Burden of Asthma Among Childhood: Based on the Global Burden of Disease Study 2021

Asthma in children is a global epidemic that causes various medical conditions associated with an increased incidence of premature death. This study aims to examine the trends in asthma incidence, prevalence, disability-adjusted life-years (DALYs), and mortality among children, alongside identifying risk factors associated with asthma-related deaths and DALYs, over the period from 1990 to 2021.

A cross-sectional study was conducted utilizing data from the Global Burden of Diseases (GBD) 2021, encompassing 204 countries and territories. The analysis included children aged 0-14 years diagnosed with asthma. Data analysis was conducted from October 1, 2024, to December 30, 2024. The primary outcomes included incidence, prevalence, all-cause and cause-specific mortality, DALYs, and the corresponding estimated annual percentage changes (EAPCs). These trends were further stratified by region, country, age, sex, and sociodemographic index (SDI).

Between 1990 and 2005, there was an overall decline in the global incidence, prevalence, and DALY rates of childhood asthma. However, from 2005 to 2010, these rates experienced an upward trend. Following 2010, the incidence, prevalence, and disability-adjusted life expectancy of childhood asthma resumed a downward trajectory. Throughout the period from 1990 to 2021, both the number of deaths and the mortality rate associated with childhood asthma consistently decreased. Over the past two decades, among the five SDI regions, the high SDI region has generally shown a more pronounced increase in incidence, prevalence, and DALY rates, while concurrently experiencing a greater reduction in mortality rates. Conversely, the low SDI region has demonstrated a more significant decrease in incidence, despite a substantial increase in the number of incident cases. Nonetheless, the current burden remains considerable. Notably, there has been a rapid escalation in the disease burden in certain areas of Central Europe and High-income North America. Central Europe and high-income regions of North America exhibited the most substantial increases in incidence, with EAPC of 1.64 (95% confidence interval [CI], 1.40-1.88) and 0.61 (95% CI, 0.27-0.94), respectively. Among 204 countries, Haiti reported the highest national incidence of childhood asthma in 2021, with a rate of 4422 per 100,000 population (95% uncertainty interval [UI], 3544-5482). Furthermore, Haiti demonstrated the highest asthma-related mortality rate, recorded at 5.33 per 100,000 population (95% UI, 1.48-9.25), and the highest rate of DALYs at 1383.24 per 100,000 population (95% UI, 920.79-1923.12). An analysis of health disparities indicated that the burden of asthma is increasingly concentrated in countries with a low SDI. On a global scale, elevated body mass index and air pollution emerged as significant risk factors influencing the rate of DALYs associated with childhood asthma in 2021.

The burden of childhood asthma continues to be significant. The results of this cross-sectional study suggest that, although there has been a global decrease in incidence, prevalence, mortality rates, and DALYs, the absolute numbers for incidence, prevalence, and DALYs remain high among children with asthma, especially in areas with a low SDI. A more thorough understanding of the epidemiology of childhood asthma could improve strategies for its prevention and management.