Abstract
Background
Asthma is a significant contributor to the global disease burden and is the most common chronic disease in children and adolescents. This study provides estimates of the prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) burden of asthma among children and adolescents from 1990 to 2021.
Methods
Using Global Burden of Disease (GBD) 2021 data, we analyzed age-standardized prevalence (ASPR), incidence (ASIR), mortality (ASMR), and DALYs (ASDR) rates of asthma among children and adolescents from 1990 to 2021. Estimated annual percentage changes (EAPC) were calculated to evaluate temporal trends. Data were stratified by sex, age, 204 nations/territories, 21 GBD regions, and five socio-demographic index (SDI) quintiles. The Bayesian age-period-cohort (BAPC) models were applied to predict asthma burden up to 2040.
Results
In 2021, there were approximately 126 million prevalent cases and 27 million incidence cases among children and adolescents worldwide. From 1990 to 2021, ASPR (EAPC −1.00) and ASIR (EAPC −0.77) declined moderately, while ASMR (EAPC −3.01) and ASDR (EAPC −1.54) decreased substantially. High SDI regions had the highest prevalence, incidence, and DALYs, whereas low SDI regions bore greater mortality. Males exhibited higher prevalence, whereas females experienced higher mortality. Prevalence peaked at ages 5–9 years, while incidence, deaths, and DALYs were highest in children younger than 5 years. High body mass index (BMI) was a leading contributor to asthma burden. During the coronavirus disease 2019 (COVID-19) pandemic (2019–2021), global asthma burden in children and adolescents decreased, particularly in deaths, while prevalence slightly increased. BAPC projections indicate that the ASPR and ASIR will remain stable through 2040, while ASMR and ASDR will continue to decline.
Conclusions
The global burden of asthma among children and adolescents has declined, but regional, sex, and age disparities persist. These findings highlight the need for targeted healthcare strategies and policies that address age, gender, and regional differences.
Keywords: Asthma, global burden of disease study, children, adolescents, trends
Highlight box.
Key findings
• This study provides the most up-to-date and comprehensive assessment of the global, regional, and national burden of asthma among children and adolescents from 1990 to 2021, with projections to 2040. Although age-standardized prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) have declined globally, substantial disparities by age, sex, region, and socio-demographic index (SDI) level persist. High SDI regions show higher prevalence and DALYs, while low SDI regions bear the highest mortality burden. Children under 5 years remain the most vulnerable group. High body mass index is now the leading contributor to asthma burden, with its attributable share increasing markedly over time.
What is known and what is new?
• Previous Global Burden of Disease (GBD)-based studies have described overall asthma burden but rarely focused specifically on children and adolescents. It is known that asthma remains one of the most common chronic diseases in young people and exhibits marked geographic heterogeneity.
• This study adds new evidence by using GBD 2021 to provide updated estimates, detailed age-sex-regional disparities, the influence of COVID-19 (2019–2021), comprehensive risk factor attribution, and future forecasts using Bayesian age-period-cohort (BAPC) models through 2040.
What is the implication, and what should change now?
• These findings highlight the need for strengthened early diagnosis, improved access to standardized care in low-resource settings, and region- and sex-specific prevention strategies. Reducing modifiable risk factors—particularly childhood obesity and air pollution—should be prioritized. The projected decline in mortality suggests that continued investment in effective asthma management can further reduce severe outcomes. Policymakers should integrate these insights into targeted public health planning and allocate resources to the populations at highest risk.
Introduction
Asthma is a chronic inflammatory condition of the lower respiratory tract characterized by airflow limitation, airway hyperresponsiveness, and structural remodeling (1). It is the most common chronic respiratory disease among children and adolescents, affecting approximately 14% of this population worldwide (2). Typical symptoms such as wheezing and coughing disrupt daily activities, schooling, and social participation. It is also the leading cause of pediatric emergency visits and preventable hospitalizations (3,4). Around 30–50% of childhood-onset asthma persists into adulthood (5,6), often leading to long-term complications such as chronic obstructive pulmonary disease (COPD) and cardiovascular disease, which substantially impair quality of life and increase healthcare utilization (7,8). In the United States, annual asthma-related healthcare costs in school-aged children exceed US$ 5.92 billion and continue to rise (9,10). Although progress has been made in asthma management and effective medications are widely available, significant disparities remain between regions. Many children in low-resource settings still lack access to standardized care, resulting in inadequate disease control (10,11). Over the past three decades, the global burden of asthma has shown notable regional and national heterogeneity and despite declining age-standardized rates (ASRs), the total numbers of prevalent and incident cases remain high, especially in younger populations, as revealed by the Global Burden of Disease (GBD) 2019 (12-16). However, comprehensive evaluations focusing exclusively on children and adolescents (aged 0–24 years) are still lacking.
The coronavirus disease 2019 (COVID-19) pandemic also profoundly affected asthma care (17). While early concerns suggested an increased risk of severe outcomes, emerging evidence indicates that public health measures such as mask use and social distancing may have reduced respiratory infections and improved asthma control in children (18). Nonetheless, the overall impact of COVID-19 on the global asthma burden in this age group remains uncertain.
Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) (19,20), this study provides updated estimates of asthma prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) among children and adolescents from 1990 to 2021. We further analyze trends by sex, age, region, and socio-demographic index (SDI), assess the contribution of major risk factors, explore the potential influence of COVID-19 (2019–2021), and predict future trends through 2040. We present this article in accordance with the STROBE reporting checklist (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-aw-2397/rc).
Methods
Data source
We extracted data from the GBD 2021 for individuals aged 0–24 years diagnosed with asthma between 1990 and 2021. Estimates of prevalence, incidence, mortality, and DALYs, with corresponding 95% uncertainty intervals (UIs), were retrieved from the Global Health Data Exchange (GHDx) (https://vizhub.healthdata.org/gbd-results/). Detailed methods for the GBD 2021 have been reported previously (19,20). Data sources included disease registries, vital registration systems, health service records, censuses, and household surveys, which were synthesized using models such as the Cause of Death Ensemble model (CODEm), spatiotemporal Gaussian process regression, and Bayesian meta-regression (DisMod-MR 2.1). The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments.
