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Global, Regional, and National Incidence and Mortality Burden of Non-Covid-19 Lower Respiratory Infections and Aetiologies, 1990–2021: A Systematic Analysis From the Global Burden of Disease Study 2021 Publisher Pubmed



Bender RG1, 9, 351 ; Sirota SB1, 351 ; Swetschinski LR1, 351 ; Dominguez RMV1, 351 ; Novotney A1, 351 ; Wool EE1, 351 ; Ikuta KS1, 11, 351 ; Vongpradith A1, 351 ; Rogowski ELB1, 12, 351 ; Doxey M13 ; Troeger CE1, 351 ; Albertson SB1, 351 ; Ma J14 ; He J1, 351 Show All Authors
Authors
  1. Bender RG1, 9, 351
  2. Sirota SB1, 351
  3. Swetschinski LR1, 351
  4. Dominguez RMV1, 351
  5. Novotney A1, 351
  6. Wool EE1, 351
  7. Ikuta KS1, 11, 351
  8. Vongpradith A1, 351
  9. Rogowski ELB1, 12, 351
  10. Doxey M13
  11. Troeger CE1, 351
  12. Albertson SB1, 351
  13. Ma J14
  14. He J1, 351
  15. Maass KL1, 351
  16. Simoes EAF15
  17. Abdoun M16
  18. Aziz JMA17, 18
  19. Abdulah DM19
  20. Rumeileh SA20
  21. Abualruz H21
  22. Aburuz S22, 23
  23. Adepoju AV25, 26
  24. Adha R27
  25. Adikusuma W28
  26. Adra S29
  27. Afraz A35
  28. Aghamiri S38
  29. Agodi A43
  30. Ahmadzade AM44
  31. Ahmed H45
  32. Ahmed A46, 48
  33. Akinosoglou K50, 51
  34. Alahdal TMA52
  35. Alamer RM53, 54
  36. Albashtawy M56
  37. Albataineh MT57
  38. Alemi H58
  39. Algheethi AAS70, 71
  40. Ali A72
  41. Ali SSS73
  42. Alqahtani JS74
  43. Alqudah M75, 77
  44. Altawfiq JA78, 79
  45. Alworafi YM80, 81
  46. Alzoubi KH30, 76
  47. Amani R82, 83
  48. Amegbor PM85
  49. Ameyaw EK86
  50. Amuasi JH87, 88
  51. Anil A89, 92
  52. Anyanwu PE93
  53. Arafat M95
  54. Areda D96, 97
  55. Arefnezhad R84
  56. Atalell KA98
  57. Ayele F99
  58. Azzam AY101, 102
  59. Babamohamadi H103
  60. Babin FX104
  61. Bahurupi Y105
  62. Baker S106
  63. Banik B108, 109
  64. Barchitta M43
  65. Barqawi HJ29
  66. Basharat Z110
  67. Baskaran P90
  68. Batra K111
  69. Batra R112, 113
  70. Bayileyegn NS114
  71. Beloukas A118, 119
  72. Berkley JA120, 121
  73. Beyene KA123, 124
  74. Bhargava A125
  75. Bhattacharjee P107, 126
  76. Bielicki JA49, 127
  77. Bilalaga MM31
  78. Bitra VR128
  79. Brown CS130, 131
  80. Burkart K1, 2, 351
  81. Bustanji Y24, 32
  82. Carr S1, 351
  83. Chahine Y3, 4
  84. Chattu VK132, 133
  85. Chichagi F59
  86. Chopra H134
  87. Chukwu IS135
  88. Chung E1, 351
  89. Dadana S136
  90. Dai X1, 2, 351
  91. Dandona L1, 137, 138, 351
  92. Dandona R1, 2, 137, 351
  93. Darban I139
  94. Dash NR29
  95. Dashti M140
  96. Dashtkoohi M60, 141
  97. Dekker DM142
  98. Delgadoenciso I143, 144
  99. Devanbu VGC145
  100. Dhama K146
  101. Diao N147
  102. Do THP149
  103. Dokova KG150
  104. Dolecek C151, 157
  105. Dziedzic AM158
  106. Eckmanns T160
  107. Eddra A161
  108. Efendi F162
  109. Eftekharimehrabad A163, 164
  110. Eyre DW152
  111. Fahim A165
  112. Feizkhah A169
  113. Felton TW170
  114. Ferreira N171
  115. Flor LS1, 2, 351
  116. Gaihre S172
  117. Gebregergis MW173
  118. Gebrehiwot M174
  119. Geffers C175
  120. Gerema U116
  121. Ghaffari K177
  122. Goldust M10
  123. Goleij P178, 179
  124. Guan SY180
  125. Gudeta MD100
  126. Guo C181
  127. Gupta VB182
  128. Gupta I183, 184
  129. Habibzadeh F185
  130. Hadi NR186
  131. Haeuser E1, 351
  132. Hailu WB187
  133. Hajibeygi R61
  134. Hajmirzaian A39, 188
  135. Haller S159, 190
  136. Hamiduzzaman M191
  137. Hanifi N192
  138. Hansel J170
  139. Hasnain MS193
  140. Haubold J194, 195
  141. Hoan NQ196
  142. Huynh HH197
  143. Iregbu KC203, 204
  144. Islam MR205
  145. Jafarzadeh A36, 206
  146. Jairoun AA207
  147. Jalili M208
  148. Jomehzadeh N209
  149. Joshua CE210
  150. Kabir MA211
  151. Kamal Z212, 213
  152. Kanmodi KK214, 215
  153. Kantar RS217, 218
