Global, regional, and national burden of non-COVID-19 lower respiratory infections and risks, 1990–2023: a systematic analysis from GBD Study 2023

Abstract Background Despite global progress in vaccination, antibiotic use, and sanitation, lower respiratory infections (LRIs) remain a substantial global burden. This study uses Global Burden of Disease 2023 data to inform LRIs control. Methods We quantified global and regional incidence, mortality, and DALYs for non-COVID-19 LRIs from 1990–2023, and assessed risks to LRI DALYs and deaths. Trend analyses used Joinpoint regression to estimate the AAPC. Results In 2023, global LRI incidence was 3,012.84 per 100,000, down since 1990 (AAPC − 1.57%; 95% CI − 1.70 to − 1.43). Africa had the highest incidence (5,848.11). From 1990–2023, incidence declined in Africa (− 1.11%; 95% CI − 1.22 to − 1.00) and Southeast Asia (− 1.03%; 95% CI − 1.11 to − 0.95). Top incidence countries: Kenya, Lesotho, Chad. By age, the ≥ 70 group had the highest incidence (12,531.69 per 100,000; UI 11,513.40–13,685.63), followed by under-5s (7,699.43; 6,660.02–8,786.62). Leading risk factors for LRI DALYs were child underweight (277.09), household air pollution from solid fuels (237.85), and child stunting (216.44). Conclusions The LRI burden declined 1990–2023, but disparities persist, with Africa and Southeast Asia bearing the highest burdens. Addressing child nutrition, air quality, and vaccination coverage—especially for vulnerable populations and high-risk regions—will promote health equity.