Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015

GBD 2015 LRI Collaborators

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Abstract

Background The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2015 provides an up-to-date analysis of the burden of lower respiratory tract infections (LRIs) in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 25 years and shows how the burden of LRI has changed in people of all ages. Methods We estimated LRI mortality by age, sex, geography, and year using a modelling platform shared across most causes of death in the GBD 2015 study called the Cause of Death Ensemble model. We modelled LRI morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for LRI using two different counterfactual approaches, the first for viral pathogens, which incorporates the aetiology-specific risk of LRI and the prevalence of the aetiology in LRI episodes, and the second for bacterial pathogens, which uses a vaccine-probe approach. We used the Socio-demographic Index, which is a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in LRI-related mortality. The two leading risk factors for LRI disability-adjusted life-years (DALYs), childhood undernutrition and air pollution, were used in a decomposition analysis to establish the relative contribution of changes in LRI DALYs. Findings In 2015, we estimated that LRIs caused 2·74 million deaths (95% uncertainty interval [UI] 2·50 million to 2·86 million) and 103·0 million DALYs (95% UI 96·1 million to 109·1 million). LRIs have a disproportionate effect on children younger than 5 years, responsible for 704 000 deaths (95% UI 651 000–763 000) and 60.6 million DALYs (95ÙI 56·0–65·6). Between 2005 and 2015, the number of deaths due to LRI decreased by 36·9% (95% UI 31·6 to 42·0) in children younger than 5 years, and by 3·2% (95% UI −0·4 to 6·9) in all ages. Pneumococcal pneumonia caused 55·4% of LRI deaths in all ages, totalling 1 517 388 deaths (95% UI 857 940–2 183 791). Between 2005 and 2015, improvements in air pollution exposure were responsible for a 4·3% reduction in LRI DALYs and improvements in childhood undernutrition were responsible for an 8·9% reduction. Interpretation LRIs are the leading infectious cause of death and the fifth-leading cause of death overall; they are the second-leading cause of DALYs. At the global level, the burden of LRIs has decreased dramatically in the last 10 years in children younger than 5 years, although the burden in people older than 70 years has increased in many regions. LRI remains a largely preventable disease and cause of death, and continued efforts to decrease indoor and ambient air pollution, improve childhood nutrition, and scale up the use of the pneumococcal conjugate vaccine in children and adults will be essential in reducing the global burden of LRI. Funding Bill & Melinda Gates Foundation.

Original languageEnglish (US)
Pages (from-to)1133-1161
Number of pages29
JournalThe Lancet Infectious Diseases
Volume17
Issue number11
DOIs
StatePublished - Nov 1 2017

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Respiratory Tract Infections
Morbidity
Mortality
Quality-Adjusted Life Years
Uncertainty
Cause of Death
Global Burden of Disease
Air Pollution
Malnutrition
Pneumococcal Pneumonia
Indoor Air Pollution
Conjugate Vaccines
Pneumococcal Vaccines
Geography

