Global, regional, and national burden of interstitial lung disease and pulmonary sarcoidosis from 1990 to 2023, and projections to 2050: A systematic analysis for the Global Burden of Disease Study 2023

Background: Interstitial lung disease (ILD) and pulmonary sarcoidosis are a group of complex respiratory conditions imposing a significant and growing global health burden. A comprehensive, up-to-date assessment of their epidemiological trends is crucial for informing policy. This study analyzes the global, regional, and national burden of ILD and pulmonary sarcoidosis from 1990 to 2023, with projections to 2050, using data from the Global Burden of Diseases (GBD) 2023 study. Methods: We extracted data on incidence, prevalence, deaths, and disability-adjusted life years (DALYs) across 204 countries and territories from the GBD 2023 database. We analyzed temporal trends using absolute numbers and age-standardized rates, examining the relationship between disease burden and the socio-demographic index (SDI). Future burden to 2050 was also forecast. Results: Globally, the absolute burden of ILD and pulmonary sarcoidosis increased substantially from 1990 to 2023, with incident cases rising to 428.16 (95 % UI: 385.88-484.19) thousand, prevalent cases to 4581.13 (95 % UI: 4092.82-5166.99) thousand, deaths to 112.65 (95 % UI: 90.85-141.59) thousand, and DALYs to 4.46 (95% UI: 3.74-5.65) million in 2023, which were 1.57, 1.22, 1.45, and 2.40 times higher than their respective 1990 levels. From 1990 to 2023, the global age-standardized incidence rate (ASIR, average annual percentage change [AAPC] 0.60%) and age-standardized prevalence rate (ASPR, AAPC 0.32%) of ILD and sarcoidosis increased modestly, whereas age-standardized death rate (ASDR, AAPC 1.97%) and age-standardized DALY rate (AAPC 1.34%) rose more steeply. Significant regional disparities were observed in 2023, with Andean Latin America and High-income Asia Pacific recording the highest burdens, and Southeast Asia the lowest. Nationally, Peru reported the highest ASIR, ASDR and age-standardized DALY rate, while Mauritius reported the highest ASPR. Burden levels were generally positively correlated with SDI. The age group with the highest global ILD and pulmonary sarcoidosis incident cases in 2023 was observed in individuals aged 70-74 years. For individuals aged 60 and above, males consistently had higher incidence rates than females across all age groups. In 2023, the estimated burden of ILD and pulmonary sarcoidosis in China was substantial, with 45,154.35 incident cases, 627,044.96 prevalent cases, 10,278.66 deaths, and 267,349.11 DALYs. Correspondingly, the age-standardized rates were 2.12 per 100,000 for incidence, 27.98 per 100,000 for prevalence, 0.46 per 100,000 for death, and 12.02 per 100,000 for DALYs. Forecasts indicate that by 2050, the global crude death and DALY rates will increase by approximately 83.53 % and 60.43 %, respectively. This rise is primarily attributable to population growth and aging, particularly in high-income regions. Conclusions: The global burden of ILD and pulmonary sarcoidosis has significantly increased, marked by persistent disparities across regions and demographics, with projections indicating that population aging will intensify this pressure, especially in high-SDI and rapidly developing areas. Addressing this challenge requires urgent, hierarchical strategies focusing on high-risk groups and strengthening multi-disciplinary disease management to mitigate future impact.