  154. Behnagh AK219, 220
  155. Kaur N223
  156. Kaur H224
  157. Khamesipour F37, 62
  158. Khan MN225, 226
  159. Khan Suheb MZ227
  160. Khanal V228, 229
  161. Khatab K230, 231
  162. Khatib MN232
  163. Kim G233, 234
  164. Kim K235
  165. Kitila ATT236, 237
  166. Komaki S238
  167. Krishan K239
  168. Krumkamp R240
  169. Kuddus MA241
  170. Kurniasari MD198, 243
  171. Lahariya C244, 245
  172. Latifinaibin K221
  173. Le NHH246, 250
  174. Le TTT249
  175. Le TDT249
  176. Lee SW252
  177. Lepape A253, 254
  178. Lerango TL255
  179. Li MC256
  180. Mahboobipour AA40
  181. Malhotra K257
  182. Mallhi TH258
  183. Manoharan A259
  184. Martinezguerra BA260
  185. Mathioudakis AG170, 263
  186. Mattiello R264
  187. May J240, 265
  188. Mcmanigal B153
  189. Mcphail SM266, 267
  190. Meto TM268
  191. Mendezlopez MA269
  192. Meo SA270
  193. Merati M63
  194. Mestrovic T1, 272, 351
  195. Mhlanga L273, 274
  196. Minh LHN199, 200
  197. Misganaw A2, 276
  198. Mishra V277, 278
  199. Misra AK279
  200. Mohamed NS280, 281
  201. Mohammadi E64
  202. Mohammed M282
  203. Mohammed M282
  204. Mokdad AH1, 2, 351
  205. Monasta L284
  206. Moore CE285
  207. Motappa R286
  208. Mougin V1, 351
  209. Mousavi P65
  210. Mulita F288, 289
  211. Mulu AA291
  212. Naghavi P292
  213. Naik GR55, 293
  214. Nainu F294
  215. Nair TS295
  216. Nargus S166
  217. Negaresh M296, 297
  218. Nguyen HTH298, 299
  219. Nguyen DH189, 300
  220. Nguyen VT247
  221. Nikolouzakis TK301, 302
  222. Noman EA303, 304
  223. Nriezedi CA305
  224. Odetokun IA306
  225. Okwute PG307, 308
  226. Olana MD309, 310
  227. Olanipekun TO148
  228. Olasupo OO311
  229. Olivasmartinez A5, 261
  230. Ordak M312
  231. Ortizbrizuela E260, 314
  232. Ouyahia A129, 315
  233. Padubidri JR316
  234. Pak A317, 319
  235. Pandey A137
  236. Pantazopoulos I290, 320
  237. Parija PP321
  238. Parikh RR322
  239. Park S323
  240. Parthasarathi A325, 326
  241. Pashaei A327
  242. Peprah P328
  243. Pham HT329
  244. Poddighe D330, 331
  245. Pollard A154, 155
  246. Poncedeleon A260
  247. Prakash PY332
  248. Prates EJS334
  249. Quan NK335
  250. Raee P41
  251. Rahim F336, 337
  252. Rahman M242
  253. Rahmati M338
  254. Ramasamy SK324
  255. Ranjan S339
  256. Rao IR333
  257. Rashid AM340
  258. Rattanavong S341
  259. Ravikumar N342
  260. Reddy MMRK287
  261. Redwan EMM343, 344
  262. Reyes LF345, 346
  263. Roberts T121, 347
  264. Rodrigues M348
  265. Rosenthal VD349
  266. Roy P350
  267. Runghien T1, 122, 351
  268. Saeed U352, 353
  269. Saghazadeh A66
  270. Sharifaskari NS29, 33
  271. Saheb Sharifaskari F29, 33
  272. Sahoo SS354
  273. Sahu M355
  274. Sakshaug JW94, 356
  275. Salami AA216, 357
  276. Saleh MA34, 358
  277. Salehi Omran H42
  278. Sallam M359, 360
  279. Samadzadeh S176, 361
  280. Samodra YL201
  281. Sanjeev RK362
  282. Sarasmita MA202, 363
  283. Saravanan A91, 364
  284. Sartorius B2, 156, 318
  285. Saulam J365, 366
  286. Schumacher AE1, 351
  287. Seyedi SA67
  288. Shafie M68
  289. Shahid S167, 168
  290. Sham S367
  291. Shamim MA89
  292. Shamshirgaran MA368
  293. Shastry RP369
  294. Sherchan SP370, 371
  295. Shiferaw D115, 372
  296. Shittu A373
  297. Siddig EE47, 374
  298. Sinto R375, 376
  299. Sood A377
  300. Sorensen RJD1, 6, 351
  301. Stergachis A2, 7
  302. Stoeva TZ378, 379
  303. Swain CK380
  304. Szarpak L381, 382
  305. Tamuzi JL275, 383
  306. Temsah MH271
  307. Tessema MBT384
  308. Thangaraju P385
  309. Tran NM386
  310. Tran NH248
  311. Tumurkhuu M387
  312. Ty SS388
  313. Udoakang AJ389
  314. Ulhaq I390, 391
  315. Umar TP392
  316. Umer AA393
  317. Vahabi SM64
  318. Vaithinathan AG394
  319. Van Den Eynde J395
  320. Walson JL6
  321. Waqas M396, 397
  322. Xing Y398
  323. Yadav MK399
