Background

The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2015 provides an up-to-date analysis of the burden of lower respiratory tract infections (LRIs) in 195 countries. This study assesses cases, deaths, and aetiologies spanning the past 25 years and shows how the burden of LRI has changed in people of all ages.

Methods

We estimated LRI mortality by age, sex, geography, and year using a modelling platform shared across most causes of death in the GBD 2015 study called the Cause of Death Ensemble model. We modelled LRI morbidity, including incidence and prevalence, using a meta-regression platform called DisMod-MR. We estimated aetiologies for LRI using two different counterfactual approaches, the first for viral pathogens, which incorporates the aetiology-specific risk of LRI and the prevalence of the aetiology in LRI episodes, and the second for bacterial pathogens, which uses a vaccine-probe approach. We used the Socio-demographic Index, which is a summary indicator derived from measures of income per capita, educational attainment, and fertility, to assess trends in LRI-related mortality. The two leading risk factors for LRI disability-adjusted life-years (DALYs), childhood undernutrition and air pollution, were used in a decomposition analysis to establish the relative contribution of changes in LRI DALYs.

Findings

In 2015, we estimated that LRIs caused 2·74 million deaths (95% uncertainty interval [UI] 2·50 million to 2·86 million) and 103·0 million DALYs (95% UI 96·1 million to 109·1 million). LRIs have a disproportionate effect on children younger than 5 years, responsible for 704 000 deaths (95% UI 651 000–763 000) and 60.6 million DALYs (95ÙI 56·0–65·6). Between 2005 and 2015, the number of deaths due to LRI decreased by 36·9% (95% UI 31·6 to 42·0) in children younger than 5 years, and by 3·2% (95% UI −0·4 to 6·9) in all ages. Pneumococcal pneumonia caused 55·4% of LRI deaths in all ages, totalling 1 517 388 deaths (95% UI 857 940–2 183 791). Between 2005 and 2015, improvements in air pollution exposure were responsible for a 4·3% reduction in LRI DALYs and improvements in childhood undernutrition were responsible for an 8·9% reduction.

Interpretation

LRIs are the leading infectious cause of death and the fifth-leading cause of death overall; they are the second-leading cause of DALYs. At the global level, the burden of LRIs has decreased dramatically in the last 10 years in children younger than 5 years, although the burden in people older than 70 years has increased in many regions. LRI remains a largely preventable disease and cause of death, and continued efforts to decrease indoor and ambient air pollution, improve childhood nutrition, and scale up the use of the pneumococcal conjugate vaccine in children and adults will be essential in reducing the global burden of LRI.

Funding

Bill & Melinda Gates Foundation.

中文翻译：

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估计195个国家/地区的下呼吸道感染的全球，区域和国家发病率，死亡率和病因：2015年全球疾病负担研究的系统分析

背景

《 2015年全球疾病，伤害和危险因素负担（GBD）研究》对195个国家/地区的下呼吸道感染（LRI）负担进行了最新分析。这项研究评估了过去25年中的病例，死亡和病因，并显示了LRI的负担如何在各个年龄段的人们中发生了变化。

方法

在GBD 2015研究中，我们使用跨大多数死亡原因共享的建模平台，按年龄，性别，地理位置和年份估算了LRI死亡率，该研究称为“死亡原因集合”模型。我们使用称为DisMod-MR的元回归平台对LRI发病率（包括发病率和患病率）进行建模。我们使用两种不同的反事实方法估计了LRI的病因，第一种方法是针对病毒病原体，其中包括了病因学方面的LRI风险和病因学在LRI发作中的发生率，第二种方法是针对细菌性病原体，使用了疫苗探针方法。我们使用了社会人口统计学指标（该指标是从人均收入，教育程度和生育率的指标得出的汇总指标）来评估与LRI相关的死亡率的趋势。

发现

2015年，我们估计LRI导致2·74百万人死亡（95％不确定区间[UI] 2·5,000万至2·86百万）和103·0百万DALY（95％UI 96·100万至109·1百万） ）。LRI对5岁以下儿童的影响不成比例，造成704 000例死亡（95％UI 651 000–763 000）和6060万DALY（95→I 56·0–65·6）。在2005年至2015年期间，5岁以下儿童的LRI死亡人数下降了36·9％（95％UI 31·6至42·0），下降了3·2％（95％UI −0· 4至6·9）。在所有年龄段，肺炎球菌性肺炎均导致LRI死亡的55·4％，总计1 517 388人死亡（95％的UI 857 940–2 183 791）。在2005年至2015年之间，空气污染暴露的改善导致LRI DALY减少4·3％，儿童营养不良的改善导致减少8·9％。

解释

LRIs是主要的传染病死因，总体上排名第五。它们是DALYs的第二大原因。在全球范围内，尽管许多地区70岁以上的人的负担有所增加，但过去10年中5岁以下儿童的LRI的负担已大大减少。LRI仍然是一种可预防的疾病和死亡原因，因此继续努力减少室内和环境空气污染，改善儿童营养并扩大儿童和成人肺炎球菌结合疫苗的使用，对于减轻LRI的全球负担至关重要。

资金

比尔和梅琳达·盖茨基金会。