Estimates
In GBD 2021, asthma was defined as a chronic lung disease characterized by reversible airway obstruction and wheezing, based on physician diagnosis or self-reported symptoms. Diagnostic codes correspond to International Classification of Diseases (ICD-10) [J45–J46] and ICD-9 [493]. Alternative case definitions include self-reported asthma in the past year, self-reported asthma ever, only a doctor’s diagnosis in the past year, and only wheezing in the past year. Mortality data were derived from cause-of-death registries and surveillance systems.
Childhood and adolescence were defined as ages 0–24 years (21), and divided into five groups: <5, 5–9, 10–14, 15–19, and 20–24 years. We employed the SDI, a measure that reflects a region’s sociodemographic progression based on income, education, and fertility levels (22). The 204 countries and territories were grouped into five quintiles (low, low-middle, middle, high-middle, and high) based on country-level estimates of SDI, and into 21 GBD regions by geographic and epidemiological similarity (20).
We also estimated mortality and DALYs attributed to key risk factors, including high body mass index (BMI), occupational asthmagens, and air pollution, stratified by sex, age, and region.
Statistical analysis
The prevalence, incidence, mortality, and DALYs of asthma in children and adolescents were analyzed at global, regional, national, and SDI levels. The ASR per 100,000 persons and estimated annual percentage change (EAPC) were utilized to measure trends in asthma disease burden. The ASR trend provided a clearer portrayal of changes in disease patterns within the population, aiding the development of targeted preventive strategies for asthma, including age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR). The EAPC quantified ASR trends over a certain period of time among various populations. To address sampling error and non-sampling variance, a UI analysis was conducted, deriving the 95% UI from 1,000 posterior distribution samples, reporting the 2.5th and 97.5th percentiles for each estimate. The ASR and 95% UI were calculated by the “ageadjust.direct” function in the “epitools” package (version 0.5-10.1) within R (version 4.4.2) (23). The EAPC was calculated using a regression model to capture the ASR pattern over a specified period (24). A linear regression model was applied to compute the 95% confidence interval (CI) for the EAPC. If both the EAPC and the lower bound of its 95% CI are positive, the ASR is considered to have an increasing trend. Conversely, if both the EAPC and the upper bound of its 95% CI are negative, the ASR shows a decreasing trend. If neither condition is met, the ASR is deemed stable (25,26). The Joinpoint regression model, implemented in Joinpoint software (version 5.2.0), analyzed long-term trends systematically from 1990 to 2021 and assessed the significance of trends between join-points by fitting optimal curves through segmented data on a logarithmic scale (27). We predicted asthma burden from 2022 to 2040 using the Bayesian age-period-cohort (BAPC) model with integrated nested Laplace approximations (INLA), based on data from the GBD 2021. The analysis was performed in R (version 4.4.2) using the “BAPC” (version 0.0.36) and “INLA” (version 24.06.27) packages, with data visualization conducted using the “ggplot2” (version 3.5.1) package.
Results
Burden of asthma in 2021
In 2021, children and adolescents accounted for 48.44% of all-age asthma prevalence cases, 70.82% of new cases, 3.52% of deaths, and 29.33% of total DALYs. The total prevalence of asthma across childhood and adolescence was 126,179,865 (95% UI: 90,052,094 to 175,671,505) cases, a 17.70% decrease from 1990, with 68,250,702 (95% UI: 48,762,525 to 95,364,169) cases in males and 57,929,162 (95% UI: 41,444,985 to 80,515,888) in females. Total incidence cases were 26,814,996 (95% UI: 15,979,965 to 42,649,143), 15.71% lower than in 1990, with 14,533,671 (95% UI: 8,611,553 to 23,180,797) in males and 12,281,325 (95% UI: 7,321,583 to 19,553,855) in females. Asthma-related deaths in childhood and adolescence totaled 15,372 (95% UI: 12,345 to 19,251), 55.02% fewer than in 1990, with 7,360 (95% UI: 5,961 to 9,062) in males and 8,012 (95% UI: 6,018 to 11,099) in females. Asthma contributed 6,283,215 (95% UI: 4,101,773 to 9,634,563) DALYs, a 29.80% decrease from 32 years ago, with 3,331,365 (95% UI: 2,148,335 to 5,139,224) DALYs in males and 2,951,850 (95% UI: 1,927,533 to 4,486,369) in females [Table 1 and supplementary table 1 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)].
Table 1. Prevalence, incidence, mortality, and DALYs of asthma in children and adolescents in 2021, and EAPC from 1990 to 2021.
| Location | Prevalence | Incidence | Mortality | DALYs | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Number [2021] | ASR, per 100,000 [2021] |
