Global, regional, and national burden of high BMI–attributable asthma: a systematic analysis and prediction for children aged 0–14 years

BACKGROUND: Pediatric asthma remains a major contributor to childhood disability and premature mortality. The population-level burden of asthma estimated as attributable to high body mass index (BMI) within the Global Burden of Disease (GBD) framework remains incompletely characterized. METHODS: Using modeled GBD 2021 estimates, we conducted a descriptive analysis of high BMI-attributable asthma among children aged 0-14 years from 1990 to 2021. Outcomes included deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR). Temporal trends were assessed using estimated annual percentage change (EAPC), Joinpoint regression, and autoregressive integrated moving average (ARIMA) forecasts to 2050. RESULTS: Globally, ASDR increased from 14.43 to 17.09 per 100,000 (EAPC 0.67), while ASMR declined from 0.036 to 0.021 per 100,000 (EAPC -1.66). Mortality was concentrated among children younger than five years, while disability increased mainly in the 5-9 and 10-14 age groups after 2009. The fastest ASMR declines occurred in High-income Asia Pacific and East Asia, whereas ASDR increased in high and high-middle Socio-demographic Index (SDI) settings. ARIMA models projected continued decline in ASMR to 0.004 and increased ASDR to 21 per 100,000 by 2050. CONCLUSIONS: From 1990 to 2021, modeled population-level estimates showed declining mortality but increasing disability burden for high BMI-attributable pediatric asthma, with marked regional and SDI disparities. ARIMA forecasts suggested that mortality may continue to decline, whereas disability burden may further increase through 2050.