Subnational Evidence for the Attributable Burden of Respiratory Infections in China's Population Under 20: Challenges from Particulate Matter Pollution

Overview

Journal Environ Health (Wash)

Publisher American Chemical Society

Date 2025 Feb 27

PMID 40012876

Authors

Junchao Duan

Ruiyang Ding

Menglong Li

Jinlei Qi

Peng Yin

Lijun Wang

Zhiwei Sun

Yifei Hu

Maigeng Zhou

Affiliations

Soon will be listed here.

Abstract

Respiratory infections and tuberculosis ranked as the second leading global causes of mortality in 2021. Following the methodology from the Global Burden of Disease Study (GBD) 2021, we aimed to estimate the attributable burden and risk factors of respiratory infections and tuberculosis among China's population under 20 from 1990 to 2021. In 2021, there were 652 million new cases and 12 699 deaths of respiratory infections and tuberculosis among people under 20 years old in China. We estimated 9054 (71.2%) deaths and 818 498 (54.6%) disability-adjusted life years (DALYs) from respiratory infections attributed to all evaluated risk factors. Mortality rates were the highest in Xizang, Xinjiang, and Qinghai in 2021, while they constantly decreased since 1990. Ambient particulate matter pollution was the second leading cause of death among males and first among females, accounting for nearly 1/5 of deaths from respiratory infections and tuberculosis in 2021. In 23 of 33 provinces, ambient particulate matter pollution was the first leading cause of death and DALY, while in Xizang and Gansu, it was not the major contributor to the burden. From 1990 to 2021, the burden from household air pollution declined remarkably in all 33 provinces except for Xizang and Gansu, while the population attributable fraction (PAF) of ambient particulate matter pollution continuously increased. The overall burden of respiratory infections and tuberculosis showed a declining trend, while it remained a fatal threat to infants in relatively less developed regions. The raised hazard of ambient particulate matter pollution underscored the necessity of the shift into the formulation of prevention and intervention strategies.

References

Yin P, Brauer M, Cohen A, Wang H, Li J, Burnett R . The effect of air pollution on deaths, disease burden, and life expectancy across China and its provinces, 1990-2017: an analysis for the Global Burden of Disease Study 2017. Lancet Planet Health. 2020; 4(9):e386-e398. PMC: 7487771. DOI: 10.1016/S2542-5196(20)30161-3. View

Jin X, Ren J, Li R, Gao Y, Zhang H, Li J . Global burden of upper respiratory infections in 204 countries and territories, from 1990 to 2019. EClinicalMedicine. 2021; 37:100986. PMC: 8343248. DOI: 10.1016/j.eclinm.2021.100986. View

Carter E, Archer-Nicholls S, Ni K, Lai A, Niu H, Secrest M . Seasonal and Diurnal Air Pollution from Residential Cooking and Space Heating in the Eastern Tibetan Plateau. Environ Sci Technol. 2016; 50(15):8353-61. DOI: 10.1021/acs.est.6b00082. View

Cakmak S, Hebbern C, Pinault L, Lavigne E, Vanos J, Crouse D . Associations between long-term PM and ozone exposure and mortality in the Canadian Census Health and Environment Cohort (CANCHEC), by spatial synoptic classification zone. Environ Int. 2017; 111:200-211. DOI: 10.1016/j.envint.2017.11.030. View

Niederman M, Krilov L . Acute lower respiratory infections in developing countries. Lancet. 2013; 381(9875):1341-1342. DOI: 10.1016/S0140-6736(12)62178-3. View

Klein S, Flanagan K . Sex differences in immune responses. Nat Rev Immunol. 2016; 16(10):626-38. DOI: 10.1038/nri.2016.90. View

. Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024; 403(10440):2162-2203. PMC: 11120204. DOI: 10.1016/S0140-6736(24)00933-4. View

Meng W, Shen G, Shen H, Chen Y, Yun X, Li J . Synergistic Health Benefits of Household Stove Upgrading and Energy Switching in Rural China. Environ Sci Technol. 2021; 55(21):14567-14575. DOI: 10.1021/acs.est.1c04242. View

. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. 2018; 18(11):1191-1210. PMC: 6202443. DOI: 10.1016/S1473-3099(18)30310-4. View

10.

Pinault L, Tjepkema M, Crouse D, Weichenthal S, van Donkelaar A, Martin R . Risk estimates of mortality attributed to low concentrations of ambient fine particulate matter in the Canadian community health survey cohort. Environ Health. 2016; 15:18. PMC: 4750218. DOI: 10.1186/s12940-016-0111-6. View

11.

Jin Y, Ma X, Chen X, Cheng Y, Baris E, Ezzati M . Exposure to indoor air pollution from household energy use in rural China: the interactions of technology, behavior, and knowledge in health risk management. Soc Sci Med. 2006; 62(12):3161-76. DOI: 10.1016/j.socscimed.2005.11.029. View

12.

Qazi S, Aboubaker S, MacLean R, Fontaine O, Mantel C, Goodman T . Ending preventable child deaths from pneumonia and diarrhoea by 2025. Development of the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea. Arch Dis Child. 2015; 100 Suppl 1:S23-8. DOI: 10.1136/archdischild-2013-305429. View

13.

. Global, regional, and national burden of congenital heart disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Child Adolesc Health. 2020; 4(3):185-200. PMC: 7645774. DOI: 10.1016/S2352-4642(19)30402-X. View

14.

Li Y, Wang X, Blau D, Caballero M, Feikin D, Gill C . Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022; 399(10340):2047-2064. PMC: 7613574. DOI: 10.1016/S0140-6736(22)00478-0. View

15.

. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396(10258):1223-1249. PMC: 7566194. DOI: 10.1016/S0140-6736(20)30752-2. View

16.

Weichenthal S, Villeneuve P, Burnett R, van Donkelaar A, Martin R, Jones R . Long-term exposure to fine particulate matter: association with nonaccidental and cardiovascular mortality in the agricultural health study cohort. Environ Health Perspect. 2014; 122(6):609-15. PMC: 4050514. DOI: 10.1289/ehp.1307277. View

17.

Xie J, Wang M, Long Z, Ning H, Li J, Cao Y . Global burden of type 2 diabetes in adolescents and young adults, 1990-2019: systematic analysis of the Global Burden of Disease Study 2019. BMJ. 2023; 379:e072385. PMC: 9727920. DOI: 10.1136/bmj-2022-072385. View

18.

. Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019: results from the Global Burden of Disease Study 2019. Lancet Infect Dis. 2022; 22(11):1626-1647. PMC: 9605880. DOI: 10.1016/S1473-3099(22)00510-2. View

19.

Luo Z, Shen G, Men Y, Zhang W, Meng W, Zhu W . Reduced inequality in ambient and household PM exposure in China. Environ Int. 2022; 170:107599. DOI: 10.1016/j.envint.2022.107599. View

20.

Ma Q, Li R, Wang L, Yin P, Wang Y, Yan C . Temporal trend and attributable risk factors of stroke burden in China, 1990-2019: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2021; 6(12):e897-e906. PMC: 9047702. DOI: 10.1016/S2468-2667(21)00228-0. View