Global, regional, and national burdens of acute respiratory infections among children and adolescents from 1990 to 2021: A systematic analysis

Objective: To evaluate the global, regional, and national burden and determinants of Acute Respiratory Infections (ARIs) among children and adolescents from 1990 to 2021. Methods: We analysed ARI mortality and disability-adjusted life years (DALYs), stratified by age, sex, and economic development level based on data retrieved from the Global Burden of Disease study 2021. Decomposition and frontier analyses were employed to identify key drivers of burden variation and visualize potential reductions based on development levels. Results: Between 1990 and 2021, the global burden of ARIs showed a significant decline in both achievable age-standardized DALYs rate and age-standardized mortality rates (EAPC= –3.87 and –3.81, respectively). Different age groups and sex witnessed different levels of ARI burden, males experienced heavier burden than females and the 0-4 years-old group experienced heavier burden than other study age groups. Most of the 204 countries and territories experienced a downward trend of ARI burden, with slight increases observed only in Lesotho and Dominica. A negative correlation was found between the Socio-demographic Index and ARI burden. Decomposition analysis indicated that the significant decreases in deaths and DALYs were primarily driven by epidemiological changes. Conclusions: The global burden of ARIs among children and adolescents has declined over the past three decades, but substantial regional disparities persist. Targeted public health strategies are needed to address the continued ARI burden in high-risk regions and vulnerable age groups.