  324. Yahya G400, 401
  325. Yon DK402
  326. Bialvaei AZ222
  327. Zakham F403, 404
  328. Zeleke AM405
  329. Zhai C406
  330. Zhang Z407
  331. Zhang H117, 262
  332. Zielinska M313
  333. Zheng P1, 2, 351
  334. Aravkin AY1, 2, 8, 351
  335. Vos T1, 2, 351
  336. Hay SI1, 2, 351
  337. Mosser JF1, 351
  338. Lim SS1, 2, 351
  339. Naghavi M1, 2, 351
  340. Murray CJL1, 2, 351
  341. Kyu HH1, 2, 351
Show Affiliations
Authors Affiliations
  1. 1. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
  2. 2. Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
  3. 3. Department of Internal Medicine, University of Washington, Seattle, WA, United States
  4. 4. Department of Cardiology, University of Washington, Seattle, WA, United States
  5. 5. Department of Biostatistics, University of Washington, Seattle, WA, United States
  6. 6. Department of Global Health, University of Washington, Seattle, WA, United States
  7. 7. Department of Pharmacy, University of Washington, Seattle, WA, United States
  8. 8. Department of Applied Mathematics, University of Washington, Seattle, WA, United States
  9. 9. School of Medicine, Yale University, New Haven, CT, United States
  10. 10. Department of Dermatology, Yale University, New Haven, CT, United States
  11. 11. Division of Infectious Diseases, Veterans Affairs Greater Los Angeles, Los Angeles, CA, United States
  12. 12. School of Medicine, Emory University, Atlanta, GA, United States
  13. 13. Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA, United States
  14. 14. Center for Biostatistics, Ohio State University, Columbus, OH, United States
  15. 15. Center for Global Health, University of Colorado, Denver, CO, United States
  16. 16. Department of Medicine, University of Setif Algeria, Setif, Algeria
  17. 17. Department of Medical Laboratory of Science, University of Human Development, Sulaymaniyah, Iraq
  18. 18. Baxshin Hospital, Baxshin Research Center, Sulaymaniyah, Iraq
  19. 19. Community and Maternity Nursing Unit, University of Duhok, Duhok, Iraq
  20. 20. Department of Neurology, Martin Luther University Halle-Wittenberg, Halle, Germany
  21. 21. Department of Nursing, Al Zaytoonah University of Jordan, Amman, Jordan
  22. 22. Department of Therapeutics, United Arab Emirates University, Al Ain, United Arab Emirates
  23. 23. College of Pharmacy, University of Jordan, Amman, Jordan
  24. 24. Department of Biopharmaceutics and Clinical Pharmacy, University of Jordan, Amman, Jordan
  25. 25. HIV and Infectious Diseases Department, Jhpiego, Abuja, Nigeria
  26. 26. Department of Adolescent Research and Care, Adolescent Friendly Research Initiative and Care, Ado Ekiti, Nigeria
  27. 27. Department of Business Administration, Muhammadiyah University of Mataram, Mataram, Indonesia
  28. 28. Department of Pharmacy, Muhammadiyah University of Mataram, Mataram, Indonesia
  29. 29. Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
  30. 30. Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
  31. 31. Department of Clinical Sciences, University of Sharjah, Sharjah, United Arab Emirates
  32. 32. Department of Basic Biomedical Sciences, University of Sharjah, Sharjah, United Arab Emirates
  33. 33. Sharjah Institute of Medical Sciences, University of Sharjah, Sharjah, United Arab Emirates
  34. 34. College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
  35. 35. Department of Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
  36. 36. Department of Immunology, Kerman University of Medical Sciences, Kerman, Iran
  37. 37. Research Center for Hydatid Disease, Kerman University of Medical Sciences, Kerman, Iran
