Disease Burden, Temporal Trends, and Key Influencing Factors of Lower Respiratory Infections in Asia, 1990–2023: Based on GBD 2023

ABSTRACT Based on Global Burden of Disease (GBD) 2023, this study systematically assesses the burden, temporal trends, population distribution, key risk factors, and etiological characteristics of lower respiratory infections (LRIs) in an Asia‐focused sample of 49 countries and territories drawn from six GBD regions from 1990 to 2023, employing age‐standardized rates, joinpoint regression, stratified analysis, inequality measures, and GIS visualization. In 2023, marked regional heterogeneity was observed: South Asia had the highest incidence (5317.98/100,000) and prevalence (111.82/100,000), Central Asia had the highest DALY rate (1988.41/100,000), Southeast Asia had the highest mortality (42.02/100,000), and East Asia and High‐income Asia‐Pacific generally had lower rates. Burden distribution was pro‐poor (Concentration Index: −0.064 to −0.196). Gini decomposition showed that transvariation accounted for more than 70% of overall inequality, showing substantial overlap between high‐ and low‐burden locations across regions. From 1990 to 2023, the overall LRI burden declined, with the largest reductions in East Asia; however, most regional estimates showed a rebound beginning in 2020 or 2021. This temporal pattern coincided with pandemic‐related changes in respiratory pathogen exposure, routine immunization, and health‐service use, but the ecological analysis cannot establish causality. Central Asia displayed a U‐shaped age pattern, with high burden in infants and older adults, whereas the other regional aggregates generally displayed J‐shaped patterns with steep increases at older ages. The burden was generally higher in males, particularly after age 30, although female excesses were observed in Afghanistan and among some groups aged 10–29 years. Air pollution, child and maternal malnutrition, and tobacco exposure were leading GBD‐attributable risks, with substantial regional variation; population attributable fractions were not summed because of overlapping causal pathways. Bacterial pathogens predominated. Streptococcus pneumoniae was the leading pathogen in most regions, while Legionella was the only pathogen with a significant upward trend in all six regional aggregates. These findings support country‐specific, life‐course, and risk‐tailored prevention strategies, whereas causal interpretations and policy effects require dedicated analytical studies.