Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

GBD 2016 Lower Respiratory Infections Collaborators

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: Lower 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. Methods: We 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. Findings: In 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. Interpretation: Our 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. Funding: Bill & Melinda Gates Foundation.

Original languageEnglish (US)
Pages (from-to)1191-1210
Number of pages20
JournalThe Lancet Infectious Diseases
Volume18
Issue number11
DOIs
StatePublished - Nov 1 2018

Fingerprint

Respiratory Tract Infections
Morbidity
Mortality
Uncertainty
Population
Streptococcus pneumoniae
Global Burden of Disease
Health Care Surveys
Literature
Haemophilus influenzae type b
Child Mortality
Respiratory Syncytial Viruses
Particulate Matter
Air Pollution
Administrative Personnel
Information Systems
Human Influenza
Cause of Death
Autopsy
Anti-Bacterial Agents

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

@article{9832504315104a49bdf892d05fed80ce,
title = "Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016",
abstract = "Background: Lower 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. Methods: We 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. Findings: In 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. Interpretation: Our 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. Funding: Bill & Melinda Gates Foundation.",
author = "{GBD 2016 Lower Respiratory Infections Collaborators} and Christopher Troeger and Brigette Blacker and Khalil, {Ibrahim A.} and Rao, {Puja C.} and Jackie Cao and Zimsen, {Stephanie R.M.} and Albertson, {Samuel B.} and Aniruddha Deshpande and Tamer Farag and Zegeye Abebe and Adetifa, {Ifedayo Morayo O.} and Adhikari, {Tara Ballav} and Mohammed Akibu and {Al Lami}, {Faris Hasan} and Ayman Al-Eyadhy and Nelson Alvis-Guzman and Amare, {Azmeraw T.} and Amoako, {Yaw Ampem} and Antonio, {Carl Abelardo T.} and Olatunde Aremu and Asfaw, {Ephrem Tsegay} and Asgedom, {Solomon Weldegebreal} and Atey, {Tesfay Mehari} and Attia, {Engi Farouk} and Avokpaho, {Euripide Frinel G.Arthur} and Ayele, {Henok Tadesse} and Ayuk, {Tambe Betrand} and Kalpana Balakrishnan and Aleksandra Barac and Quique Bassat and Masoud Behzadifar and Meysam Behzadifar and Soumyadeep Bhaumik and Bhutta, {Zulfiqar A.} and Ali Bijani and Michael Brauer and Alexandria Brown and Camargos, {Paulo A.M.} and Casta{\~n}eda-Orjuela, {Carlos A.} and Danny Colombara and Sara Conti and Dadi, {Abel Fekadu} and Lalit Dandona and Rakhi Dandona and Do, {Huyen Phuc} and Eleonora Dubljanin and Dumessa Edessa and Hajer Elkout and Endries, {Aman Yesuf} and Oren, {Eyal -}",
year = "2018",
month = "11",
day = "1",
doi = "10.1016/S1473-3099(18)30310-4",
language = "English (US)",
volume = "18",
pages = "1191--1210",
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 infections in 195 countries, 1990–2016

T2 - a systematic analysis for the Global Burden of Disease Study 2016

AU - GBD 2016 Lower Respiratory Infections Collaborators

AU - Troeger, Christopher

AU - Blacker, Brigette

AU - Khalil, Ibrahim A.

AU - Rao, Puja C.

AU - Cao, Jackie

AU - Zimsen, Stephanie R.M.

AU - Albertson, Samuel B.

AU - Deshpande, Aniruddha

AU - Farag, Tamer

AU - Abebe, Zegeye

AU - Adetifa, Ifedayo Morayo O.

AU - Adhikari, Tara Ballav

AU - Akibu, Mohammed

AU - Al Lami, Faris Hasan

AU - Al-Eyadhy, Ayman

AU - Alvis-Guzman, Nelson

AU - Amare, Azmeraw T.

AU - Amoako, Yaw Ampem

AU - Antonio, Carl Abelardo T.

AU - Aremu, Olatunde

AU - Asfaw, Ephrem Tsegay

AU - Asgedom, Solomon Weldegebreal

AU - Atey, Tesfay Mehari

AU - Attia, Engi Farouk

AU - Avokpaho, Euripide Frinel G.Arthur

AU - Ayele, Henok Tadesse

AU - Ayuk, Tambe Betrand

AU - Balakrishnan, Kalpana

AU - Barac, Aleksandra

AU - Bassat, Quique

AU - Behzadifar, Masoud

AU - Behzadifar, Meysam

AU - Bhaumik, Soumyadeep

AU - Bhutta, Zulfiqar A.

AU - Bijani, Ali

AU - Brauer, Michael

AU - Brown, Alexandria

AU - Camargos, Paulo A.M.

AU - Castañeda-Orjuela, Carlos A.

AU - Colombara, Danny

AU - Conti, Sara

AU - Dadi, Abel Fekadu

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Do, Huyen Phuc

AU - Dubljanin, Eleonora

AU - Edessa, Dumessa

AU - Elkout, Hajer

AU - Endries, Aman Yesuf

AU - Oren, Eyal -

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: Lower 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. Methods: We 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. Findings: In 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. Interpretation: Our 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. Funding: Bill & Melinda Gates Foundation.

AB - Background: Lower 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. Methods: We 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. Findings: In 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. Interpretation: Our 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. Funding: Bill & Melinda Gates Foundation.

UR - http://www.scopus.com/inward/record.url?scp=85056226781&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056226781&partnerID=8YFLogxK

U2 - 10.1016/S1473-3099(18)30310-4

DO - 10.1016/S1473-3099(18)30310-4

M3 - Article

AN - SCOPUS:85056226781

VL - 18

SP - 1191

EP - 1210

JO - The Lancet Infectious Diseases

JF - The Lancet Infectious Diseases

SN - 1473-3099

IS - 11

ER -