Changing patterns and regional inequalities of asthma burden and attributable risks in China, 1990-2023

BACKGROUND: The national and subnational burden of asthma in China remains insufficiently characterized. We aimed to assess the long-term trends in asthma burden and associated risk factors across China from 1990 to 2023. METHODS: Using data from the Global Burden of Disease 2023 study, we assessed asthma deaths, prevalence, and disability-adjusted life years (DALYs) in China and its provincial-level administrative regions from 1990 to 2023, stratified by age and sex. Decomposition analyses were conducted to quantify the contributions of demographic changes and level 2 risk factors to changes in the asthma burden estimates. RESULTS: Between 1990 and 2023, the age-standardized asthma death rate (95% uncertainty interval [UI]) in China declined from 2.4 (1.1-4.0) to 1.1 (0.7-2.0) per 100,000, while the age-standardized prevalence rate (95% UI) increased from 2902.7 (2392.7-3550.4) to 3066.8 (2529.4-3675.7) per 100,000. Age-standardized DALY rates decreased overall, with years lived with disability (YLDs) accounting for an increasing proportion of total DALYs. Substantial provincial heterogeneity was also observed. Tobacco use remained the leading contributor to the asthma burden, particularly among males, whereas the contribution of high body mass index (BMI) increased steadily. Population aging was the main driver of changes in asthma mortality, while increasing exposure to high BMI drove increases in DALYs. CONCLUSIONS: Asthma mortality in China has declined substantially, but the nonfatal burden continues to rise, driven by increasing prevalence and metabolic risk factors. Integrated strategies targeting both respiratory risk factors and metabolic risks are required to reduce asthma-related disabilities, especially in high-burden regions.