Regional and national burden and aetiologies of non-COVID lower respiratory infections in Latin America and the Caribbean, 1990–2023: a secondary analysis of the global burden of disease study 2023

Background: Lower respiratory tract infections (LRTIs) remain a leading cause of morbidity and mortality worldwide, with a disproportionate impact in low- and middle-income regions. Reliable, up-to-date burden estimates are essential for informing public health strategies, particularly in Latin America and the Caribbean, where respiratory infections remain a persistent challenge. High incidence strains the healthcare system capacity and quality, while prevention and management strategies remain limited or heterogeneous across countries. Methods: We analysed estimates from the Global Burden of Disease (GBD) 2023 study to quantify the burden of LRTIs in Latin America and the Caribbean between 1990 and 2023. Cause-specific estimates of mortality, incidence, and disability-adjusted life years (DALYs), expressed as years of life lost (YLL) plus years lived with disability (YLD), were extracted from the GBD Results Tool. Estimates were produced following the standardised GBD protocol, coordinated by the Institute for Health Metrics and Evaluation (IHME), which synthesises multiple data sources using validated statistical models. Findings: Globally, LRTIs accounted for 41·0 (36·0–48·0) deaths per 100 000 person-years in 2023, representing a 33·2% decline from 62 (53·0–72·0) per 100 000 in 1990. Within Latin America and the Caribbean, trends were heterogeneous across countries. Mortality rates declined substantially in Chile (from 48·0 [44·1–51·8] to 27·9 [24·1–31·4] deaths per 100 000; annualized rates of change [ARC] -1·63) and Mexico (from 36·3 [33·3–39·8] to 28·2 [24·6–32·3]; ARC -0·76), while reductions were most pronounced among children under five years, notably in Brazil (from 150·6 [131·2–175·2] to 18·5 [15·9–21·3] per 100 000; ARC -6·16) and Chile (from 55·1 [50·6–60·1] to 5·4 [4·3–6·5]; ARC -6·79). DALY rates also declined markedly in several countries, with the largest reductions observed in Peru (from 5771·5 [4896·0–6845·4] to 1629·9 [1357·9–1940·8] per 100 000; ARC -3·76) and Mexico (from 2359·6 [2123·0–2619·1] to 825·5 [727·2–927·7]; ARC -3·13). Following a sustained decline in incidence from 1990 to 2019, the post-COVID-19 era saw a marked reversal across all age groups, with incidence rates rising steadily through 2023, most notably among children under five years in Brazil (ARC +7·919) and Suriname (ARC +8·844), and older adults over 70 years in Cuba (ARC +5·050) and Chile (ARC +5·138). Based on aetiological causes, in 2023 Streptococcus pneumoniae remained the leading agent of LRTI mortality in the region (7·84 [6·99–8·92] deaths per 100 000), followed by Staphylococcus aureus (3·36 [3·02–3·69] deaths per 100 000). Interpretation: LRTIs remain a leading cause of death and disability in Latin America and the Caribbean, yet our findings demonstrate substantial progress in reducing mortality and DALY burden over three decades. We document marked heterogeneity across countries and age groups, with the greatest gains among children under five years old. Shifts in pathogen distribution are evident: S. pneumoniae persists as the leading cause of LRTI mortality, while S. aureus and non-tuberculous mycobacteria (NTM) have emerged as increasingly important contributors. The post-COVID period has reversed prior incidence trends across all age groups, underscoring the vulnerability of regional health systems to pandemic disruptions. These findings highlight the urgent need for sustained investment in vaccination programmes, equitable access to care, and strengthened epidemiological surveillance to reduce the burden of LRTI in the region.