoint regression assessed temporal trends, calculating average annual percentage change (AAPC). Autoregressive Integrated Moving Average (ARIMA) modeling forecasted future disease burden for 20 years. From 1990 to 2021, global cancer attributable to smoking deaths and DALYs increased, with deaths rising from 1,328.88 to 2,012.85 thousand and DALYs from 35,581.64 to 47,976.55 thousand, despite declining age-standardized mortality (ASMR) from 33.76 to 23.31 per 100,000 (AAPC: -1.19) and DALYs (ASDR) from 863.94 to 546.86 per 100,000 (AAPC: -1.47). Males exhibited a higher burden, with ASMR at 42.68 and ASDR at 978.15 per 100,000 in 2021, compared to females (7.01 and 161.30). High Socio-demographic Index (SDI) regions showed the steepest ASMR decline (AAPC: -1.80). Tracheal, bronchus, and lung, esophageal, and stomach cancers dominated the burden. In 2021, specific regions within Greenland, Eastern Europe, Central Asia, East Asia, and the Middle East demonstrated notably higher compared to other regions. The ARIMA model predicts that the ASMR and ASDR for cancer attributable to smoking in both males and females will continue to decline from 2022 to 2041. This study reveals a rising global burden of cancer attributable to smoking deaths and DALYs. However, ASMR and ASDR have decreased, with males bearing a higher burden, indicating a relative reduction in disease burden. High SDI regions exhibit steeper declines in the burden of cancer attributable to smoking. Tracheal, bronchus, and lung, esophageal, and stomach cancers dominate, with ARIMA forecasts predicting continued reductions through 2041. It remains imperative to enhance tobacco control, especially in low SDI regions, to sustain this declining trend.

INTRODUCTIONThis study analyzes the global, regional, and national health burden of secondhand smoke-related tracheal, bronchus, and lung (TBL) cancer from 1990 to 2021.METHODSThis is a secondary dataset analysis of the GBD dataset. First, the number and age-standardized rate (ASR) per 100000 population of deaths and disability-adjusted life years (DALY) related to TBL cancer due to secondhand smoke in 2021 were analyzed at multiple levels. The temporal trends in disease burden between 1990 and 2021 were then analyzed by a linear regression model.RESULTSGlobally, the number of deaths and DALYs from secondhand smoke-related TBL cancer increased from 57.6 thousand and 1598.9 thousand in 1990 to 97.9 thousand and 2355.9 thousand in 2021. Men faced higher risks, with 56.8 thousand deaths and 1359.6 thousand DALYs in 2021. The highest number of deaths and DALYs occurred in the age groups of 70–74 years (15731; 95% UI: 1787–30495) and 65–69 years (380606; 95% UI: 47383–717297), respectively. Disease burden varies widely across sociodemographic index (SDI) regions, GBD regions, and countries. In 2021, the high-middle SDI region had the highest ASRs of deaths (1.96; 95% UI: 0.23–3.67) and DALYs (47.2; 95% UI: 5.65–87.54), and the highest number of deaths (39124; 95% UI: 4613–73341) and DALYs (936577; 95% UI: 111577–1736627). ASR for deaths and DALYs was highest in East Asia (2.75; 95% UI: 0.34–5.18 and 62.42; 95% UI: 7.79–116.4). Among the countries, China has the highest number of deaths (58034; 95% UI: 7170–109625) and DALYs (1359730; 95% UI: 170188–2537368), and Montenegro has the highest ASR of deaths (3.45; 95% UI: 0.38–7.06) and DALYs (84.34; 95% UI: 9.36–170.96).CONCLUSIONSThis study describes the disease burden of secondhand smoke-related TBL cancer, emphasizing secondhand smoke is a non-negligible risk factor for TBL cancer. The findings of this study can serve as a basis for formulating targeted tobacco control policies, which could significantly contribute to reducing the global burden of TBL cancer.