EAPC, 1990–2021 | Number [2021] | ASR, per 100,000 [2021] | EAPC, 1990–2021 | Number [2021] | ASR, per 100,000 [2021] | EAPC, 1990–2021 | Number (2021) |
ASR, per 100,000 [2021] | EAPC, 1990–2021 | ||||
| Global | 126,179,865 (90,052,094, 175,671,505) |
3,936.34 (2,809.39, 5,479.86) |
−1 (−1.16, −0.83) | 26,814,996 (15,979,965, 42,649,143) |
857.24 (513.22, 1,360.72) |
−0.77 (−0.93, −0.61) | 15,372 (12,345, 19,251) |
0.48 (0.38, 0.60) | −3.01 (−3.05, −2.97) | 6,283,215 (4,101,773, 9,634,563) |
196.18 (128.16, 300.72) |
−1.54 (−1.67, −1.4) | |||
| Low SDI | 31,240,350 (23,467,346, 41,040,694) |
4,432.88 (3,330.78, 5,821.13) |
−1.18 (−1.28, −1.09) | 7,005,829 (4,523,052, 10,524,157) |
974.79 (626.74, 1,466.31) |
−0.88 (−0.97, −0.8) | 6,501 (4,662, 9,140) |
0.95 (0.69, 1.34) | −3.04 (−3.11, −2.98) | 1,767,551 (1,228,609, 2,529,264) |
252.4 (175.8, 360.69) |
−1.92 (−1.98, −1.85) | |||
| Low-middle SDI | 25,729,273 (18,106,049, 36,139,633) |
2,769.85 (1,949.82, 3,890.37) |
−1.78 (−2, −1.55) | 5,842,692 (3,488,823, 9,319,412) |
643.72 (385.35, 1,025.97) |
−1.32 (−1.54, −1.1) | 4,624 (3,763, 5,914) |
0.49 (0.40, 0.63) | −3.93 (−4.02, −3.85) | 1,389,927 (919,903, 2,080,000) |
149.24 (98.67, 223.49) |
−2.54 (−2.68, −2.4) | |||
| Middle SDI | 32,352,116 (22,276,323, 46,398,690) |
3,556.83 (2448.27, 5096.58) |
−1.15 (−1.35, −0.96) | 7,070,663 (4,049,499, 11,553,512) |
808.44 (466.7, 1,315.93) |
−0.96 (−1.15, −0.77) | 3,324 (2,759, 4,069) |
0.36 (0.30, 0.44) | −3.18 (−3.3, −3.06) | 1,565,956 (976,245, 2,459,677) |
172.17 (107.41, 270.12) |
−1.64 (−1.82, −1.45) | |||
| High-middle SDI | 13,209,056 (8,632,219, 19,750,610) |
3,533.76 (2,303.3, 5,283.85) |
−0.65 (−0.84, −0.46) | 2,701,995 (1,462,917, 4,623,887) |
759.36 (415.21, 1,295.23) |
−0.58 (−0.77, −0.39) | 382 (324, 458) | 0.10 (0.08, 0.12) | −5.34 (−5.48, −5.2) | 564,521 (312,418, 955,806) |
150.99 (83.4, 255.56) |
−1.17 (−1.37, −0.98) | |||
| High SDI | 23,490,665 (16,586,438, 32,811,629) |
8,032.73 (5,644.75, 11,267.61) |
0.21 (0.04, 0.39) | 4,162,277 (2,402,035, 6,748,670) |
1,535.41 (894.89, 2,479.18) |
0.36 (0.18, 0.53) | 514 (486, 546) | 0.16 (0.15, 0.17) | −3.5 (−3.78, −3.22) | 986,772 (580,430, 1,599,082) |
337.06 (197.17, 548.24) |
−0.03 (−0.21, 0.15) | |||
| Central Europe, Eastern Europe, and Central Asia | |||||||||||||||
| Central Asia | 1,050,697 (678,370, 1,577,449) |
2,500.86 (1,615.53, 3,752.3) |
−0.3 (−0.35, −0.26) | 257,602 (138,631, 433,386) |
601.04 (323.23, 1,010.73) |
−0.22 (−0.26, −0.18) | 40 (32, 50) | 0.10 (0.08, 0.12) | −5.62 (−6.19, −5.05) | 45,457 (25,284, 76,549) |
108.4 (60.42, 182.14) |
−1.11 (−1.21, −1.01) | |||
| Central Europe | 2,070,189 (1,384,113, 3,035,487) |
7,230.15 (4,826.32, 10,605.26) |
1.07 (0.91, 1.23) | 427,495 (241,197, 702,558) |
1,560.31 (885.82, 2,556.13) |
1 (0.84, 1.17) | 6 (6, 7) | 0.02 (0.02, 0.02) | −6.66 (−6.93, −6.39) | 84,415 (45,894, 140,961) |
294.85 (160.16, 493.15) |
0.93 (0.76, 1.1) | |||
| Eastern Europe | 2,000,297 (1,282,264, 3,058,736) |
3,524.17 (2,249.63, 5,383.65) |
−1.03 (−1.11, −0.96) | 451,983 (238,233, 774,704) |
834.74 (444.19, 1,426.85) |
−0.86 (−0.92, −0.81) | 29 (27, 31) | 0.05 (0.05, 0.05) | −6.6 (−6.97, −6.23) | 83,202 (43,990, 143,763) |
146.52 (77.21, 252.9) |
−1.34 (−1.44, −1.25) | |||
| High-income | |||||||||||||||
| Australasia | 905,320 (634,054, 1,240,266) |
9,569.24 (6,671.35, 13,159.96) |
−1.3 (−1.47, −1.13) | 97,413 (54,614, 157,825) |
1,111.1 (628.65, 1,790.05) |
−1.27 (−1.52, −1.02) | 28 (25, 32) | 0.28 (0.25, 0.32) | −3.09 (−3.42, −2.75) | 38,643 (22,836, 61,245) |
407.77 (239.72, 648.6) |
−1.41 (−1.56, −1.26) | |||
| High-income Asia Pacific | 1,641,161 (1,058,493, 2,485,389) |
4,267.37 (2,744.94, 6,469.74) |
−1.65 (−1.92, −1.39) | 313,226 (166,118, 543,417) |
896.42 (482.23, 1,545.51) |
−1.23 (−1.49, −0.97) | 20 (16, 28) | 0.05 (0.04, 0.07) | −9.49 (−9.77, −9.21) | 67,986 (36,192, 116,542) |
176.65 (93.67, 303.28) |
−2.26 (−2.57, −1.95) | |||
| High-income North America | 12,584,967 (8,887,009, 17,519,799) |
11,389.43 (8,012.82, 15,905.19) |
0.76 (0.51, 1.01) | 2,460,195 (1,432,941, 3,933,415) |
2,400.7 (1,411.92, 3,820.36) |
0.69 (0.43, 0.96) | 320 (301, 339) | 0.27 (0.25, 0.28) | −1.45 (−1.73, −1.18) | 531,884 (316,451, 850,144) |
480.56 (284.33, 772.59) |
0.62 (0.39, 0.86) | |||
| Southern Latin America | 1,452,398 (946,953, 2,159,591) |
5,973.58 (3,875.97, 8,903.3) |
0.31 (0.16, 0.45) | 242,774 (127,862, 421,028) |
1,083.23 (578.41, 1,867.15) |
0.31 (0.18, 0.44) | 23 (20, 28) | 0.09 (0.07, 0.1) | −4.13 (−4.27, −3.99) | 60,476 (32,970, 102,608) |
248.4 (134.83, 422.5) |
0.06 (−0.09, 0.21) | |||
| Western Europe | 7,122,560 (4,858,281, 10,072,639) |
6,032.9 (4,095.51, 8,573.03) |
−0.31 (−0.43, −0.2) | 945,347 (516,347, 1,584,579) |
865.63 (475.84, 1,445.33) |
−0.04 (−0.15, 0.06) | 124 (117, 132) | 0.1 (0.1, 0.11) | −3.81 (−3.99, −3.63) | 296,077 (167,459, 480,207) |
