Abstract
OBJECTIVE: To characterize sex- and age-specific changes in the comprehensive burden of major chronic respiratory diseases (CRDs) and their attributable risk factors among adults aged ≥55 years globally, regionally, and nationally from 1990 to 2021 using the Global Burden of Disease (GBD) 2021 database. METHODS: Utilizing the GBD 2021 database, we performed in-depth analyses and preliminary projections of global, regional, and national burden trends for chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease & pulmonary sarcoidosis (ILD&PS) through multi-model approaches including but not limited to Age-Period-Cohort (APC) models, Joinpoint regression, and Bayesian Age-Period-Cohort (BAPC) modeling. RESULTS: The overall global CRD burden among adults ≥55 years declined from 1990 to 2021. However, the Corona Virus Disease 2019 (COVID-19) pandemic differentially altered asthma and COPD prevalence and incidence trends globally: low Socio-demographic Index (SDI) regions experienced an accelerated increase in prevalence, while high SDI regions showed a steeper rise in incidence. High mortality and disability-adjusted life years (DALYs) rates remained concentrated in low-middle SDI regions, notably Asia and North America. Consequently, prevalent CRD cases in this age group reached 223 million (95% UI 206.5-241.5) in 2021-accounting for half of all-age cases-with 18.47 million incident cases (95% UI 16.97-20.11), causing 4.15 million deaths (95% UI 3.76-4.58) and 83.67 million DALYs (95% UI 77.49-90.36). Air pollution, smoking, obesity, and chronic cold exposure persistently influenced COPD and asthma prevalence across regions and sexes. CONCLUSION: The pandemic shifted global CRD burden trends, particularly for asthma followed by COPD. Concurrent with global aging, burden trajectories across SDI levels raise concerns. As COVID-19 becomes endemic, older adults will experience impacts from recurrent viral infections, increasingly manifesting in coming years.