Global, regional, and national burden of asthma and atopic dermatitis, 1990-2021, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021 - G. B. D. Asthma; Allergic Diseases, Collaborators (Lancet Respir Med, 2025)
BACKGROUND: Asthma and atopic dermatitis are common allergic conditions that contribute to substantial health loss, economic burden, and pain across individuals of all ages worldwide. Therefore, as a component of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we present updated estimates of the prevalence, disability-adjusted life-years (DALYs), incidence, and deaths due to asthma and atopic dermatitis and the burden attributable to modifiable risk factors, with forecasted prevalence up to 2050. METHODS: Asthma and atopic dermatitis prevalence, incidence, DALYs, and mortality, with corresponding 95% uncertainty intervals (UIs), were estimated for 204 countries and territories from 1990 to 2021. A systematic review identified data from 389 sources for asthma and 316 for atopic dermatitis, which were further pooled using the Bayesian meta-regression tool. We also described the age-standardised DALY rates of asthma attributable to four modifiable risk factors: high BMI, occupational asthmagens, smoking, and nitrogen dioxide pollution. Furthermore, as a secondary analysis, prevalence was forecasted to 2050 using the Socio-demographic Index (SDI), air pollution, and smoking as predictors for asthma and atopic dermatitis. To assess trends in the burden of asthma and atopic dermatitis before (2010-19) and during (2019-21) the COVID-19 pandemic, we compared their average annual percentage changes (AAPCs). FINDINGS: In 2021, there were an estimated 260 million (95% UI 227-298) individuals with asthma and 129 million (124-134) individuals with atopic dermatitis worldwide. Asthma cases declined from 287 million (250-331) in 1990 to 238 million (209-272) in 2005 but increased to 260 million in 2021. Atopic dermatitis cases consistently rose from 107 million (103-112) in 1990 to 129 million (124-134) in 2021. However, age-standardised prevalence rates decreased-by 40.0% (from 5568.3 per 100 000 to 3340.1 per 100 000) for asthma and 8.3% (from 1885.4 per 100 000 to 1728.5 per 100 000) for atopic dermatitis. In 2021, there were substantial variations in the burden of asthma and atopic dermatitis across different SDI groups, with the highest age-standardised DALY rate found in south Asia for asthma (465.0 [357.2-648.9] per 100 000) and the high-income super-region for atopic dermatitis (3552.5 [3407.2-3706.1] per 100 000). During the COVID-19 pandemic, the decline in asthma prevalence had stagnated (AAPC pre-pandemic -1.39% [-2.07 to -0.71] and during the pandemic 0.47% [-1.86 to 2.79]; p=0.020); however, there was no significant difference in atopic dermatitis prevalence in the same period (pre-pandemic -0.28% [-0.33 to -0.22] and during the pandemic -0.35% [-0.78 to 0.08]; p=0.20). Modifiable risk factors were responsible for 29.9% of the global asthma DALY burden; among them, high BMI was the greatest contributor (39.4 [19.6-60.2] per 100 000), followed by occupational asthmagens (20.8 [16.7-26.5] per 100 000) across all regions. The age-standardised DALY rate of asthma attributable to high BMI was highest in high-SDI settings, whereas the contribution of occupational asthmagens was highest in low-SDI settings. According to our forecasting models, we expect 275 million (224-330) asthma cases and 148 million (140-158) atopic dermatitis cases in 2050, with population growth driving this increase. However, age-standardised prevalence rates are expected to remain stable (-23.2% [-44.4 to 5.3] for asthma and -1.4% [-9.1 to 7.0] for atopic dermatitis) from 2021 to 2050. INTERPRETATION: Although the increases in the total number of asthma and atopic dermatitis cases will probably continue until 2050, age-standardised prevalence rates are expected to remain stable. A considerable portion of the global burden could be managed through efforts to address modifiable risk factors. Additionally, the contribution of risk factors to the burden substantially varied by SDI, which suggests the need for tailored initiatives for specific SDI settings. The growing number of individuals expected to be affected by asthma and atopic dermatitis in the future suggests that it is essential to improve our understanding of risk factors for asthma and atopic dermatitis and collect disease prevalence data that are globally generalisable. FUNDING: Gates Foundation.
Keywords: journalArticle; (CASAC), Johns Hopkins EHE Advisory Board, Harvard external advisory committee; (published), A method to transform cow dung into the wall paint by using natural; (published), A system for disposed personal protection equipment (PPE) into; *Asthma/epidemiology/mortality; *Dermatitis, Atopic/epidemiology/mortality; *Global Burden of Disease/trends; 113-2314-B-003-002); ANI/Exeltis USA, Frictionless Solutions, Schipher, Crealta/Horizon, Medisys,; Adult; Assessment, Lancet Countdown, US EPA Clean Air Scientific Advisory Committee; Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life; Bayes Theorem; BioPharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals,; College of Rheumatology, Yale University, Hulio, Horizon Pharmaceuticals, DINORA,; Committee; Corrente 34/2017), payments made to the Institute for Maternal and Child Health; Cost of Illness; Council Member, Indian Meteorological Society, Jaipur Chapter (India) and as; Disability-Adjusted Life Years; Education Chapter Committee, outside the submitted work. L Ronfani reports; Effects Institute, Yale Women Faculty Forum, Robert Wood Johnson Foundation, Yale; Ekundayo reports grants or contracts from PDF Research Fellowship, University of; Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding Corp, Aebona; Female; Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Putnam; Forecasting; Fund Fellowship, Harvard University, University of Montana, and SciQuest; Global Health; Humans; IRCCS Burlo Garofolo. B Oancea reports grants or contracts from; IRCCS Burlo Garofolo. Y L Samodra and J H V Ticoalu report a leadership or; Incidence; Institute for Biospheric Studies, and Wellcome Trust Foundation; Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart, Atyu; Male; Member Secretary of DSTPURSE Program, outside the submitted work. M Zielinska; Monitoring Board or Advisory Board as a member of the FDA Arthritis Advisory; National Institutes of Health (NIH), Hutchinson Postdoctoral Fellowship, Health; Nature Conference; OMERACT; PNRR/2022/C9/MCID/I8 project 760096, outside the submitted work. N E Ismail; Pharmaceuticals, and Charlotte's Web Holdingss; Pharmacy (Malaysia) and as Committee Member of Malaysian Pharmacists Society; Prevalence; Public Health, Columbia University, Harvard University, CMAS Conference, and; Risk Factors; Science, UBM, Trio Health, Medscape, WebMD, Practice Point Communications, and; South Africa, outside the submitted work. I M Ilic reports support for the; University of Texas, Duke University, Harvard University, American Journal of; University, IOP Publishing, NIH, Health Canada, EHS, PAC-10, UKRI, AXA Research; University, University of Pennsylvania, Brown University, Northeastern; advocacy group, paid or unpaid as a past steering committee member of the; advocacy group, unpaid as The Bursar and Council Member of Malaysian Academy of; aid for formulation of gel and method thereof (Published), Herbal drug; and previous ownership of stock; and the National Academies Panels and Committees, outside the submitted work. T C; attending meetings or travel from OMERACT; biofuel through pyrolysis and method (published), A novel herbal pharmaceutical; board, society, committee or advocacy group, paid or unpaid as the Executive