3 research outputs found
Dynamic mechanical analysis of waste tyre rubber filled brake friction composite materials
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Global burden of lower respiratory infections and aetiologies, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023
No full textBackground: Lower respiratory infections (LRIs) remain the world’s leading infectious cause of death. This analysis
from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and
national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to
26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With
new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through
these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and
Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years.
Methods: Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using
the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally
invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity
due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for
all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age
group and location using splined binomial regression to create internally consistent estimates of incidence and
mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed
towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly
equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years.
Findings: In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24–2·81) deaths and
98·7 million (87·7–112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the
highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4–47·4) since 2010, with a global
mortality rate of 94·8 (75·6–116·4) per 100000 person-years in 2023. Among adults aged 70 years and older, the burden
remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100000 for
children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, subSaharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5
mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number
of LRI deaths globally (634000 [95% UI 565000–721000] deaths or 25·3% [24·5–26·1] of all LRI deaths), followed by
Staphylococcus aureus (271000 [243000–298000] deaths or 10·9% [10·3–11·3]), and Klebsiella pneumoniae (228000
[204000–261000] deaths or 9·1% [8·8–9·5]). Among pathogens newly modelled in this study, non-tuberculous
mycobacteria (responsible for 177000 [95% UI 155000–201000] deaths) and Aspergillus spp (responsible for 67800
[59900–75900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for
approximately 22% of LRI deaths.
Interpretation: This comprehensive analysis underscores both the gains achieved through vaccination and the
challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities
in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as
well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target.
Progress towards this target requires equitable access to vaccines and preventive therapies—including newer
interventions such as respiratory syncytial virus monoclonal antibodies—and health systems capable of early
diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation
programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge
of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future
pneumonia control strategies