Global, regional, and national burden of interstitial lung disease and pulmonary sarcoidosis from 1990 to 2023, and projections to 2050: A systematic analysis for the Global Burden of Disease Study 2023

Based on the results extracted from the Global Burden of Disease (GBD) 2021, the objective of this research is to examine the spatiotemporal trends of bladder cancer attributable to smoking from 1990 to 2021, and to make projections up to the year 2046. This study conducted a secondary dataset analysis of smoking-attributable bladder cancer data extracted from GBD 2021. Bladder cancer was classified using the International Classification of Diseases 10th Revision (ICD-10) in GBD, and smoking exposure was defined as both current and past use of smoked tobacco products. By employing a Bayesian age-period-cohort (BAPC) model, the average annual percentage change (AAPC) was determined to examine trends over time. From 1990 to 2021, the number of deaths and disability-adjusted life years (DALYs) due to smoking-attributable bladder cancer increased significantly. The age-standardized death rate (ASDR) decreased, with an AAPC of -1.54 (95% CI: -1.62 - -1.46). The age-standardized DALY rate (ASDLR) also showed a decline, with an AAPC of -1.68 (95% CI: -1.81 - -1.56). The regions that experienced the most significant age-standardized rate (ASR) burden were Central Europe and Western Europe. Regions with high-medium sociodemographic index (SDI) values had the highest number of deaths and DALYs, as well as the highest ASR for both indicators. The heaviest global disease burden is concentrated among males and individuals aged ≥70 years. Smoking-attributable bladder cancer deaths are projected to rise over the next 25 years, reaching 90021.45 by 2046. Despite a decrease in the ASRs of smoking-attributable bladder cancer, the absolute burden has increased and is expected to continue growing. Therefore, continuous and targeted tobacco control measures and medical strategies are needed, especially for developed regions, the elderly, and male populations. And due to the unique mechanisms by which tobacco causes disease, the youth and female populations should not be neglected.

The aim of this study was to assess the global burden of disease from non-communicable chronic diseases (NCD) due to diet low in fruits from 1990 to 2019. Based on data from the Global Burden of Disease (GBD) 2019, the global burden of disease due to diet low in fruits was analyzed for each country or region, disaggregated by disease type, age, sex, and year. The number of deaths and disability-adjusted life years (DALYs), population attributable fraction (PAF), age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were calculated, and the average annual percentage change (AAPC) was calculated to describe trends in ASMR and ASDR from 1990 to 2019. From 1990 to 2019, the number of deaths and DALYs due to diet low in fruits increased by 31.5 and 27.4%, respectively. Among the tertiary diseases, ischemic heart disease, stroke, and diabetes and kidney disease were the top three contributors to the global increase in deaths and DALYs. However, both ASMR and ASDR showed a decreasing trend. The fastest decline in ASMR and ASDR was in stroke, with AAPC of -2.13 (95% CI: -2.22, -2.05, p < 0.05) and -0.56 (95% CI: -0.62, -0.51, p < 0.05), respectively. For GBD regions, high PAF occurred mainly in South Asia, Oceania, and sub-Saharan Africa. Age-specific PAF for stroke and ischemic heart disease death attributable to diet low in fruits was significantly negatively associated with age. Diet low in fruits related ASMR and ASDR showed an M-shaped relationship with the socio-demographic index (SDI), but with an overall decreasing trend. The number of deaths and DALYs due to diet low in fruits continues to increase. Therefore, early nutritional interventions should be implemented by the relevant authorities to reduce the burden of diseases caused by diet low in fruits.

Global Disease Burden From Acute Glomerulonephritis 1990–2019

Background Inflammatory bowel disease (IBD) is a significant component of the global disease burden, particularly among adolescents and young adults. This study aimed to investigate the patterns and trends of IBD among adolescents from 1990 to 2021. Methods We retrieved data on the incidence and disability-adjusted life years (DALYs) of IBD in adolescents (aged 15-39 years) from the Global Burden of Disease (GBD) 2021 study, Temporal trends of incidence and DALYs were calculated using the average annual percent change (AAPC). The correlation between age-specific incidence rates and DALYs rates with the Sociodemographic Index (SDI) was performed using Spearman’s correlation analysis. Results From 1990 to 2021, age-specific incidence rates significantly increased while age-specific DALYs rates declined [AAPC: 0.22vs-0.16]. All SDI regions saw a decline in age-specific incidence rates while age-specific DALYs rates in adolescent showed an increasing trend in low and middle SDI regions but a-decrease in high, high-middle and low-middle SDI regions. Incidence rates rose from 1990 to 2021 in 21-GBD regions except for high-income North America. In contrast, DALYs rates increased in regions such as Western Sub-Saharan Africa, Central Latin America, Tropical Latin America, Australasia, Eastern Sub-Saharan Africa, Central Sub-Saharan Africa, Central Asia, and North Africa and the Middle East, while they declined in the remaining 21-GBD regions. Among the 204-countries, China exhibited the fastest-growing age-specific incidence rate among adolescents [AAPC: 2.60], followed by Libya (AAPC: 2.59) and Oman (AAPC: 1.56), while Italy showed the fastest decline [AAPC: -0.76] (Figure-1A). Mauritius experienced the fastest growth in age-specific DALYs rates among adolescents (AAPC: 1.93), followed by Libya (AAPC: 1.79) and Mexico (AAPC: 1.45), while Northern Mariana Islands saw the fastest decline (AAPC: -3.28) (Figure-1B). Moreover, the AAPC of age-specific incidence rates for adolescent IBD exhibited a slight decreasing trend with increasing SDI (Figure-1C), and the AAPC of DALYs rates significantly declined with increasing SDI (Figure-1D). Conclusion The regional disparities in the incidence and DALYs rates of adolescent IBD highlight the urgent need for innovative prevention and healthcare strategies to alleviate the global burden of IBD among adolescents. Early screening could be crucial in mitigating the impact of IBD on adolescents.

