Research Information System
LANCET INFECTIOUS DISEASES, vol.25, no.1, pp.36-51, 2025 (SCI-Expanded, Scopus)
Background Upper respiratory infections (URIs) are the leading cause of acute disease incidence worldwide and contribute to a substantial health-care burden. Although acute otitis media is a common complication of URIs, the combined global burden of URIs and otitis media has not been studied comprehensively. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to explore the fatal and non-fatal burden of the two diseases across all age groups, including a granular analysis of children younger than 5 years, in 204 countries and territories from 1990 to 2021. Methods Mortality due to URIs and otitis media was estimated with use of vital registration and sample-based vital registration data, which are used as inputs to the Cause of Death Ensemble model to separately model URIs and otitis media mortality by age and sex. Morbidity was modelled with a Bayesian meta-regression tool using data from published studies identified via systematic reviews, population-based survey data, and cause-specific URI and otitis media mortality estimates. Additionally, we assessed and compared the burden of otitis media as it relates to URIs and examined the collective burden and contributing risk factors of both diseases. Findings The global number of new episodes of URIs was 12 center dot 8 billion (95% uncertainty interval 11 center dot 4 to 14 center dot 5) for all ages across males and females in 2021. The global all-age incidence rate of URIs decreased by 10 center dot 1% (-12 center dot 0 to -8 center dot 1) from 1990 to 2019. From 2019 to 2021, the global all-age incidence rate fell by 0 center dot 5% (-0 center dot 8 to -0 center dot 1). Globally, the incidence rate of URIs was 162 484 center dot 8 per 100 000 population (144 834 center dot 0 to 183 289 center dot 4) in 2021, a decrease of 10 center dot 5% (-12 center dot 4 to -8 center dot 4) from 1990, when the incidence rate was 181 552 center dot 5 per 100 000 population (160 827 center dot 4 to 206 214 center dot 7). The highest incidence rates of URIs were seen in children younger than 2 years in 2021, and the largest number of episodes was in children aged 5-9 years. The number of new episodes of otitis media globally for all ages was 391 million (292 to 525) in 2021. The global incidence rate of otitis media was 4958 center dot 9 per 100 000 (3705 center dot 4 to 6658 center dot 6) in 2021, a decrease of 16 center dot 3% (-18 center dot 1 to -14 center dot 0) from 1990, when the incidence rate was 5925 center dot 5 per 100 000 (4371 center dot 8 to 8097 center dot 9). The incidence rate of otitis media in 2021 was highest in children younger than 2 years, and the largest number of episodes was in children aged 2-4 years. The mortality rate of URIs in 2021 was 0 center dot 2 per 100 000 (0 center dot 1 to 0 center dot 5), a decrease of 64 center dot 2% (-84 center dot 6 to -43 center dot 4) from 1990, when the mortality rate was 0 center dot 7 per 100 000 (0 center dot 2 to 1 center dot 1). In both 1990 and 2021, the mortality rate of otitis media was less than 0 center dot 1 per 100 000. Together, the combined burden accounted for by URIs and otitis media in 2021 was 6 center dot 86 million (4 center dot 24 to 10 center dot 4) years lived with disability and 8 center dot 16 million (4 center dot 99 to 12 center dot 0) disability-adjusted life-years (DALYs) for all ages across males and females. Globally, the all-age DALY rate of URIs and otitis media combined in 2021 was 103 per 100 000 (63 to 152). Infants aged 1-5 months had the highest combined DALY rate in 2021 (647 per 100 000 [189 to 1412]), followed by early neonates (aged 0-6 days; 582 per 100 000 [176 to 1297]) and late neonates (aged 7-24 days; 482 per 100 000 [161 to 1052]). Interpretation The findings of this study highlight the widespread burden posed by URIs and otitis media across all age groups and both sexes. There is a continued need for surveillance, prevention, and management to better understand and reduce the burden associated with URIs and otitis media, and research is needed to assess their impacts on individuals, communities, economies, and health-care systems worldwide.