Frontier analysis and Quality of Care Index (QCI) of common non-communicable chronic respiratory diseases in older adults: a systematic analysis of GBD 2021

Introduction Common non-communicable respiratory diseases contribute substantially to the global burden of disease, particularly in the older adults. Although previous studies have examined the burden of individual respiratory diseases, comprehensive analyses of multiple diseases in the older adults remain lacking.Theory We conducted a secondary analysis of Global Burden of Disease 2021, applying Socio-demographic Index (SDI) stratification, a Quality of Care Index (QCI), and frontier analysis.Method We analyzed five non-communicable chronic respiratory diseases in adults aged ≥60 years, 1992–2021. Age–period–cohort modeling provided net and local drifts, and Joinpoint regression identified trend inflection years. A QCI was constructed and examined across SDI quintiles. Frontier analysis assessed potential for further burden reduction. Reporting followed the GATHER statement.Results Net drifts in incidence per year were: tracheal, bronchus, and lung cancer 0.59% (95% confidence interval 0.52 to 0.66); chronic obstructive pulmonary disease 0.10% (0.07 to 0.15); asthma −0.94% (−1.08 to −0.80); interstitial lung disease (ILD) and pulmonary sarcoidosis 1.38% (1.22 to 1.55); pneumoconiosis −0.77% (−0.96 to −0.58). Corresponding disability-adjusted life year drifts were 0.22% (0.15 to 0.30), −1.40% (−1.47 to −1.33), −1.98% (−2.09 to −1.87), 1.77% (1.66 to 1.88), and −2.02% (−2.20 to −1.84). QCI declined for ILD and pulmonary sarcoidosis but increased for the remaining diseases. Frontier analysis showed considerable unrealized potential even in high-SDI locations.Discussion Burden, care quality, and improvement potential varied markedly across diseases and SDI levels, indicating a need for strategies tailored to local disease profiles and development levels.