Background and Objectives: Alzheimer's disease and other dementias represent some of the leading public health concerns worldwide. This study aimed to assess the global burden of Alzheimer's disease and other dementias attributable to high fasting plasma glucose in the last decades. Materials and Methods: A descriptive epidemiological study was conducted. The Global Burden of Disease (GBD) study data about deaths and Disability-Adjusted Life Years (DALYs) were used. All figures were presented as age-standardized rates (ASRs). The average annual percent change (AAPC) was computed using the Joinpoint regression analysis. Also, age-period-cohort analysis was performed. Results: A total of 2 million deaths from Alzheimer's disease and other dementias were reported worldwide in 2021, whereby the total number deaths from Alzheimer's disease and other dementias attributable to high fasting plasma glucose was 290,032 (98,900 males and 191,132 females) in 2021. The highest ASRs of burden of Alzheimer's disease and other dementias attributable to high fasting plasma glucose were found in Afghanistan, Iraq, Morocco, Qatar, and the United States of America, while the lowest ASRs were in Belarus and Mongolia. From 1990 to 2021, a significant increase (p < 0.001) was noted in ASRs of deaths and DALYs for Alzheimer's disease and other dementias attributable to high fasting plasma glucose. Looking at the GBD regions, the trends in ASRs for mortality and for DALYs of Alzheimer's disease and other dementias attributable to high fasting plasma glucose between 1990 and 2021 showed a growth 10-fold faster in High-income North America (AAPC = 2.0%, for both equally) and Central Asia (AAPC = 2.4% and AAPC = 2.5%, respectively) than in the region of High-income Asia Pacific (AAPC = 0.1% and AAPC = 0.2%, respectively). The relative risk of mortality and DALYs for Alzheimer's disease and other dementias attributable to high fasting plasma glucose demonstrated statistically significant (p < 0.0001) period and cohort effects, and net drift and local drifts. Conclusions: This study showed an increase in the global burden of Alzheimer's disease and other dementias attributable to high fasting plasma glucose in the last decades. Future successful entire-population strategies targeting high fasting plasma glucose may reduce the burden of a wide range of these diseases.

BackgroundThe distribution of diet-attributable cancer burden has not been systematically analyzed globally. This study aimed to analyze the diet-attributable cancer burden using the Global Burden of Disease (GBD) database to provide insights into reducing the dietary risk-related cancer burden across regions with different development levels.MethodsData on cancer deaths and disability-adjusted life years (DALYs) attributable to diet were downloaded from the GBD database (1990–2021). The cancer burden attributable to nine dietary factors and total dietary factors was sorted, and Joinpoint regression analysis was performed according to the Socio-Demographic Index (SDI) regions. Then, using the DALYs data, a health inequality analysis was conducted, and the Slope Index of Inequality (SII) and concentration indices (CI) for 1990 and 2021 were calculated.ResultsFrom 1990 to 2021, the global cancer burden attributed to diet decreased continuously, with an average annual percentage change (AAPC) of -1.40 (-1.48, -1.32) for mortality (P < 0.01) and an AAPC of -1.49 (-1.57, -1.42) for DALYs (P < 0.01). Colon and rectal cancers were the most influenced by dietary factors, with diet-attributable deaths comprising 71.70% and 68.14% of total deaths in 1990 and 2021, respectively, followed by breast and stomach cancers, which both exceeded 40% in both years. The diet-related cancer burden decreased rapidly in the high and high-middle SDI regions with AAPCs for both mortality and DALYs being less than 0 (P < 0.01). In contrast, there was Little improvement in the low- and low-middle SDI regions. In 2021, the absolute values of the SII (296.72) and CI (-0.17) attributed to global dietary risks were higher than those in 1990 with the SII of 267.61 and CI of -0.17.ConclusionDietary factors continued to be a significant risk factor for cancer in 2021. High red meat consumption, low intake of whole grains, and low milk intake were the three primary dietary risks.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24570-7.

