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Burden of lower respiratory infections attributable to PM2.5 and the impact of COVID-19 in China and the G20: 1990–2023
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DOI：10.1007/s00484-026-03283-5.png)
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Abstract
En 中文
Lower respiratory infections (LRIs) remain a leading cause of mortality worldwide. The study used Global Burden of Disease 2023 data to quantify deaths and disability-adjusted life years (DALYs) from LRIs attributable to ambient and household PM2.5 in China and the G20. Joinpoint regression was applied to assess annual percentage change (APC) and average annual percentage change (AAPC) in age-standardized DALY rate (ASDR), with subgroup analyses by sex. Forest plots visualized AAPC, and loess smoothing was used to examine the association between the Social Development Index (SDI) and LRI burden. From 1990 to 2023, ASDR of LRIs attributable to ambient PM2.5 generally declined in China and the G20, but reversed upward during 2021–2023 (APC: China 12.76–14.23%; G20 14.94–16.04%). Household PM2.5-related ASDR continued to decline in China but increased in the G20 since 2021 (APC 8.49–11.20%). In 2023, the LRI burden attributable to ambient and household PM2.5 was concentrated among children under 5 and older adults (≥ 70 years). During COVID-19, PM2.5-attributable LRIs affected China’s elderly and children under 5 in the G20. Notably, the mortality rate among Chinese children under 5 was very low. Higher SDI was associated with lower LRI burdens from both ambient and household PM2.5 across the G20. LRIs attributable to ambient and household PM2.5 have generally declined, but recent increases highlight emerging risks, with children under 5 and the elderly remaining most vulnerable. Higher SDI is associated with lower burdens, emphasizing the need for targeted PM2.5 mitigation, particularly for high-risk populations and low-SDI regions.
Keywords:
PM2.5
LRIs
DALY
Ambient PM2.5
Household PM2.5
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