Chronic respiratory disease is third leading cause of death globally with air pollution killing 1.3 million people

Published April 25, 2023

doctor examines an x-ray of lungs
  • The highest number of deaths from chronic respiratory diseases (CRDs) resulted from smoking, air pollution, and occupational risks (e.g., breathing in chemicals or dust).
  • 1 in 20 people globally suffered from CRD.
  • East Asia and South Asia had the highest rates of CRD mortality.
  • Low-middle and low Socio-demographic Index (SDI) countries had the highest age-standardized rates of CRD deaths.
  • This is the first Global Burden of Disease paper highlighting high body mass index (BMI) as a leading risk factor for asthma mortality, especially for women.
  • From 1990 to 2019, the total deaths and prevalence of CRDs increased by 28.5% and 39.8%; however, age-standardized rates dropped by 41.7% and 16.9%, respectively, showing overall improvement.

SEATTLE, Wash. April 25, 2023 – New findings on chronic respiratory disease (CRD) now show it is the third leading cause of death globally, accounting for approximately 4 million deaths worldwide in 2019. This is according to new research published in The Lancet’s journal eClinicalMedicine.

Nearly 80% of CRD deaths were caused by chronic obstructive pulmonary disease (COPD). Significant progress has been made globally in lowering age-standardized rates of deaths, disability-adjusted life years (DALYs), prevalence, and incidence of COPD, asthma, and pneumoconiosis in both sexes combined. Nonetheless, this trend varied according to geographical location and gender. Since 1990, the age-standardized mortality rate has steadily decreased by approximately 41.7%. East Asia experienced the greatest decline in age-standardized mortality rates due to CRDs in 2019 compared to 1990, with a 70% decrease.

During 1990-2019, men had higher mortality rates due to CRDs, with nearly 70% higher age-standardized death rates globally in 2019 compared to women. More specifically, the gender disparity in mortality rates was evident in COPD and pneumoconiosis. Furthermore, the age-standardized mortality rates from CRDs attributed to occupational risks were more than three times higher in men than in women in 2019, which is explained by women's lower employment rate in professions involving the relevant exposures.

In 2019, East Asia and South Asia had the highest rates of CRD mortality. However, when age-standardized rates were considered, Oceania's mortality rates exceeded those of South Asia and East Asia. Despite having moderate age-standardized prevalence rates, the low-middle and low SDI quintiles had the highest age-standardized rates of CRD deaths. The high SDI quintile, on the other hand, had the highest age-standarzied rate of prevalence but the lowest deaths in 2019. These findings highlight the variation in management and quality of care across countries with varying income levels.

According to the study, nearly 460 million people, or slightly more than one in every 20 people, suffered from CRDs in 2019. Asthma was diagnosed in approximately 60% of these people (approximately 262 million), making it the most common CRD. Since 1990, the number of new cases of CRDs has increased by 49.0%, owing primarily to population growth. The age-standardized incidence rate, on the other hand, has decreased by 5.3%.

Modifiable risk factors were responsible for roughly 70% of CRD deaths. Tobacco use was the leading risk factor for nearly 1.8 million CRD deaths worldwide in 2019. However, when age distribution is considered, the rate of CRD deaths due to tobacco smoking has decreased by 45.7% over the last three decades. This demonstrates that targeted tobacco control strategies have significantly impacted global smoking reduction. Nonetheless, many countries have not fully implemented tobacco control policies, indicating a significant potential for further reduction of the global burden of CRDs caused by smoking.

Air pollution was the second leading risk factor for CRD deaths worldwide in 2019, accounting for slightly more than 1.3 million deaths. South Asia accounted for 48% of these fatalities. After controlling for population size and age distribution, the rate of CRD deaths due to air pollution in South Asia was more than triple the global rate. However, when age distribution is taken into account, the death rate attributable to air pollution has decreased by 57.4% globally since 1990.

This is the first Global Burden of Disease (GBD) report to highlight the role of increased body mass index (BMI) as the leading risk factor for asthma mortality, with a greater role in women. This finding emphasizes the importance of global attention to lifestyle modification interventions that may reduce morbidity in patients with asthma and obesity.

Unlike other regions where tobacco was the primary risk factor, household air pollution from solid fuels was the primary risk factor for age-standardized CRD death rates in sub-Saharan Africa, disproportionately affecting women. Globally, the attributed burden of CRDs due to household air pollution has decreased the most (79.4%) compared to other risk factors from 1990 to 2019. However, it continues to be a significant burden in sub-Saharan Africa. This finding emphasizes geographic disparities in the risk factors responsible for CRD deaths and the need for additional efforts to provide modern energy sources for people in these regions. This not only has the potential to reduce CRD mortality significantly, but it also has the potential to improve gender equality, access to affordable and clean energy, climate change, and protecting terrestrial ecosystems.

More than 800 researchers from over 60 countries collaborated with the Institute for Health Metrics and Evaluation (IHME) at the University of Washington to estimate the burden of chronic respiratory diseases (CRDs) and their risk factors attributable burden at global, regional, and national levels from 1990 to 2019. The research was funded by the Bill and Melinda Gates Foundation.

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About the Institute for Health Metrics and Evaluation

The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. IHME is committed to transparency and makes this information widely available so that policymakers have the evidence they need to make informed decisions on allocating resources to improve population health.

About the Global Burden of Disease study

The Global Burden of Disease (GBD) study is the largest and most comprehensive effort to quantify health loss across places and over time. It draws on the work of more than 8,000 collaborators from 157 countries and territories. IHME coordinates the study. The GBD 2019 study was published in October 2020 and includes more than 38 billion estimates of 369 diseases and injuries and 87 risk factors in 204 countries and territories from 1990 to 2019.


Scientific Publication

Global, regional, and national incidence and mortality burden of non-COVID lower respiratory infections and aetiologies, 1990-2021