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

@article{d11099cbb7fe4297a791585640363b1c,
title = "Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015",
abstract = "Background The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2015 provides an up-to-date analysis of the burden of lower respiratory tract infections (LRIs) in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 25 years and shows how the burden of LRI has changed in people of all ages. Methods We estimated LRI mortality by age, sex, geography, and year using a modelling platform shared across most causes of death in the GBD 2015 study called the Cause of Death Ensemble model. We modelled LRI morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for LRI using two different counterfactual approaches, the first for viral pathogens, which incorporates the aetiology-specific risk of LRI and the prevalence of the aetiology in LRI episodes, and the second for bacterial pathogens, which uses a vaccine-probe approach. We used the Socio-demographic Index, which is a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in LRI-related mortality. The two leading risk factors for LRI disability-adjusted life-years (DALYs), childhood undernutrition and air pollution, were used in a decomposition analysis to establish the relative contribution of changes in LRI DALYs. Findings In 2015, we estimated that LRIs caused 2·74 million deaths (95{\%} uncertainty interval [UI] 2·50 million to 2·86 million) and 103·0 million DALYs (95{\%} UI 96·1 million to 109·1 million). LRIs have a disproportionate effect on children younger than 5 years, responsible for 704 000 deaths (95{\%} UI 651 000–763 000) and 60.6 million DALYs (95{\`U}I 56·0–65·6). Between 2005 and 2015, the number of deaths due to LRI decreased by 36·9{\%} (95{\%} UI 31·6 to 42·0) in children younger than 5 years, and by 3·2{\%} (95{\%} UI −0·4 to 6·9) in all ages. Pneumococcal pneumonia caused 55·4{\%} of LRI deaths in all ages, totalling 1 517 388 deaths (95{\%} UI 857 940–2 183 791). Between 2005 and 2015, improvements in air pollution exposure were responsible for a 4·3{\%} reduction in LRI DALYs and improvements in childhood undernutrition were responsible for an 8·9{\%} reduction. Interpretation LRIs are the leading infectious cause of death and the fifth-leading cause of death overall; they are the second-leading cause of DALYs. At the global level, the burden of LRIs has decreased dramatically in the last 10 years in children younger than 5 years, although the burden in people older than 70 years has increased in many regions. LRI remains a largely preventable disease and cause of death, and continued efforts to decrease indoor and ambient air pollution, improve childhood nutrition, and scale up the use of the pneumococcal conjugate vaccine in children and adults will be essential in reducing the global burden of LRI. Funding Bill & Melinda Gates Foundation.",
author = "{GBD 2015 LRI Collaborators} and Christopher Troeger and Mohammad Forouzanfar and Rao, {Puja C.} and Ibrahim Khalil and Alexandria Brown and Scott Swartz and Nancy Fullman and Jonathan Mosser and Thompson, {Robert L.} and Reiner, {Robert C.} and Amanuel Abajobir and Noore Alam and Alemayohu, {Mulubirhan Assefa} and Amare, {Azmeraw T.} and Antonio, {Carl Abelardo} and Hamid Asayesh and Euripide Avokpaho and Aleksandra Barac and Beshir, {Muktar A.} and Boneya, {Dube Jara} and Michael Brauer and Lalit Dandona and Rakhi Dandona and Fitchett, {Joseph R.A.} and Gebrehiwot, {Tsegaye Tewelde} and Hailu, {Gessessew Buggsa} and Hotez, {Peter J.} and Amir Kasaeian and Tawfik Khoja and Niranjan Kissoon and Luke Knibbs and Kumar, {G. Anil} and Rai, {Rajesh Kumar} and {El Razek}, {Hassan Magdy Abd} and Mohammed, {Muktar S.K.} and Katie Nielson and Oren, {Eyal -} and Abdalla Osman and George Patton and Mostafa Qorbani and Roba, {Hirbo Shore} and Benn Sartorius and Miloje Savic and Mika Shigematsu and Bryan Sykes and Soumya Swaminathan and Roman Topor-Madry and Kingsley Ukwaja and Andrea Werdecker and Naohiro Yonemoto",
year = "2017",
month = "11",
day = "1",
doi = "10.1016/S1473-3099(17)30396-1",
language = "English (US)",
volume = "17",
pages = "1133--1161",
journal = "The Lancet Infectious Diseases",
issn = "1473-3099",
publisher = "Lancet Publishing Group",
number = "11",

}

TY - JOUR

T1 - Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries

T2 - a systematic analysis for the Global Burden of Disease Study 2015

AU - GBD 2015 LRI Collaborators

AU - Troeger, Christopher

AU - Forouzanfar, Mohammad

AU - Rao, Puja C.

AU - Khalil, Ibrahim

AU - Brown, Alexandria

AU - Swartz, Scott

AU - Fullman, Nancy

AU - Mosser, Jonathan

AU - Thompson, Robert L.

AU - Reiner, Robert C.

AU - Abajobir, Amanuel

AU - Alam, Noore

AU - Alemayohu, Mulubirhan Assefa

AU - Amare, Azmeraw T.

AU - Antonio, Carl Abelardo

AU - Asayesh, Hamid

AU - Avokpaho, Euripide

AU - Barac, Aleksandra

AU - Beshir, Muktar A.

AU - Boneya, Dube Jara

AU - Brauer, Michael

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Fitchett, Joseph R.A.

AU - Gebrehiwot, Tsegaye Tewelde

AU - Hailu, Gessessew Buggsa

AU - Hotez, Peter J.

AU - Kasaeian, Amir

AU - Khoja, Tawfik

AU - Kissoon, Niranjan

AU - Knibbs, Luke

AU - Kumar, G. Anil

AU - Rai, Rajesh Kumar

AU - El Razek, Hassan Magdy Abd

AU - Mohammed, Muktar S.K.