  38. 38. Department of Biotechnology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  39. 39. Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  40. 40. Tracheal Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  41. 41. Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  42. 42. Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  43. 43. Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
  44. 44. Department of Neuroscience, Mashhad University of Medical Sciences, Mashhad, Iran
  45. 45. Department of Biosciences, COMSATS Institute of Information Technology, Islamabad, Pakistan
  46. 46. Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
  47. 47. Unit of Basic Medical Sciences, University of Khartoum, Khartoum, Sudan
  48. 48. Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
  49. 49. Department of Paediatric Infectious Diseases, University of Basel, Basel, Switzerland
  50. 50. Department of Internal Medicine, University of Patras, Patras, Greece
  51. 51. Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, Patras, Greece
  52. 52. Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
  53. 53. School of Nursing, Yarmouk University, Irbid, Jordan
  54. 54. School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia
  55. 55. Department of Engineering, Western Sydney University, Sydney, NSW, Australia
  56. 56. Community and Mental Health Department, Al al-Bayt University, Mafraq, Jordan
  57. 57. Department of Molecular Biology and Genetics, Khalifa University, Abu Dhabi, United Arab Emirates
  58. 58. Hematology, Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  59. 59. Department of Scientific Research, Tehran University of Medical Sciences, Tehran, Iran
  60. 60. Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran
  61. 61. Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
  62. 62. Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
  63. 63. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  64. 64. Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  65. 65. Noncommunicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
  66. 66. Research Center for Immunodeficiencies, Tehran University of Medical Sciences, Tehran, Iran
  67. 67. Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  68. 68. Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran
  69. 69. Tehran University of Medical Sciences, Tehran, Iran
  70. 70. Global Centre for Environmental Remediation, University of Newcastle, Newcastle, NSW, Australia
  71. 71. Cooperative Research Centre for Contamination Assessment and Remediation of the Environment, Newcastle, NSW, Australia
  72. 72. Department of Zoology, Abdul Wali Khan University Mardan, Mardan, Pakistan
  73. 73. Center for Biotechnology and Microbiology, University of Swat, Swat, Pakistan
  74. 74. Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
  75. 75. Department of Pathology and Microbiology, Jordan University of Science and Technology, Irbid, Jordan
  76. 76. Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
  77. 77. Cell Therapy and Applied Genomics Department, King Hussein Cancer Center, Amman, Jordan
  78. 78. Department of Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
  79. 79. Medicine Department, Indiana University School of Medicine, Indianapolis, IN, United States
  80. 80. Department of Medical Sciences, Azal University for Human Development, Sana'a, Yemen
  81. 81. Department of Clinical Sciences, University of Science and Technology of Fujairah, Fujairah, United Arab Emirates
  82. 82. Interdisciplinary Graduate Program in Human Toxicology, University of Iowa, Iowa City, IA, United States
  83. 83. Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  84. 84. Department of Anatomy, Shiraz University of Medical Sciences, Shiraz, Iran
  85. 85. School of Global Public Health, New York University, New York, NY, United States
