Burden of lower respiratory infections in five East Asian countries from 1990 to 2021

Observation, comparison, and forecast from the global burden of disease study 2021

Bibliographic Data

ID22068624
AuthorsShiwei Wang (0009-0003-9492-9637, Fujian University of Traditional Chinese Medicine), Shuai Lin (0000-0002-4089-5721, Guangdong Provincial Hospital of Traditional Chinese Medicine), Guodong Zhong (0000-0002-0942-4497, Fujian University of Traditional Chinese Medicine), Zhihong Qi (0000-0002-8512-9377, Fujian University of Traditional Chinese Medicine), Zhangyang Qi, Wei Wang (0000-0001-5806-2368, Fujian University of Traditional Chinese Medicine), Wen Wen (0000-0002-8086-6386, Fujian Medical University, corresponding author)
Year2025
Volume13
Pages1679714-1679714
Publication date2025-10-24
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2025.1679714
PMID41211396
OpenAlexW4415501757
LanguageEN
References cited29

Objective: Lower respiratory infections (LRIs) remain a major global health challenge. Although the overall burden has declined, cross-country differences in long-term trends, age-sex patterns, and risk factors in East Asia are not well characterized. This study provides the first systematic comparison of long-term LRI trends across five East Asian countries-China, Japan, Republic of Korea, Democratic People's Republic of Korea, and Mongolia-using Global Burden of Disease Study 2021 (GBD 2021) data. Methods: We analyzed LRI incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021. Temporal trends were quantified by estimated annual percentage change (EAPC). We combined decomposition analysis and autoregressive integrated moving average (ARIMA) forecasting to quantify the relative contributions of population growth, aging, and epidemiological changes, and to project future trajectories. Risk factor attribution was evaluated using population-attributable fractions, and age-sex patterns were compared across countries. Results: From 1990 to 2021, all five countries showed substantial reductions in age-standardized incidence and mortality, with Mongolia and China achieving the steepest declines. The burden shifted from children under five to older adults, particularly those aged ≥70 years, a novel epidemiological transition most evident in Japan and Korea. Decomposition indicated that epidemiological improvements were the primary drivers of mortality reductions, while population aging in Japan and Korea partially counteracted these improvements. Forecasts suggest continued declines in incidence and mortality across most countries, though Japan may experience a plateau in mortality. Conclusion: This study provides the first systematic comparison of long-term LRI trends across five East Asian countries. While the overall burden has declined, population aging, air pollution, and smoking are emerging challenges. By combining decomposition and ARIMA forecasting, our findings highlight the shift from children to older adults and offer timely evidence for age-sensitive, country-specific interventions such as vaccination for older adults, environmental regulation, and tobacco control

Burden of disease · Disease · Disease burden · Double burden · East Asia · Population · Psychological intervention · Pediatric health and respiratory diseases · Pneumonia and Respiratory Infections · Respiratory viral infections research · Epidemiology

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