The burden of Chronic Respiratory Diseases and attributable risk factors in Pakistan- A systematic analysis of global burden of disease study (GBD) 2019

<bold>Objective:</bold>To identify burden of CRDs in Pakistan with analysis of trends from 1990-2019 using Global Burden of Diseases(GBD)2019 data. <bold>Methods:</bold>Estimationof prevalence, morbidity, mortality attributable to CRDs was conducted through an analysis of deaths, disability-adjusted life-years(DALYs),& years of life lost(YLL). <bold>Results:</bold> In 2019,6,085,677 indiviudals(95%UI 5,506,999 -6,726,139) in Pakistan had a CRD,with an approximate increase of 40% in absolute numbers compared with 1990. Age-sex-specific prevalence of CRDs in 2019 varied geographically.CRDs prevalence per 100,000 was highest in Sindh region with 4,704 prevalent cases per 100,000 population.CRDs were the seventh leading cause of death in 2019(5.53% [95% UI 4.8–6.58] of all deaths) & deaths due to CRDs numbered 82,757(95% UI 67,880–102,124),an increase of 27.3% since 1990,while total DALYs increased by 46.95%. However, when accounting for ageing & population growth, declines were observed in age-standardized prevalence(9.8% decline),age-standardized death rates(23.15%),& age-standardized DALY rates(21.74%). In regional analyses, mortality rates from CRDs were greatest in South Asia globally, highest in Nepal and lowest in Pakistan. Smoking &household air pollution were the predominant risk factors for CRDs among men and women respectively, most CRD-attributable deaths and DALYs were due to COPD. <bold>Conclusion:</bold>To the best of our knowlege, this is first CRD burden estimation from Pakistan. When compared to 1990,a rise in the absolute numbers of deaths, prevalence, DALY was seen however sharp declines in age-standardized measures were observed. Gender specific differences were also significant.