250.92 (141.23, 408.45) |
−0.5 (−0.62, −0.37) | |||
| Latin America and Caribbean | |||||||||||||||
| Andean Latin America | 2,113,575 (1,465,488, 3,005,027) |
7,364.2 (5,110.54, 10,465.43) |
−2.05 (−2.28, −1.82) | 444,262 (264,821, 707,913) |
1,571.07 (939.88, 2,498.35) |
−1.56 (−1.73, −1.39) | 58 (41, 83) | 0.2 (0.14, 0.29) | −8.36 (−8.81, −7.92) | 90,437 (51,780, 146,741) |
315.24 (180.58, 511.42) |
−3.08 (−3.43, −2.73) | |||
| Caribbean | 2,251,258 (1,773,692, 2,846,181) |
12,195.78 (9,622.8, 15,410.29) |
−0.36 (−0.42, −0.29) | 419,051 (282,196, 610,811) |
2,315.87 (1,569.75, 3,363.43) |
−0.18 (−0.24, −0.12) | 358 (171, 593) | 1.95 (0.92, 3.24) | −1.41 (−1.66, −1.15) | 119,846 (79,146, 174,250) |
651.82 (430.11, 947.37) |
−0.67 (−0.77, −0.57) | |||
| Central Latin America | 5,001,404 (3,421,216, 7,204,405) |
4,830.49 (3,310.83, 6,948.7) |
−1.66 (−1.93, −1.39) | 1,086,578 (624,180, 1,799,679) |
1,090.51 (631.98, 1,798.79) |
−1.31 (−1.57, −1.04) | 203 (162, 264) | 0.2 (0.15, 0.26) | −6.19 (−6.49, −5.89) | 218,679 (126,442, 355,059) |
211.51 (122.6, 343.22) |
−2.37 (−2.67, −2.07) | |||
| Tropical Latin America | 6,385,735 (4,334,635, 9,345,819) |
7,855.16 (5,339.48, 11,492.77) |
−1.74 (−1.91, −1.56) | 1,401,313 (789,376, 2,310,389) |
1,762.76 (996.05, 2,901.56) |
−1.28 (−1.44, −1.12) | 151 (128, 176) | 0.18 (0.15, 0.21) | −4.82 (−5.07, −4.57) | 269,384 (153,283, 446,524) |
331.17 (188.33, 549.66) |
−1.98 (−2.14, −1.83) | |||
| North Africa and Middle East | 10,341,344 (7,275,943, 14,509,228) |
3,605.96 (2,536.43, 5,057.75) |
−1.21 (−1.26, −1.16) | 2,292,176 (1,364,706, 3,661,109) |
806.29 (482.04, 1,284.79) |
−0.95 (−0.99, −0.91) | 853 (636, 1,154) | 0.3 (0.22, 0.4) | −5.28 (−5.36, −5.21) | 484,810 (299,512, 750,939) |
169.22 (104.67, 261.83) |
−2.31 (−2.37, −2.25) | |||
| South Asia | 16,364,649 (10,794,374, 24,097,418) |
1,945.66 (1,283.27, 2,865.78) |
−1.91 (−2.39, −1.42) | 3,620,658 (2,023,910, 6,058,378) |
453.45 (254.37, 758.09) |
−1.43 (−1.93, −0.92) | 2,932 (2,293, 4,048) |
0.33 (0.25, 0.45) | −3.7 (−3.98, −3.42) | 874,697 (562,406, 1,331,847) |
102.64 (65.59, 156.78) |
−2.49 (−2.76, −2.22) | |||
| Southeast Asia, East Asia, and Oceania | |||||||||||||||
| East Asia | 12,122,705 (7,583,550, 18,799,705) |
2,868.12 (1,786.96, 4,439.56) |
−0.73 (−1.21, −0.25) | 2,674,388 (1,414,193, 4,608,136) |
664.75 (355.22, 1,141.01) |
−0.66 (−1.13, −0.19) | 185 (142, 245) | 0.04 (0.03, 0.06) | −8.92 (−9.25, −8.59) | 507,502 (264,647, 887,710) |
120.08 (62.45, 209.73) |
−1.64 (−2.16, −1.12) | |||
| Oceania | 204,957 (160,364, 258,169) |
2,631.56 (2,060.26, 3,315.47) |
−1.63 (−1.77, −1.49) | 50,576 (34,881, 71,493) |
628.84 (430.73, 891.31) |
−1.41 (−1.54, −1.28) | 125 (66, 207) | 1.63 (0.88, 2.7) | −1.34 (−1.49, −1.19) | 18,096 (11,796, 26,175) |
233.6 (153.27, 337.83) |
−1.48 (−1.63, −1.33) | |||
| Southeast Asia | 9,263,993 (6,834,395, 12,497,443) |
3,323.25 (2,452.3, 4,483.64) |
−1.27 (−1.36, −1.18) | 2,035,840 (1,274,931, 3,121,307) |
751.34 (473.49, 1,149.56) |
−1.08 (−1.17, −1) | 3,491 (2,803, 4,328) |
1.23 (0.98, 1.53) | −2.35 (−2.43, −2.27) | 646,702 (473,781, 889,226) |
231.21 (168.98, 318.29) |
−1.82 (−1.9, −1.75) | |||
| Sub-Saharan Africa | |||||||||||||||
| Central Sub-Saharan Africa | 2,931,246 (2,147,230, 3,898,314) |
3,315.96 (2,431.5, 4,406.01) |
−1.42 (−1.54, −1.31) | 706,426 (453,261, 1,059,333) |
780.52 (498.69, 1,171.13) |
−1.19 (−1.29, −1.08) | 857 (498, 1,442) | 1.02 (0.6, 1.72) | −3.04 (−3.22, −2.87) | 185,349 (124,194, 273,153) |
212.44 (142.68, 313.82) |
−2.23 (−2.35, −2.11) | |||
| Eastern Sub-Saharan Africa | 15,631,064 (11,763,850, 20,454,812) |
5,701.83 (4,292.71, 7,456.46) |
−1.29 (−1.37, −1.22) | 3,405,628 (2,190,568, 5,099,774) |
1,221.22 (781.97, 1,831.86) |
−1.01 (−1.08, −0.94) | 3,020 (2,043, 4,664) |
1.13 (0.77, 1.74) | −3.14 (−3.26, −3.01) | 868,840 (598,759, 1,264,757) |
318.37 (219.71, 462.77) |
−1.98 (−2.05, −1.91) | |||
| Southern Sub-Saharan Africa | 831,981 (582,548, 1,171,654) |
2,181.4 (1,527.83, 3,070.95) |
−2.09 (−2.34, −1.84) | 202,822 (122,201, 319,968) |
538.82 (325.28, 849.45) |
−1.97 (−2.23, −1.72) | 333 (260, 413) | 0.88 (0.68, 1.09) | −1.84 (−2.22, −1.46) | 59,307 (42,964, 83,022) |
155.97 (113.01, 218.19) |
−1.98 (−2.19, −1.77) | |||
| Western Sub-Saharan Africa | 13,908,364 (10,128,441, 19,197,850) |
4,287.67 (3,124.41, 5,911.99) |
−0.83 (−0.89, −0.78) | 3,279,242 (2,048,856, 5,063,844) |
975.22 (605.95, 1,507.33) |
−0.69 (−0.74, −0.64) | 2,215 (1,542, 3,030) |
0.72 (0.51, 0.99) | −2.44 (−2.55, −2.33) | 731,427 (489,109, 1,087,972) |
227.84 (153.01, 337.83) |
−1.37 (−1.4, −1.33) | |||
Data are presented as value (95% UI). ASR, Dataage-standardized rate; DALYs, disability-adjusted life-years; EAPC, estimated annual percentage change; SDI, socio-demographic index; UI, uncertainty interval.
