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경희대학교 의과대학, 경희의료원
Lancet Resp. Med., Sep 17 2026, S2213-2600(26)00218-3 | https://doi.org/10.1016/S2213-2600(26)00218-3
State-level burden of chronic respiratory diseases in the USA, 1990-2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023
GBD 2023 US Chronic Respiratory Disease Collaborators*
Jaeyu Park *A, Jiyeon Oh *B, Jaehyeong Cho *C, Yesol Yim *D, Youn Ho Shin E,F, Abdullahi Tunde Aborode G, Ahmed Abu-Zaid H,I, Oluwatobi E Adegbile J,K, Shailesh M Advani L,M, Anurag Agrawal N, Mahsa Ahadi O, Syed Anees Ahmed P, Yagiz Matthew Akiska Q,R, Syed Mahfuz Al Hasan S, Syed Yusuf Ali T, Hany Aly U, Aleksandr Y Aravkin V,W,X, Julie Alaere Atta Y, Ahmed Y Azzam Z,AA, Mainak Bardhan AB, Amadou Barrow AC,AD, Kavita Batra AE, Michelle L Bell AF,AG, Abiye Assefa Berihun AH, Robert S Bernstein AI,AJ, Michael Brauer W,AK, Patrick R Ching AL, Sunghyun Chung AM, Aaron J Cohen W,AN, Bashir Dabo AO,AP, Xiaochen Dai W,X, Samuel E Danso AQ, Xueting Ding AR, Ojas Prakashbhai Doshi AS, Menayit Tamrat Dresse AT,AU, Abdel Rahman E'mar U, Muhammed Elhadi AV, Chadi Eltaha AW, Ali Gerami Matin AX, Sama Ghoba W, Ayman Grada AY, Arvin Haj-Mirzaian AZ, Erin B Hamilton W, Simon I Hay W,X, Golnaz Heidari BA, Tsegaye Gebreyes Hundie BB, Chidozie Declan Iwu BC, Akhil Jain BD, Mohamed Jalloh BE,BF, Ebbie Kalan BG, Arun Kamireddy BH, Rami S Kantar BI, Mohammad Ali Khaksar BJ,BK, Sepehr Khosravi BL,BM, Jagdish Khubchandani BN, Ruth W Kimokoti BO,BP, Adnan Kisa BQ,BR, Qing Lan BS, Jiaying Li,BT, Weilong Li,BU, Xuefeng Liu BV,BW, Kevin Sheng-Kai Ma BX, Sammer Marzouk BY, Rishi P Mediratta BZ, George A Mensah CA,CB, Tomislav Mestrovic W,CC, Dennis Miezah CD,CE, Ted R Miller CF, Christopher J L Murray W,X, Gurudatta Naik CG, Zuhair S Natto CH,CI, Dang Nguyen CJ,CK, Fred Nugen CL,CM, Michael Safo Oduro CN, Ke Pang CO,CP, Shankargouda Patil CQ, Hoang Nhat Pham CR,CS, Farzad Pourghazi CT, Jagadeesh Puvvula CU, Monika Sawhney CV, Seyed Mohammad Seyed Alshohadaei CW, Allen Seylani CX, Abebaw B Seyoum CY, Dan Shan CZ,DA, Kerem Shuval DB, Gizeaddis Lamesgin Simegn DC, Jasvinder A Singh DD,DE, Dagne Feleke Siyoum DF, Ranjan Solanki DG,DH, Aayushi Sood DI, Jabeen Taiba DJ, Thang Huu Tran DK,DL, Ruixuan Wang DM, Suowen Xu DN,DO, Deniz Yuce DP, Michael Zastrozhin DQ,DR, Jiayan Zhou DS, Hafsa Zia DT, Min Seo Kim** DU,DV, Jae Il Shin** DW, Dong Keon Yon** E, Ali H Mokdad*** W,X
ACenter for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
BDepartment of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
CDepartment of Medicine, CHA University School of Medicine, Seongnam, South Korea
DDepartment of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
EDepartment of Pediatrics, Kyung Hee University, Seoul, South Korea
FDepartment of Pediatrics, CHA University School of Medicine, Seoul, South Korea
...
