Global burden of disease 2021: particulate matter pollution–attributable burden of upper respiratory infections, otitis media, and lower respiratory infections

The global burden of lower respiratory infections (LRIs), upper respiratory infections (URIs), and otitis media attributable to air pollution has exhibited notable temporal patterns. Our study analyzed the patterns in disability-adjusted life years (DALYs) and age-standardized DALY rates (ASDRs) attributable to particulate matter pollution (PMP) for LRIs, and for URIs and otitis media (infants <1 year), using Global Burden of Disease (GBD) 1990–2021 estimates. We applied frontier analysis to estimate improvement potential by development status, assessed cross-country inequality, and used decomposition analysis to evaluate the contributions of population growth, aging, and epidemiological changes. Furthermore, an autoregressive integrated moving average (ARIMA) model was employed to forecast trends through 2031. Our findings revealed that the PMP -attributable burden of LRIs, infant URIs and infant otitis media, decreased globally from 1990 to 2021, with notable reductions in East Asia (LRIs, URIs), and Central Europe (otitis media). Despite progress, burdens remains highest in low-socio-demographic index (SDI) regions, indicating substantial potential for further reduction. Decomposition attributed most global declines to epidemiological change, whereas population growth increased burden in low-SDI regions. Projections suggest continued declines for PMP -attributable burden of LRIs and infant URIs but a slight rise for infant otitis media by 2031. These findings highlight the need for further targeted preventive interventions, especially in high-burden regions.