The global ASPR of asthma in 2021 for both sexes combined was 3,936.34 (95% UI: 2,809.39 to 5,479.86) per 100,000 persons, 29.56% less than in 1990, with 4,139.72 (95% UI: 2,957.49 to 5,783.11) for males and 3,718.17 (95% UI: 2,660.82 to 5,167.35) for females. The ASIR for both sexes was 857.24 (95% UI: 513.22 to 1,360.72), 25.75% lower than in 1990, with 903.35 (95% UI: 537.74 to 1,437.95) for males and 807.69 (95% UI: 483.94 to 1,283.37) for females. The ASMR of both sexes was 0.48 (95% UI: 0.38 to 0.60), a 61.23% decrease, with 0.45 (95% UI: 0.36 to 0.55) for males and 0.51 (95% UI: 0.38 to 0.71) for females. The worldwide ASDR was 196.18 (95% UI: 128.16 to 300.72), down by 39.70% from 1990, with 202.23 (95% UI: 130.53 to 311.85) for males and 189.65 (95% UI: 123.89 to 288.17) for females [Table 1 and supplementary table 2 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)]. Compared to the entire population, children and adolescents had higher ASPR and ASIR but lower ASMR and ASDR.
In 2021, analysis by SDI level showed that middle SDI regions had the highest numbers of prevalence and incidence, whereas low SDI regions exhibited the highest mortality and DALYs. After age standardization, high SDI regions presented the highest ASPR, ASIR, and ASDR, while low-middle SDI quintile had the highest ASMR. Geographically, South Asia reported the highest prevalence, incidence, and DALYs number, while Southeast Asia had the top number of deaths. However, the ASPR, ASIR, and ASDR were highest in Caribbean and high-income North America. Meanwhile, Caribbean demonstrated significantly higher ASMR (Table 1 and Figure 1). At the national level, India ranked first in total prevalence, incidence, deaths, and DALYs [Figure 1 and supplementary table 1 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)], while Haiti had the highest ASPR, ASIR, ASMR, and ASDR [Figure 1 and supplementary table 2 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)].
Figure 1.
Global distribution of asthma disease burden in children and adolescents in 2021. (A) Age-standardized prevalence rate; (B) age-standardized incidence rate; (C) age-standardized mortality rate; (D) age-standardized DALYs rate. DALYs, disability-adjusted life-years.
Distinct age- and sex-specific patterns were observed in the asthma burden. Incidence, deaths, ASIR, ASMR, and ASDR peaked among children aged 0–5 years, whereas 5–9 prevalence, DALYs, and ASPR were highest in the 5–9 years group. Overall, males showed higher ASPR, ASIR, and ASDR before age 15 years. In contrast, females exhibited higher ASMR in most age groups except 5–9 years, where it was slightly lower than in males [supplementary figure 1 and table 3 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)]. This divergence was most evident in the 15–24-year group, where females bore a disproportionate burden of severe outcomes.
Temporal trend of asthma burden from 1990 to 2021
From 1990 to 2021, the overall asthma burden among childhood and adolescents showed a marked decline worldwide. The ASPR decreased with an EAPC of −1.00 (Figure 2A and Table 1), with a slightly faster decline in males (EAPC: −1.03) than females (EAPC: −0.96) [supplementary figure 2 and table 4 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)]. A transient increase occurred between 2005 and 2010. Among SDI level, High SDI regions showed a slight rise of ASPR (EAPC: 0.21), while low-middle SDI regions experienced the most significant declines (EAPC: −1.78). Among the 21 GBD regions, Central Europe (EAPC: 1.07), high-income North America (EAPC: 0.76), and Southern Latin America (EAPC: 0.31) showed slight increases. At the regional and national levels, most countries and territories exhibited declining or fluctuating trends, with Poland (EAPC: 2.13), Taiwan (province of China) (EAPC: 1.11), and Oman (EAPC: 0.92) showing the highest growth [supplementary table 4 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)].
Figure 2.
Temporal trends in asthma disease burden across childhood and adolescence, 1990–2021. (A) Age-standardized prevalence rate; (B) age-standardized incidence rate; (C) age-standardized mortality rate; (D) age-standardized DALYs rate. DALYs, disability-adjusted life-years; SDI, socio-demographic index.
Similarly, the ASIR showed downward trend with an EAPC of −0.77 (Figure 2B and Table 1), with parallel trends in both sexes. A temporary rise appeared between 2005 and 2010. High SDI regions had a minor increase (EAPC: 0.36), and upward trends were noted in Central Europe (EAPC: 1.00), high-income North America (EAPC: 0.69), and Southern Latin America (EAPC: 0.31). Most countries/regions showed stable or decreasing trends, while Poland (EAPC: 1.97), Italy (EAPC: 0.89), and Taiwan (province of China) (EAPC: 0.83) exhibited the highest growth [supplementary table 4 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)].