DRDepartment of Administration, PGxAI, San Francisco, CA, USA
DSSchool of Medicine, Stanford University, Stanford, CA, USA
DTDepartment of Epidemiology, University of Washington, Seattle, WA, USA
DUCardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
DVMassachusetts General Hospital, Boston, MA, USA
DWDepartment of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
*Joint first authors
**Contributed equally
***Senior author
*Collaborators listed at the end of the Article
Correspondence to: Dr Dong Keon Yon
Jaeyu Park *A, Jiyeon Oh *B, Jaehyeong Cho *C, Yesol Yim *D, Youn Ho Shin E,F, Abdullahi Tunde Aborode G, Ahmed Abu-Zaid H,I, Oluwatobi E Adegbile J,K, Shailesh M Advani L,M, Anurag Agrawal N, Mahsa Ahadi O, Syed Anees Ahmed P, Yagiz Matthew Akiska Q,R, Syed Mahfuz Al Hasan S, Syed Yusuf Ali T, Hany Aly U, Aleksandr Y Aravkin V,W,X, Julie Alaere Atta Y, Ahmed Y Azzam Z,AA, Mainak Bardhan AB, Amadou Barrow AC,AD, Kavita Batra AE, Michelle L Bell AF,AG, Abiye Assefa Berihun AH, Robert S Bernstein AI,AJ, Michael Brauer W,AK, Patrick R Ching AL, Sunghyun Chung AM, Aaron J Cohen W,AN, Bashir Dabo AO,AP, Xiaochen Dai W,X, Samuel E Danso AQ, Xueting Ding AR, Ojas Prakashbhai Doshi AS, Menayit Tamrat Dresse AT,AU, Abdel Rahman E'mar U, Muhammed Elhadi AV, Chadi Eltaha AW, Ali Gerami Matin AX, Sama Ghoba W, Ayman Grada AY, Arvin Haj-Mirzaian AZ, Erin B Hamilton W, Simon I Hay W,X, Golnaz Heidari BA, Tsegaye Gebreyes Hundie BB, Chidozie Declan Iwu BC, Akhil Jain BD, Mohamed Jalloh BE,BF, Ebbie Kalan BG, Arun Kamireddy BH, Rami S Kantar BI, Mohammad Ali Khaksar BJ,BK, Sepehr Khosravi BL,BM, Jagdish Khubchandani BN, Ruth W Kimokoti BO,BP, Adnan Kisa BQ,BR, Qing Lan BS, Jiaying Li,BT, Weilong Li,BU, Xuefeng Liu BV,BW, Kevin Sheng-Kai Ma BX, Sammer Marzouk BY, Rishi P Mediratta BZ, George A Mensah CA,CB, Tomislav Mestrovic W,CC, Dennis Miezah CD,CE, Ted R Miller CF, Christopher J L Murray W,X, Gurudatta Naik CG, Zuhair S Natto CH,CI, Dang Nguyen CJ,CK, Fred Nugen CL,CM, Michael Safo Oduro CN, Ke Pang CO,CP, Shankargouda Patil CQ, Hoang Nhat Pham CR,CS, Farzad Pourghazi CT, Jagadeesh Puvvula CU, Monika Sawhney CV, Seyed Mohammad Seyed Alshohadaei CW, Allen Seylani CX, Abebaw B Seyoum CY, Dan Shan CZ,DA, Kerem Shuval DB, Gizeaddis Lamesgin Simegn DC, Jasvinder A Singh DD,DE, Dagne Feleke Siyoum DF, Ranjan Solanki DG,DH, Aayushi Sood DI, Jabeen Taiba DJ, Thang Huu Tran DK,DL, Ruixuan Wang DM, Suowen Xu DN,DO, Deniz Yuce DP, Michael Zastrozhin DQ,DR, Jiayan Zhou DS, Hafsa Zia DT, Min Seo Kim** DU,DV, Jae Il Shin** DW, Dong Keon Yon** E, Ali H Mokdad*** W,X
ACenter for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
BDepartment of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
CDepartment of Medicine, CHA University School of Medicine, Seongnam, South Korea
DDepartment of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
EDepartment of Pediatrics, Kyung Hee University, Seoul, South Korea
FDepartment of Pediatrics, CHA University School of Medicine, Seoul, South Korea
...
DRDepartment of Administration, PGxAI, San Francisco, CA, USA
DSSchool of Medicine, Stanford University, Stanford, CA, USA
DTDepartment of Epidemiology, University of Washington, Seattle, WA, USA
DUCardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
DVMassachusetts General Hospital, Boston, MA, USA
DWDepartment of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
*Joint first authors
**Contributed equally
***Senior author
*Collaborators listed at the end of the Article
Correspondence to: Dr Dong Keon Yon
Abstract
Background: Chronic respiratory diseases are a leading cause of mortality in the USA, with considerable regional disparities influenced by environmental, occupational, and behavioural risk factors. This study aimed to quantify levels of, and trends in, the burden of chronic respiratory diseases in the USA from 1990 to 2023, with estimates of prevalence, mortality, and disability-adjusted life-years (DALYs); identify risk factors contributing to this burden; and project prevalence trends until 2050.
Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we estimated the disease burden for four types of chronic respiratory disease: asthma, chronic obstructive pulmonary disease (COPD), pneumoconiosis, and interstitial lung disease (ILD) and pulmonary sarcoidosis. Estimates were stratified by age group, sex, and year from 1990 to 2023, along with corresponding 95% uncertainty intervals (UIs). Furthermore, we examined total percentage change before and during the COVID-19 pandemic, and forecast the future burden of chronic respiratory diseases through 2050.
Findings: In 2023, an estimated 54·50 million (95% UI 48·86-61·60) individuals lived with chronic respiratory disease in the USA, compared with 33·28 million (28·61-38·23) in 1990. The age-standardised prevalence rate increased by 10·24% (8·01-12·47) between 1990 and 2023, while the age-standardised mortality rate rose modestly from 31·19 (28·85-32·95) per 100 000 population to 34·56 (30·64-37·89) per 100 000 population, indicating persistent gaps in disease control. Marked geographical variation was observed, with the highest age-standardised mortality rates due to COPD and pneumoconiosis in Appalachian states (eg, Kentucky and West Virginia) and elevated asthma and ILD burden in the southern and Great Plains regions. Modifiable risk factors accounted for 44·54% (41·71-45·74) of total DALYs due to chronic respiratory diseases, driven mainly by high BMI for asthma, smoking for COPD, and occupational exposure to asthmagens for pneumoconiosis. Across the US states, higher cigarette taxation and broader respiratory infection vaccination coverage were linked to lower age-standardised DALY rates for COPD and ILD and pulmonary sarcoidosis, whereas asthma showed no consistent pattern. According to our projection models, by 2050, 45·72 million (28·96-67·27) individuals in the USA will have asthma, while 19·61 million (16·70-22·26) will have COPD, 1·05 million (0·74-1·44) will have ILD and pulmonary sarcoidosis, and 0·01 million (0·008-0·02) will have pneumoconiosis.
Interpretation: State-level policy environments, including fiscal and preventive health measures, might contribute to shaping respiratory health outcomes beyond individual risk factors. Integrating tobacco control measures, equitable vaccination programmes, and targeted health-system investments could help to address the uneven burden of chronic respiratory diseases across US states and the growing mortality gap despite stable prevalence, although further research is needed to clarify which specific policy determinants underlie these associations.
Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we estimated the disease burden for four types of chronic respiratory disease: asthma, chronic obstructive pulmonary disease (COPD), pneumoconiosis, and interstitial lung disease (ILD) and pulmonary sarcoidosis. Estimates were stratified by age group, sex, and year from 1990 to 2023, along with corresponding 95% uncertainty intervals (UIs). Furthermore, we examined total percentage change before and during the COVID-19 pandemic, and forecast the future burden of chronic respiratory diseases through 2050.
Findings: In 2023, an estimated 54·50 million (95% UI 48·86-61·60) individuals lived with chronic respiratory disease in the USA, compared with 33·28 million (28·61-38·23) in 1990. The age-standardised prevalence rate increased by 10·24% (8·01-12·47) between 1990 and 2023, while the age-standardised mortality rate rose modestly from 31·19 (28·85-32·95) per 100 000 population to 34·56 (30·64-37·89) per 100 000 population, indicating persistent gaps in disease control. Marked geographical variation was observed, with the highest age-standardised mortality rates due to COPD and pneumoconiosis in Appalachian states (eg, Kentucky and West Virginia) and elevated asthma and ILD burden in the southern and Great Plains regions. Modifiable risk factors accounted for 44·54% (41·71-45·74) of total DALYs due to chronic respiratory diseases, driven mainly by high BMI for asthma, smoking for COPD, and occupational exposure to asthmagens for pneumoconiosis. Across the US states, higher cigarette taxation and broader respiratory infection vaccination coverage were linked to lower age-standardised DALY rates for COPD and ILD and pulmonary sarcoidosis, whereas asthma showed no consistent pattern. According to our projection models, by 2050, 45·72 million (28·96-67·27) individuals in the USA will have asthma, while 19·61 million (16·70-22·26) will have COPD, 1·05 million (0·74-1·44) will have ILD and pulmonary sarcoidosis, and 0·01 million (0·008-0·02) will have pneumoconiosis.
Interpretation: State-level policy environments, including fiscal and preventive health measures, might contribute to shaping respiratory health outcomes beyond individual risk factors. Integrating tobacco control measures, equitable vaccination programmes, and targeted health-system investments could help to address the uneven burden of chronic respiratory diseases across US states and the growing mortality gap despite stable prevalence, although further research is needed to clarify which specific policy determinants underlie these associations.
논문정보
- Research article
- 2026년 09월 (BRIC 등록일 2026-09-21)
- 국내(교신)+국외 연구진
- 바이오·의료융합 > 바이오·의료융합 기타
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