Stalled Progress and a Post-Pandemic Rebound: The Global Burden of Asthma in Children, Adolescents, and Young Adults Aged 0–24 Years, 1990–2023

Background: Asthma accounts for the great majority of the chronic respiratory disease burden below 25 years of age, yet pediatric analyses based on the Global Burden of Disease (GBD) 2021 round terminate in 2021, predating the full COVID-19 period. We estimated the global, regional, and national burden of asthma among individuals aged 0–24 years from 1990 to 2023. Methods: We extracted estimates from the GBD Results Tool, GBD Study 2023 (data downloaded 13–15 August 2026), and aggregated six measures (prevalence, incidence, deaths, disability-adjusted life-years [DALYs], years lived with disability, and years of life lost) across the 0–24-year age range—using the official under-5-years aggregate row (which includes the 1-year age group, for which no single-year estimates are published) plus the 5–9, 10–14, 15–19, and 20–24-year bands—for 204 countries and territories, 21 GBD regions, and five Socio-demographic Index (SDI) quintiles, with 95% uncertainty intervals (UIs). Trends were quantified as estimated annual percentage changes (EAPCs) for 1990–2023 and the 2019–2023 pandemic window. Results: In 2023, an estimated 150,837,112 (95% UI 103,730,853–218,576,263) individuals aged 0–24 years were living with asthma, with 22,126 (15,409–32,090) deaths and 7,753,206 (5,069,966–11,580,326) DALYs. Between 1990 and 2023, prevalent cases rose by 23.1% while the all-population age-standardized prevalence rate (ASPR) was stable (EAPC +0.01, 95% confidence interval −0.04 to +0.05) and the all-population age-standardized mortality rate (ASMR) declined (EAPC −1.56). During 2019–2023, the all-population ASPR increased significantly (EAPC +1.07, +0.63 to +1.52) and deaths increased by 3.78% in absolute counts (point estimate). Low-SDI countries concentrated 55.3% of asthma deaths at these ages, with an all-population ASMR 13.6 times that of high-SDI countries. The male-to-female ratio of deaths converged from 1.758 in 1990 to near parity (1.017) in 2023, with sex-specific UIs overlapping throughout. Ten countries accounted for 46.3% of global cases, led by the United States (12.90 million). Conclusions: Case numbers continue to grow while the all-population age-standardized prevalence rate remains flat, and mortality remains concentrated where health systems are weakest. Priorities include reliable inhaled-corticosteroid access in low-SDI settings, surveillance of adolescent girls and young women, and protection of chronic respiratory care continuity in pandemic preparedness.