The ASMR declined substantially (EAPC: −3.01) (Figure 2C and Table 1), with decreases in both males (EAPC: −3.28) and females (EAPC: −2.73) [supplementary figure 2 and table 4 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)]. All SDI regions showed downward trends, most notably in high-middle SDI regions (EAPC: −5.34). The steepest regional declines occurred in high-income Asia Pacific (EAPC: −9.49) and East Asia (EAPC: −8.92). Only Zimbabwe (EAPC: 3.6), Lesotho (EAPC: 1.38), and Dominica (EAPC: 0.99) exhibited increasing ASMR [supplementary table 4 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)].
The ASDR similarly declined (EAPC: −1.54) (Figure 2D and Table 1), with both sexes following comparable patterns [supplementary figure 2 and table 4 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)]. All SDI and GBD regions showed decreasing or stable trend except Central Europe (EAPC: 0.93) and high-income North America (EAPC: 0.62), where ASDR slightly increased. At the regional and national level, Poland (EAPC: 2.01), Zimbabwe (EAPC: 0.94), and Taiwan (province of China) (EAPC: 0.90) showed the greatest growth [supplementary table 4 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)].
During the COVID-19 pandemic [2019–2021], ASPR rose modestly worldwide (EAPC: 0.56), mainly driven by low SDI regions (EAPC: 0.98) and Central Europe (EAPC: 3.17), with Myanmar showing the most significant growth (EAPC: 1.59). The global ASIR remained stable (EAPC: 0.34), with growth observed in low SDI regions (EAPC: 0.75) and Central Europe (EAPC: 3.11), and Poland (EAPC: 5.41) exhibiting the highest increase. Conversely, ASMR continued to decline (EAPC: −3.38), with decreases across all the SDI and GBD regions. The ASDR showed a slower decline (EAPC: −0.30), with only Central Europe (EAPC: 3.06) displaying an upward trend [supplementary table 5 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)].
In the analysis of asthma disease burden across different age groups, the 5–9 years group accounted for the largest number of prevalence cases with the highest ASPR, while the largest decline was observed in the <5 years, with an EAPC of −1.31 (95% CI: −1.46 to −1.17). Incidence cases among children under 5 years accounted for about half of the total childhood and adolescence cases over the past three decades. Although the ASIR for this group remained high, the decline was most pronounced with an EAPC of −0.96 (95% CI: −1.16 to −0.76), while other age groups maintained more gradual declines in ASIR. The proportion of deaths in the under-5-year group had consistently been the highest but decreased over time, while the proportion increased among those aged 20–24 years. ASMR showed a decreasing trend across all age groups, with the largest decline in the <5-year group (EAPC: −4.26, 95% CI: −4.34 to −4.18). The number of DALYs also decreased with age, and ASDR trended downward, with the sharpest decline in the <5-year group (EAPC: −2.42, 95% CI: −2.54 to −2.3) [Figure 3 and supplementary table 6 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)]. Notably, between 2019–2021, only the <5-year and 5–9-year groups experienced a significant upward trend in ASPR, while all other age groups showed stable or decreasing trends in ASR [supplementary table 6 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)].
Figure 3.
Number and age-standardized rate of asthma burden in children and adolescents by age groups from 1990 to 2021. Number (A) and age-standardized rate (B) of prevalence; number (C) and age-standardized rate (D) of incidence; number (E) and age-standardized rate (F) of mortality; number (G) and age-standardized rate (H) of DALYs. DALYs, disability-adjusted life-years.
Asthma disease burden attributable to risk factors
To better understand the contribution of risk factors to asthma burden among children and adolescents, we examined deaths and DALYs attributable to risk factors including high BMI, occupational asthmagens, and air pollution. Since no death data were available for air pollution, analyses of asthma-related deaths focused on high BMI and occupational asthmagens.
In 2021, high BMI was the leading risk factor, accounting for 7.83% of global asthma deaths (7.52% in males; 8.11% in females), followed by occupational asthmagens at 4.83% (5.95% in males; 3.81% in females). The highest proportions of deaths due to high BMI were observed in high SDI regions (17.41%) and high-income North America (18.94%), with the Cook Islands (28.70%) showing the highest national burden. Deaths from occupational asthmagens were most frequent in high SDI regions (5.88%) and East Asia (9.29%), with Cambodia (10.25%) led at the national level. The 20–24-year group contributed the largest share of deaths from both high BMI (10.34%), and occupational asthmagens (12.64%). Deaths from occupational asthmagens were generally higher in males, whereas the BMI-related burden was greater in females in Southern Sub-Saharan Africa (14.32% vs. 9.65%) [supplementary figure 3 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)].
Compared to 1990, the proportion of asthma deaths attributable to high BMI more than doubled globally by 2021, with the steepest increase in Tropical Latin America (2.7-fold). Deaths due to occupational asthmagens rose markedly in Andean Latin America (3.86-fold) but declined in Western and Eastern Europe [Figure 4A and supplementary table 7 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)].
Figure 4.
Percentage of deaths (A) and DALYs (B) attributable to risk factors in 2021 and 1990. DALYs, disability-adjusted life-years; SDI, socio-demographic index.
Regarding DALYs, high BMI remained the dominant contributor, contributing 10.00% of total asthma DALYs (9.86% in males; 10.16% in females). The burden was greatest in high SDI regions (15.41%) and Australasia (17.08%), with the Cook Islands (25.33%) having the highest national proportion. Occupational asthmagens accounted for 2.59% of DALYs (2.83% in males; 2.31% in females), highest in high SDI regions (3.05%), Australasia (4.13%), and Iceland (6.45%). Air pollution accounted for 3.49% of DALYs (3.67% in males; 3.28% in females), peaking in high-middle SDI regions (6.30%), high-income Asia Pacific (8.79%), and Lebanon (21.66%). The 20–24-year group bore the highest DALYs from high BMI (14.21%) and occupational asthmagens (12.62%), while the 5–9 years group had the greatest DALYs proportion from air pollution (3.59%). BMI-related DALYs were generally higher in females, whereas occupational and pollution-related burdens predominated in males [supplementary figure 4 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)].
