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

Troeger, Christopher and Blacker, Brigette and Khalil, Ibrahim A and Rao, Puja C. and Cao, Shujin and Zimsen, Stephanie R. M and Albertson, Sam and Stanaway, Jeffrey D and Deshpande, Aniruddha and Farag, Tamer and Forouzanfar, Mohammad H and Abebe, Zegeye and Adetifa, Ifedayo and Adhikari, Tara Ballav and Akibu, Mohammed and Al Lami, Faris Hasan and Al-Eyadhy, Ayman and Alvis-Guzman, Nelson and Amare, Azmeraw T and Amoako, Yaw Ampem and Antonio, Carl Abelardo and Aremu, Olatunde and Asfaw, Ephrem Tsegay and Asgedom, Solomon and Atey, Tesfay Mehari and Attia, Engi Farouk and Avokpaho, Euripide Frinel G. Arthur and Ayele, Henok Tadesse and Ayuk,, Tambe Betrand and Balakrishnan, Kalpana and Barac,, Aleksandra and Bassat, Quique and Behzadifar, Masoud and Behzadifar, Meysam (2018) 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. LANCET INFECTIOUS DISEASES, 18 (11). pp. 1191-1210.

Preview

Text 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 Stu.pdf Download (7MB) | Preview

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 healthcare 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 spatiotemporal 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 (2145 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 (1189 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. Copyright (C) The Author(s). Published by Elsevier Ltd.

Actions (login required)

View Item