Obesity as the predominant contributor to asthma burden: insights from GBD and NHANES analyses

Although age-standardized incidence and mortality rates declined, asthma remained prevalent in 2021 with an estimated 37 million new cases and 21.4 million DALYs, disproportionately affecting children (0-14 years) and older adults (55-74 years). Decomposition analysis attributed most DALY increases to demographic changes, particularly population growth and aging. Frontier analysis showed that while high-SDI regions achieved notable reductions in burden, rising obesity rates expanded the at-risk population even in these areas. High BMI emerged as the leading global risk factor for asthma-related DALYs-ranking first in high-SDI regions and, since the late 2010s, in low-SDI regions as well. NHANES analyses confirmed that individuals with asthma exhibited significantly higher BMI (Non- Asthma: 29.4 ± 7.32, Asthma: 31.2 ± 8.48, P < 0.001) Adjusted regression demonstrated that obesity independently predicted asthma onset and progression across all age groups (BMI Adjusted Odds Ratio (aOR): 1.41; 95% confidence interval (CI): 1.17-1.68.) CONCLUSION: Despite declines in standardized rates, asthma continues to impose a heavy global burden, concentrated in vulnerable age groups, especially among the young and elderly. Obesity has emerged as the foremost modifiable risk factor worldwide. Tailored public health strategies focusing on weight management are urgently needed to curb asthma incidence and severity.