From 1990 to 2021, DALYs attributable to high BMI increased in nearly all regions, particularly in East Asia (2.44-fold). The burden from occupational asthmagens either increased or decreased regionally, with the highest rise in Andean Latin America (1.42-fold), and the largest decrease in Central Europe (reduced by half). DALYs attributable to air pollution increased in most regions, most notably in Oceania (3.02-fold), while decreasing in North America and Europe [Figure 4B, supplementary table 7 and supplementary table 8 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf)].
Prediction of asthma burden by 2040
From 2022 to 2040, the global burden of asthma among children and adolescents is projected to show moderate but distinct changes across indicators. Overall patterns of ASR and absolute numbers are depicted in Figure 5 and supplementary figures 5-7 (available at https://cdn.amegroups.cn/static/public/jtd-2025-aw-2397-1.pdf). The global ASPR is expected to remain relatively stable, decreasing slightly from approximately 3,940 per 100,000 persons in 2021 to 3,850 per 100,000 by 2040. Despite this, the number of prevalent cases will continue to rise, from 126.18 million to approximately 129.19 million, driven mainly by population growth, with a faster increase in females. The ASIR is projected to decrease modestly for 860 to 720 per 100,000 persons, and new cases are expected to fall from 26.18 million to 23.09 million globally. Deaths and DALYs are forecast to fall substantially. The ASMR will likely decrease by over 60%, from 0.48 to 0.19 per 100,000 persons, with both sexes showing similar declines. Correspondingly, total deaths are projected to drop from about 15,000 in 2021 to around 6,600 in 2040. The ASDR is expected to fall by more than 30%, from 196 to 131 per 100,000 persons, and total number of DALYs from 6.3 million to around 4.5 million until 2040. Consistent decreases are projected for both males and females.
Figure 5.
Future forecasts of global burden of asthma in children and adolescents. (A) Age-standardized prevalence rate; (B) age-standardized incidence rate; (C) age-standardized mortality rate; (D) age-standardized DALYs rate. DALYs, disability-adjusted life-years.
Discussion
This study represents a comprehensive analysis of the global, regional, and national burden of asthma among children and adolescents using data from the GBD 2021 study. Our findings provide several key insights into the trends and disparities in asthma burden across different regions, sexes, and age groups, offering evidence to guide targeted prevention and management strategies.
In 2021, asthma affected over 100 million children and adolescents globally, accounting for nearly half of all prevalence and 70% of new cases, underscoring its substantial public health impact in this age group. After adjusting for ASR, prevalence, incidence, and DALYs were particularly high in high SDI regions, as well as Caribbean and high-income North America, whereas mortality remained disproportionately concentrated in low SDI regions and Caribbean, with Haiti reporting particularly high levels across multiple burden indicators.
Between 1990 to 2021, the global burden of asthma in children and adolescents declined across all major indicators, though the reduction varied by sex and region, consistent with previous GBD studies (12-16). During the study period, the total number and ASR of prevalence, incidence, deaths, and DALYs all decreased, with the most substantial decline observed in deaths, which exceeded 50%. This is likely due to improved early diagnosis and the widespread adoption of inhaled corticosteroids (ICSs), which improve asthma control, pulmonary function, and reduce exacerbations (28). Across all indicators, the decline was more pronounced in males, potentially due to gender-specific environmental exposure change, biases in medical resource allocation favoring males, and the higher prevalence of severe asthma in females (29). High SDI regions maintained elevated ASPR, ASIR, and ASDR but low ASMR over the past three decades. Notably, both ASPR and ASIR showed a slight upward trend in high SDI regions, as well as in Central Europe, high-income North America, and Southern Latin America, with the most significant increase in Poland (30). This is likely driven by better economic conditions and healthcare systems, including comprehensive child and adolescent wellness checkups and respiratory screening (31). However, it is also closely linked to rising industrialization, urbanization, and increased exposure to environmental risk factors such as cockroaches, rodents, and indoor air pollution (32,33). In addition, a recent study has confirmed that extreme weather events have increasingly heightened the risk of asthma in children and females (34). In contrast, low SDI areas continue to experience high mortality, nearly twice the global average. Although ASMR declined overall, several countries, including Zimbabwe, Lesotho, and Dominica, showed unfavorable trends. Persistent high mortality in these setting likely reflects limited access to timely diagnosis, essential medications, and specialist care, compounded by under-resourced health systems (10). In Sub-Saharan Africa and Southeast Asia, resource-limited healthcare systems hinder timely diagnosis and effective management, contributing to persistently high mortality rates. ASDR increased in only two geographical regions, Central Europe and high-income North America, and only a few nations, including Poland and Zimbabwe. In regions with advanced healthcare systems such as Central Europe and high-income North America, higher diagnostic intensity may partly explain the rising number of identified cases, but it also points to gaps in long-term disease control and treatment adherence. In contrast, in resource-limited countries such as Zimbabwe, elevated DALYs likely reflect restricted access to care and suboptimal asthma management.
During the COVID-19 pandemic, the global asthma burden in children and adolescents generally followed previous trends, with continued declines in deaths and modest changes in prevalence, although increases were observed in Central Europe. Early in the pandemic, the relationship between COVID-19 and asthma was controversial, with some researchers suggesting asthma could be a risk factor for COVID-19 exacerbation (35). However, a systematic review found that asthma accounted for 8.08% of COVID-19 cases, with a lower infection risk compared to non-asthmatics (36). Other studies suggested that childhood and adolescent asthma may not significantly increase COVID-19 risk, potentially due to fewer comorbidities, lack of smoking, and enhanced immunity from vaccinations (37). Recent research has also found no link between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction positivity and new asthma diagnosis in children (38). The relative stabilization or decline in asthma burden during this period may also be partly explained by non-pharmaceutical interventions, including lockdowns and mask-wearing, which reduced allergen exposure, limited respiratory virus transmission, and decreased respiratory infections through social isolation (39). Although COVID-19 did not significantly affect the disease burden of asthma in children and adolescents, our findings highlight the need for resilient asthma care systems capable of maintaining diagnosis, treatment, and follow-up during large-scale disruptions. Developing emergency preparedness strategies for pediatric asthma may help prevent avoidable disease burden during future pandemics or similar global crises.
