Burden of chronic respiratory disease in Asia, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023
- Hyesu Jo, Tae Hyeon Kim, Jaeyu Park, Jiyeon Oh, Min Seo Kim, Shehab Uddin Al Abid, Ripon Kumar Adhikary, Qorinah Estiningtyas Sakilah Adnani, Anurag Agrawal, Danish Ahmad, Khabir Ahmad, Sajjad Ahmad, Tauseef Ahmad, Aram Mahmood Ahmed, Haroon Ahmed, MD Faisal Ahmed, Naveed Ahmed, Syed Anees Ahmed, Mohammed Ahmed Akkaif, Syed Mahfuz Al Hasan, Khurshid Alam, Mohammed Usman Ali, Rafat Ali, Syed Shujait Ali, Syed Yusuf Ali, Sheikh Mohammad Alif, Syed Mohamed Aljunid, Md Al-Mamun, Awais Altaf, Kabilan Annadurai, Sumbul Ansari, Jesu Arockiaraj, Mahwish Arooj, Nurila Aryntayeva, Syed Mohammed Basheeruddin Asdaq, Muhammad Abdul Basit Ashraf, Syed Amir Ashraf, Tahira Ashraf, Yuni Asri, Anil Raj Assariparambil, Giridhara Rathnaiah Babu, Ashish D Badiye, Atif Amin Baig, Shankar M Bakkannavar, Biswajit Banik, Mainak Bardhan, Saurav Basu, Narasimha M Beeraka, Samiun Nazrin Bente Kamal Tune, Jeetendra Bhandari, Niroj Bhandari, Ajay Nagesh Bhat, Anup Bhat, Arushee Bhatnagar, Priyadarshini Bhattacharjee, Bijit Biswas, Mohammad Shahangir Biswas, Ahmad Naoras Bitar, Linh Phuong Bui, Nadeem Shafique Butt, Zahid A Butt, Muthia Cenderadewi, Chiranjib Chakraborty, Sandip Chakraborty, Jeffrey Shi Kai Chan, Vijay Kumar Chattu, Sirshendu Chaudhuri, An-Tian Chen, Haiyan Chen, Hitesh Chopra, Dinh-Toi Chu, Sunghyun Chung, Vinoth Gnana Chellaiyan Devanbu, Devananda Devegowda, Syed Masudur Rahman Dewan, Amol S Dhane, Sreedhar Dharmagadda, Samath Dhamminda Dharmaratne, Narayan Babu Dhital, Bibha Dhungel, Guodong Ding, Xueting Ding, Huyen Phuc Do, Thao Huynh Phuong Do, Ojas Prakashbhai Doshi, Siddhartha Dutta, Ferry Efendi, Ibrahim Elsohaby, Ayesha Fahim, Ildar Ravisovich Fakhradiyev, Mohammad Fareed, Zareen Fatima, Ginenus Fekadu, Balasubramanian Ganesh, Xiang Gao, Rupesh K Gautam, Arun Ghuge, Artyom Urievich Gil, Mahaveer Golechha, Shi-Yang Guan, Damitha Asanga Gunawardane, Gaurav Gupta, Lalit Gupta, Rajat Das Gupta, Sapna Gupta, Pritam Halder, Sajid Hameed, Asif Hanif, Md Aminul Haque, Andy Martahan Andreas Hariandja, Eka Mishbahatul Marah Has, Omed Hassan Ahmed, Simon I Hay, Qida He, Ramesh Holla, Mehdi Hoseinzadeh, Md Sabbir Hossain, Junjie Huang, Zhenyao Huang, Bing-Fang Hwang, Leeberk Raja Inbaraj, Meesha Iqbal, Lalu Muhammad Irham, Md Rabiul Islam, Md Shahinul Islam, Nahlah Elkudssiah Ismail, Yerlan Ismoldayev, Zhanat Bakhitovna Ispayeva, Jazlan Jamaluddin, Jerin James, Shubha Jayaram, Min Jiang, Jost B Jonas, Nitin Joseph, Jiseung Kang, Neeti Kapoor, Sonali Kar, Himanshu Khajuria, Maseer Khan, Mohammad Jobair Khan, Mohd Faheem Khan, Serab Khan, Ubaid Khan, Sameer Uttamaro Khasbage, Feriha Fatima Khidri, Jagdish Khubchandani, Jinho Kim, Yun Jin Kim, Sanjay Kini, Abdul Basith KM
- https://doi.org/10.1016/S2213-2600(25)00404-7
Summary
Background
Chronic respiratory diseases are an important global issue, particularly in Asia, where burden patterns vary widely across countries. With more than half the world’s population living in Asia, understanding the national and regional burden of chronic respiratory diseases is essential; however, research on this area remains inadequate. We aimed to investigate the burden of chronic respiratory diseases in Asia at national and regional levels, and to identify key risk factors.
Methods
The Global Burden of Diseases, Injuries, and Risk Factors Study 2023 provides estimates for assessing the burden of chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease (ILD), and pulmonary sarcoidosis. We focused on 34 countries in Asia, encompassing the high-income Asia Pacific region and central, east, south, and southeast Asia. Estimates for age-standardised prevalence and disability-adjusted life-year (DALY) rates per 100 000 population, including 95% uncertainty intervals (UIs), were extracted by location, sex, year, and Socio-demographic Index (SDI). The average annual percentage change was calculated and presented as a percentage with 95% CIs. Estimates of modifiable attributable risk factors for DALYs and mortality were also included.
Findings
In Asia, the age-standardised prevalence and DALY rates for chronic respiratory diseases generally declined from 1990 to 2023; however, the trend varied substantially by disease and country. In 2023, the age-standardised prevalence rate of COPD was highest in south Asia (3044·18 [95% UI 2748·67–3303·04] per 100 000 population), while the age-standardised asthma prevalence rate was highest in the high-income Asia Pacific region (4870·24 [4046·70–5962·78] per 100 000 population) and southeast Asia (4778·18 [3970·25–5735·61] per 100 000 population). Despite southeast Asia and the high-income Asia Pacific region having a similar age-standardised asthma prevalence rate, southeast Asia had a higher age-standardised DALY rate (508·67 [95% UI 394·89–669·92] per 100 000 population) compared with the high-income Asia Pacific region (204·40 [129·23–290·41] per 100 000 population). A decrease in the age-standardised DALY rate for chronic respiratory diseases was observed with increasing SDI, contrasting with its prevalence patterns. Age-standardised DALY rates of COPD decreased in all Asian countries except for Georgia (average annual percentage change 1·37 [95% CI 1·26–1·48]) and Kazakhstan (0·73 [0·55–0·93]), and age-standardised DALY rates of asthma decreased in all countries. Smoking and ambient particulate matter pollution were identified as leading attributable risk factors for chronic respiratory diseases across Asia. Household air pollution from solid fuels was a regionally pronounced risk factor for chronic respiratory diseases, particularly in south Asia (age-standardised DALY rate 657·58 [95% UI 485·04–880·45] per 100 000 population). Although smoking was a major risk factor in males, ambient particulate matter pollution and secondhand smoke emerged as important attributable risk factors for chronic respiratory diseases in females.
Interpretation
Countries with lower SDI had markedly higher DALY rates, highlighting the need to address socioeconomic and health-care inequities. Household air pollution from solid fuels continues to impose a substantial but preventable burden in south Asia, calling for clean energy adoption and improved ventilation.
Funding
Gates Foundation.