Abstract
BACKGROUND: The assessment of lower respiratory infection (LRI) mortality, incidence, and responsible pathogens in China provides a scientific basis for the prevention and management of LRI, especially for evaluating the impact of coronavirus disease 2019 (COVID-19). We provide a national estimate of the non-COVID-19 LRI burden and trends on people from 1990 to 2021 based on Global Burden of Disease (GBD) study 2021. METHODS: We estimated China's mortality, incidence, disability-adjusted life years (DALYs), risk factors and aetiology attribution for LRI without including COVID-19 by using the estimated data of GBD study 2021. Mortality, incidence, DALYs, risk factors and aetiology were stratified by sex and age. Trends were evaluated using estimated annual percentage change. RESULTS: In 2021, it is estimated that there were 206930.22 deaths (95% uncertainty interval [UI]: 171260.88-251990.47), with all-age mortality rate of 14.54 deaths (95% UI: 12.04-17.71) per 100,000 population. Compared to 2019, the all-age mortality rate had a 3.60% increase. Analyzing risk factors from 1990 to 2021, we found that the percentage of DALYs attributed to tobacco increased from 7.44% (95% UI: 1.26-15.72%) to 22.14% (95% UI: 3.28-38.41%), and that attributable to ambient particulate matter pollution increased from 19.84% (95% UI: 8.79-30.20%) to 32.72% (95% UI: 22.78-41.77%). The leading cause of mortality from LRIs remains Streptococcus pneumoniae from 1990 to 2021. However, the proportions of viral infections decreased. Compared to 2019, the proportion of deaths in 2021 caused by Influenza decreased from 13.03 to 2.70%, and the proportion of deaths due to RSV decreased from 2.21 to 0.41%. CONCLUSIONS: In China, substantial progress has been made in reducing LRI mortality, yet LRIs have remained a threat in China from 1990 to 2021. During the COVID-19 pandemic, the mortality attributable to Influenza and RSV declined. Effective vaccines and treatments targeted at the main pathogens of LRI are important. CLINICAL TRIAL NUMBER: Not applicable.