AU - Nielson, Katie

AU - Oren, Eyal -

AU - Osman, Abdalla

AU - Patton, George

AU - Qorbani, Mostafa

AU - Roba, Hirbo Shore

AU - Sartorius, Benn

AU - Savic, Miloje

AU - Shigematsu, Mika

AU - Sykes, Bryan

AU - Swaminathan, Soumya

AU - Topor-Madry, Roman

AU - Ukwaja, Kingsley

AU - Werdecker, Andrea

AU - Yonemoto, Naohiro

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2015 provides an up-to-date analysis of the burden of lower respiratory tract infections (LRIs) in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 25 years and shows how the burden of LRI has changed in people of all ages. Methods We estimated LRI mortality by age, sex, geography, and year using a modelling platform shared across most causes of death in the GBD 2015 study called the Cause of Death Ensemble model. We modelled LRI morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for LRI using two different counterfactual approaches, the first for viral pathogens, which incorporates the aetiology-specific risk of LRI and the prevalence of the aetiology in LRI episodes, and the second for bacterial pathogens, which uses a vaccine-probe approach. We used the Socio-demographic Index, which is a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in LRI-related mortality. The two leading risk factors for LRI disability-adjusted life-years (DALYs), childhood undernutrition and air pollution, were used in a decomposition analysis to establish the relative contribution of changes in LRI DALYs. Findings In 2015, we estimated that LRIs caused 2·74 million deaths (95% uncertainty interval [UI] 2·50 million to 2·86 million) and 103·0 million DALYs (95% UI 96·1 million to 109·1 million). LRIs have a disproportionate effect on children younger than 5 years, responsible for 704 000 deaths (95% UI 651 000–763 000) and 60.6 million DALYs (95ÙI 56·0–65·6). Between 2005 and 2015, the number of deaths due to LRI decreased by 36·9% (95% UI 31·6 to 42·0) in children younger than 5 years, and by 3·2% (95% UI −0·4 to 6·9) in all ages. Pneumococcal pneumonia caused 55·4% of LRI deaths in all ages, totalling 1 517 388 deaths (95% UI 857 940–2 183 791). Between 2005 and 2015, improvements in air pollution exposure were responsible for a 4·3% reduction in LRI DALYs and improvements in childhood undernutrition were responsible for an 8·9% reduction. Interpretation LRIs are the leading infectious cause of death and the fifth-leading cause of death overall; they are the second-leading cause of DALYs. At the global level, the burden of LRIs has decreased dramatically in the last 10 years in children younger than 5 years, although the burden in people older than 70 years has increased in many regions. LRI remains a largely preventable disease and cause of death, and continued efforts to decrease indoor and ambient air pollution, improve childhood nutrition, and scale up the use of the pneumococcal conjugate vaccine in children and adults will be essential in reducing the global burden of LRI. Funding Bill & Melinda Gates Foundation.

AB - Background The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2015 provides an up-to-date analysis of the burden of lower respiratory tract infections (LRIs) in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 25 years and shows how the burden of LRI has changed in people of all ages. Methods We estimated LRI mortality by age, sex, geography, and year using a modelling platform shared across most causes of death in the GBD 2015 study called the Cause of Death Ensemble model. We modelled LRI morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for LRI using two different counterfactual approaches, the first for viral pathogens, which incorporates the aetiology-specific risk of LRI and the prevalence of the aetiology in LRI episodes, and the second for bacterial pathogens, which uses a vaccine-probe approach. We used the Socio-demographic Index, which is a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in LRI-related mortality. The two leading risk factors for LRI disability-adjusted life-years (DALYs), childhood undernutrition and air pollution, were used in a decomposition analysis to establish the relative contribution of changes in LRI DALYs. Findings In 2015, we estimated that LRIs caused 2·74 million deaths (95% uncertainty interval [UI] 2·50 million to 2·86 million) and 103·0 million DALYs (95% UI 96·1 million to 109·1 million). LRIs have a disproportionate effect on children younger than 5 years, responsible for 704 000 deaths (95% UI 651 000–763 000) and 60.6 million DALYs (95ÙI 56·0–65·6). Between 2005 and 2015, the number of deaths due to LRI decreased by 36·9% (95% UI 31·6 to 42·0) in children younger than 5 years, and by 3·2% (95% UI −0·4 to 6·9) in all ages. Pneumococcal pneumonia caused 55·4% of LRI deaths in all ages, totalling 1 517 388 deaths (95% UI 857 940–2 183 791). Between 2005 and 2015, improvements in air pollution exposure were responsible for a 4·3% reduction in LRI DALYs and improvements in childhood undernutrition were responsible for an 8·9% reduction. Interpretation LRIs are the leading infectious cause of death and the fifth-leading cause of death overall; they are the second-leading cause of DALYs. At the global level, the burden of LRIs has decreased dramatically in the last 10 years in children younger than 5 years, although the burden in people older than 70 years has increased in many regions. LRI remains a largely preventable disease and cause of death, and continued efforts to decrease indoor and ambient air pollution, improve childhood nutrition, and scale up the use of the pneumococcal conjugate vaccine in children and adults will be essential in reducing the global burden of LRI. Funding Bill & Melinda Gates Foundation.

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UR - http://www.scopus.com/inward/citedby.url?scp=85028066593&partnerID=8YFLogxK

U2 - 10.1016/S1473-3099(17)30396-1

DO - 10.1016/S1473-3099(17)30396-1

M3 - Article

C2 - 28843578

AN - SCOPUS:85028066593

VL - 17

SP - 1133

EP - 1161

JO - The Lancet Infectious Diseases

JF - The Lancet Infectious Diseases

SN - 1473-3099

IS - 11

ER -