Subnational Evidence for the Attributable Burden of\nRespiratory Infections in China’s Population under 20: Challenges\nfrom Particulate Matter Pollution

Respiratory\ninfections and tuberculosis ranked as the second leading\nglobal causes of mortality in 2021. Following the methodology from\nthe Global Burden of Disease Study (GBD) 2021, we aimed to estimate\nthe attributable burden and risk factors of respiratory infections\nand tuberculosis among China’s population under 20 from 1990\nto 2021. In 2021, there were 652 million new cases and 12 699\ndeaths of respiratory infections and tuberculosis among people under\n20 years old in China. We estimated 9054 (71.2%) deaths and 818 498\n(54.6%) disability-adjusted life years (DALYs) from respiratory infections\nattributed to all evaluated risk factors. Mortality rates were the\nhighest in Xizang, Xinjiang, and Qinghai in 2021, while they constantly\ndecreased since 1990. Ambient particulate matter pollution was the\nsecond leading cause of death among males and first among females,\naccounting for nearly 1/5 of deaths from respiratory infections and\ntuberculosis in 2021. In 23 of 33 provinces, ambient particulate matter\npollution was the first leading cause of death and DALY, while in\nXizang\nand Gansu, it was not the major contributor to the burden. From 1990\nto 2021, the burden from household air pollution declined remarkably\nin all 33 provinces except for Xizang and Gansu, while the population\nattributable fraction (PAF) of ambient particulate matter pollution\ncontinuously increased. The overall burden of respiratory infections\nand tuberculosis showed a declining trend, while it remained a fatal\nthreat to infants in relatively less developed regions. The raised\nhazard of ambient particulate matter pollution underscored the necessity\nof the shift into the formulation of prevention and intervention strategies.