BackgroundIn recent decades, the escalating prevalence of obesity has contributed to a significant increase in the global burden of disease, with cardiovascular diseases (CVDs) emerging as the leading cause among all diseases attributable to high body-mass index (BMI). Utilizing global burden of disease (GBD) dataset from 1990 to 2021, we conducted a comprehensive analysis of the global, regional, and national trends in deaths and disability-adjusted life years (DALYs) attributable to CVDs caused by high BMI. Age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were also investigated. Furthermore, we examined the associations of gender, age, and socio-demographic index (SDI) with the burden of CVDs attributable to high BMI. Finally, we assessed the evolution of health inequalities across countries and projected the global deaths and DALYs due to high BMI-related CVDs over the next two decades.MethodsThe absolute numbers and the rates of age-standardized death, Disability-Adjusted Life Years (DALYs) per 100,000 people due to high BMI-related CVDs between 1990 and 2021 were extracted from GBD 2021. The estimated annual percentage changes (EAPCs) of high BMI-related CVDs disease burdens were calculated under the GBD's comparative risk assessment framework. Additionally, the disease burden prediction of the high BMI-related CVDs from 2022 to 2041 was performed using the bayesian age-period-cohort (BAPC) statistical model.ResultsIn 2021, high BMI-related CVDs accounted for 1.90 million deaths globally, representing an increase of 120.63% compared to 1990, with DALYs rising by 115.47% over the same period. Notably, while ASMR and ASDR among male showed no decline, female experienced 11.30% reduction in ASMRs and 6.12% reduction in ASDR. The burden was disproportionately borne by middle-aged and older populations across all age groups. Global health inequalities related to high BMI-related CVDs demonstrated a narrowing trend from 1990 to 2010, followed by a reversal into a negative correlation and continued to widen until 2021. Looking ahead, the burden of high BMI-related CVDs is projected to rise significantly due to population growth, the increasing prevalence of obesity, and aging populations.ConclusionThe results indicate that from 1990 to 2021, the burden of CVDs caused by high BMI has significantly increased. Particular attention should be directed toward middle and low-middle SDI regions. To mitigate this burden, it is imperative to implement public health strategies that emphasize education and awareness regarding the correlation between high BMI and CVDs. Policies promoting healthy dietary habits and regular physical activity are essential for reducing the future impact of high BMI-related cardiovascular morbidity and mortality. Such measures are not only urgently needed but also offer substantial long-term benefits for global health.

Chronic kidney disease (CKD) is a significant contributor to the global burden of disease. Among its causes, chronic kidney disease due to type 2 diabetes (CKD-T2D) is the primary subtype. This study aims to provide an updated assessment of the global disease burden of CKD-T2D from 1990 to 2021. It will analyse the trends in the global burden of CKD-T2D and the differences in risk factors, as well as project changes over the next 15 years. The data for this study were derived from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021. Estimates of prevalence, incidence, deaths and disability-adjusted life years (DALYs) for CKD-T2D, along with their 95% uncertainty intervals (UIs), were extracted. The trends in CKD-T2D burden from 1990 to 2021 were analysed from overall and local perspectives. An age-period-cohort model was used to estimate the age, period and cohort effects on the prevalence and incidence of CKD-T2D between 1990 and 2021. A decomposition analysis was conducted to assess the contribution of population size, age structure and epidemiological changes to the burden of CKD-T2D. Population-attributable fractions were determined for each risk factor, and a difference analysis was conducted. Additionally, projections were made regarding changes in the burden of CKD-T2D over the next 15 years. In 2021, the global burden of CKD-T2D remained significant, with a total of 107 559 955 cases. The age-standardized prevalence rate (ASPR) was 1259.63 per 100 000 people. The age-standardized incidence rate (ASIR) was 23.07 per 100 000 people, and the age-standardized death rate (ASDR) was 5.72 per 100 000 people. The age-standardized disability-adjusted life years (DALYs) was 131.08 per 100 000. The global burden of CKD-T2D showed variation across different socio-demographic index (SDI) regions. In 2021, the overall burden of CKD-T2D continued to rise, with the age effect increasing with age. Both prevalence and incidence risks showed an upward trend over time. Decomposition analysis indicated that population growth and ageing were the primary contributors to the global burden of DALYs related to CKD-T2D. Metabolic risk factors such as high fasting plasma glucose and high body mass index (BMI) are the most significant attributable risk factors. It is projected that by 2036, the trends in ASPR, ASIR, ASDR and age-standardized DALYs will stabilize. However, ASIR and age-standardized DALYs are expected to continue rising, and the number of cases of prevalence, incidence, mortality and DALYs will persist in their upward trend. CKD-T2D imposes a significant global disease burden, with health disparities and unequal disease outcomes continuing to worsen across countries and regions due to differences in socio-economic development levels. This burden is primarily driven by population growth, ageing and metabolic risks such as obesity, hyperglycaemia and hypertension. Although the rate of increase in disease burden may slow over the next 15 years, the number of cases is expected to rise substantially. Therefore, enhancing prevention, early screening and effective treatment interventions, particularly in high-risk areas, is crucial for reducing the disease burden and narrowing health disparities.