Among the age groups included in this study, children under 5 years of age represent a population of particular concern, as a high asthma disease burden over the past 32 years. This is partly due to their susceptibility to allergies, with early childhood wheezing often triggered by viral respiratory infections. Many of these children experience allergic sensitization and lower lung function, which predisposes them to asthma (40,41). Furthermore, severe asthma remains a leading cause of death in children, with those affected facing greater risks of medication-related side effects and recurrent, life-threatening exacerbations that significantly impact quality of life (42). Fortunately, recent years have seen a significant decline in both ASMR and ASDR among children under 5, which has been attributed to increased awareness, improved diagnostic and management systems, along with the use of newer and safer medications, resulting in fewer cases of severe asthma and improved prognosis (43-45).
Sex differences are a key feature of asthma epidemiology in childhood and adolescence. In our study, males showed higher ASPR, ASIR, and ASDR before age 15 years, indicating a greater non-fatal disease burden in childhood, whereas females had higher ASMR across most age groups and a disproportionate burden of severe outcomes in late adolescence. Over the past three decades, ASPR, ASIR, and ASDR remained higher in males, while ASMR was consistently higher in females for most of the period. These findings reflect a distinct “gender switch” in asthma burden during the transition to young adulthood (29,46). This pattern likely arises from a complex interplay of biological, genetic, epigenetic, social, and environmental factors, together with sex-specific responses to asthma therapies (47). Although boys carry a higher burden in early childhood, pubertal hormonal changes, particularly rising estrogen levels, contribute to a shift toward greater severity in females after adolescence (48). Estrogens enhance Th2-driven airway inflammation and airway reactivity, which may partly explain the higher ASMR observed among females after age 15 years in our study (49). In contrast, testosterone appears to exert protective, anti-inflammatory effects, contributing to the relative decline in burden among maturing males. Beyond biological mechanisms, sex-related differences may also influence therapeutic responsiveness. Adolescent girls may show reduced responsiveness to corticosteroids and other controller medications, increasing the risk of poor disease control and severe outcomes (50). Together, these findings support the need for gender-sensitive management strategies tailored to children and adolescents rather than relying on uniform management paradigms (51).
Although the global disease burden of asthma in children and adolescents continues to decline, the contribution of several risk factors has increased over time. In 2021, high BMI accounted for 7.83% of global asthma deaths and 10.00% of DALYs, remaining the primary risk factor with a notable increase over the past 32 years (52). This finding highlights a shift in pediatric asthma risk profiles toward metabolic determinants. Previous cohort evidence supports this pattern, showing that children genetically predisposed to higher BMI are at increased risk for severe wheezing (53). Occupational asthmagens contribute 4.83% of asthma deaths and 2.59% of DALYs, with males bearing a higher burden. Although most children and adolescents are not directly exposed to occupational hazards, indirect exposure through household environments or early employment may partly explain this association. Air pollution accounts for 3.49% of DALYs, with the highest burden observed in 5–9 age groups. Exposure to air pollution such as PM2.5, O3, NO2, and SO2 has been linked to the exacerbation of asthma (54). Gender and regional disparities are evident, with females bearing a relatively higher BMI-related burden in certain regions, while males are more affected by occupational exposures and air pollution. The increasing prevalence of obesity and environmental pollution underscores the importance of targeted interventions. Integrating weight management, such as promoting physical activity and providing nutritional education, into pediatric asthma care, strengthening environmental protection, and tailoring interventions to regional and sex-specific risk profiles may help mitigate future asthma burden among children and adolescents.
The predicted trends suggest that while the overall prevalence and incidence for asthma in children and adolescents may remain relatively stable. The most notable decline is in deaths, with a dramatic decrease in both ASMR and total number of deaths, which indicates that advancements in treatment and prevention are likely to be successful in reducing asthma-related fatalities. The consistent decline in DALYs further supports this, reflecting a reduction in the overall burden of the disease. However, the higher rate of increase in prevalence among females suggests a growing gender disparity in asthma’s impact, which could imply underlying risk factors or differences in healthcare access or management. This warrants further attention, as it may indicate the need for gender-specific approaches in asthma care and intervention strategies.
Future asthma management in children and adolescents should focus on early diagnosis, gender-specific approaches, and addressing regional disparities. Accurate diagnosis and management are essential for improving outcomes (2). Early screening and interventions are particularly critical in regions with rising prevalence and incidence. Targeted efforts at national, local, and individual levels to reduce childhood obesity, minimize exposure to indoor and outdoor air pollution, and improve asthma care in low SDI regions are crucial (55,56). Gender differences in asthma prevalence and severity should inform treatment plans. Additionally, asthma management should enhance healthcare accessibility and promote public health strategies that reduce asthma risk factors.
There are several limitations in this study. First, diagnostic standards and health management levels for asthma vary across countries and regions. In some low-income countries, asthma diagnosis may rely on symptoms or clinical experience rather than standardized procedures, potentially leading to underreporting or misdiagnosis. Second, although the GBD 2021 study provides data for different age groups, it lacks granularity for specific subgroups, particularly children under 5 years old, which may result in underrepresentation in this vulnerable group. Third, regions with lower SDI or limited healthcare infrastructure may have less reliable disease registration systems, contributing to systematic underreporting. Finally, the GBD methodology involves various assumptions and modeling techniques, introducing some uncertainty in the estimates. While statistical methods help address these uncertainties, the results should be interpreted as the best available estimates based on current evidence.
Conclusions
In conclusion, although the asthma burden among children and adolescents has declined since 1990, regional, gender, and age disparities still persist. High SDI regions report higher prevalence, incidence and DALYs, while low SDI regions bear disproportionate mortality. Males have higher prevalence, whereas females experience higher mortality, and younger children remain particularly vulnerable. Importantly, high BMI has become an increasingly influential risk factor. Addressing these inequities requires age- and sex-sensitive prevention strategies, strengthened care in resource-limited settings, and integrated management of metabolic and environmental risk.
Supplementary
The article’s supplementary files as
Acknowledgments
We would like to thank the Institute for Health Metrics and Evaluation (University of Washington), the GBD Collaborators, and all staff for providing the data necessary for this study.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments.
Footnotes
Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-aw-2397/rc
Funding: This study was supported by the “Xinglin Scholar” Research Fund of Chengdu University of Traditional Chinese Medicine (No. XKTD2021004), and the Youth Fund of Natural Science Foundation of Sichuan Province (No. 2025ZNSFSC1844).
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-aw-2397/coif). The authors have no conflicts of interest to declare.
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