Otitis media (OM), including acute OM, chronic OM, and OM with effusion, is associated with varying degrees of hearing impairment. Children and adolescents (CAAs) are particularly vulnerable to OM. However, epidemiological data on OM in CAAs is relatively scarce. This study investigates the global, regional, and national burden of OM in CAAs from 1990 to 2021, with projections extending to 2040. Data were extracted from Global Burden of Diseases (GBD) 2021 on incidence, prevalence, deaths and disability-adjusted life years (DALYs). Trends were evaluated using the metric of estimated annual percentage change (EAPC). Subgroup analyses were conducted according to socio-demographic index (SDI), and age. Additionally, projections were estimated for 2040 using the Nordpred model. Globally, the rates with their 95% uncertainty intervals (UI) in 2021 were 12473.66 (7287.91-19931.88) for incidence, 2438.73 (1918.03-3055.21) for prevalence, 0.0095 (0.0022-0.0320) for deaths, and 49.33 (27.68-78.84) for DALYs. From 1990 to 2021, the EAPC and its 95% UI of incidence rate increased by 0.13 (0.11-0.16), while EAPC of deaths -3.79 (-4.07 to -3.52), prevalence -0.08 (-0.09 to -0.07), and DALYs -0.2 (-0.23 to -0.17) decreased. The aforementioned indicators are negatively correlated with the SDI. Regionally, both mortality rates and DALYs significantly decrease with increasing SDI. Sub-Saharan Africa and South Asia have high levels of incidence and prevalence. At the national level, countries with a high burden of OM are primarily concentrated in Sub-Saharan Africa and South Asia. For example: Pakistan, India, Ethiopia, Kenya, Nepal, Bangladesh, Somalia, South Sudan, Mozambique, Burundi, and Madagascar. From 2022 to 2040, the incidence rate, prevalence, and DALYs of OM are expected to show a downward trend. However, the mortality rate may slightly increase. From 1990 to 2021, there has been some progress in the management of OM. However, the incidence in CAAs has increased. Epidemiological data vary across different regions and countries, with regions and countries with lower SDI typically experiencing a heavier burden. It is necessary to implement dynamic monitoring of OM in CAAs and develop strategies to mitigate the future burden of this disease.

Although global smoke-free policies have significantly reduced smoking rates, exposure to secondhand smoke (SHS) in homes and public places remains common. SHS continues to be a significant risk factor for lower respiratory infections (LRIs) in children. However, there is still a lack of systematic assessment of the spatiotemporal trends and future disease burden of LRIs attributable to SHS in children aged under 14 years. This study is a secondary analysis of the Global Burden of Disease (GBD) 2021 data. We used joinpoint regression to analyze trends and calculate the average annual percentage change (AAPC) in the burden of LRIs attributable to SHS among children aged under 14 years, globally from 1990 to 2021. Age-standardized rates (ASRs) of mortality and DALYs were quantified at the global, regional, and national levels. Finally, a Bayesian age-period-cohort (BAPC) model was applied to forecast trends up to 2035, providing a basis for formulating targeted intervention strategies. In 2021, the number of deaths and disability-adjusted life years (DALYs) among children aged under 14 years worldwide due to LRIs caused by SHS decreased significantly. The ASR declined to 2.25 (95% UI: 0.73-3.86) for mortality and 199.84 (95% UI: 64.82-342.97) for DALYs per 100000 population. The forecast results indicated that by 2035, both the mortality and the DALY rates would continue to decline. Although the global burden had declined significantly and was expected to continue decreasing through 2035, SHS remained a significant contributor to LRIs in children.