  86. 86. School of Graduate Studies, Lingnan University, Hong Kong
  87. 87. Department of Global Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  88. 88. Global Health and Infectious Diseases, Kumasi Center for Collaborative Research in Tropical Medicine, Kumasi, Ghana
  89. 89. Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
  90. 90. Department of Community Medicine and Famil Medicine, All India Institute of Medical Sciences, Jodhpur, India
  91. 91. Department of Pharmacology and Research, All India Institute of Medical Sciences, Jodhpur, India
  92. 92. All India Institute of Medical Sciences, Bhubaneswar, India
  93. 93. Warwick Medical School, Coventry, United Kingdom
  94. 94. University of Warwick, Coventry, United Kingdom
  95. 95. College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
  96. 96. College of Art and Science, Ottawa University, Surprise, AZ, United States
  97. 97. School of Life Sciences, Arizona State University, Tempe, AZ, United States
  98. 98. Department of Pediatrics and Child Health Nursing, University of Gondar, Gondar, Ethiopia
  99. 99. School of Medical Laboratory Sciences, Haramaya University, Harar, Ethiopia
  100. 100. Department of Clinical Pharmacy, Haramaya University, Harar, Ethiopia
  101. 101. Department of Neurovascular Research, Nested Knowledge, Saint Paul, MN, United States
  102. 102. Faculty of Medicine, October 6 University, 6th of October City, Egypt
  103. 103. Department of Nursing, Semnan University of Medical Sciences and Health Services, Semnan, Iran
  104. 104. Merieux Foundation, Lyon, France
  105. 105. Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
  106. 106. Department of Medicine, University of Cambridge, Cambridge, United Kingdom
  107. 107. Department of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
  108. 108. Institute of Health and Wellbeing (IHW), Federation University Australia, Melbourne, VIC, Australia
  109. 109. Manna Institute, University of New England, Armidale, NSW, Australia
  110. 110. Alpha Genomics, Islamabad, Pakistan
  111. 111. Department of Medical Education, University of Nevada Las Vegas, Las Vegas, NV, United States
  112. 112. School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, United States
  113. 113. IT Department, Coforge, GA, United States
  114. 114. Department of Surgery, Jimma University, Jimma, Ethiopia
  115. 115. Department of Epidemiology, Jimma University, Jimma, Ethiopia
  116. 116. Department of Public Health, Jimma University, Jimma, Ethiopia
  117. 117. School of Public Health, Peking University, Beijing, China
  118. 118. Department of Biomedical Sciences, University of West Attica, Athens, Greece
  119. 119. Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
  120. 120. Clinical Research Department, Kenya Medical Research Institute, Wellcome Trust Research Programme, Kilifi, Kenya
  121. 121. Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
  122. 122. Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
  123. 123. School of Pharmacy, University of Auckland, Auckland, New Zealand
  124. 124. Department of Pharmaceutical and Administrative Sciences, University of Health Sciences and Pharmacy in St Louis, St Louis, MO, United States
  125. 125. Department of Internal Medicine, Wayne State University, Detroit, MI, United States
  126. 126. Department of Clinical Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
  127. 127. Department of Infection and Immunity, St George's University of London, London, United Kingdom
  128. 128. Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
  129. 129. Faculty of Medicine, University Ferhat Abbas of Setif, Setif, Algeria
  130. 130. HCAI, Fungal, AMR, AMU and Sepsis Division, United Kingdom Health Security Agency, London, United Kingdom
  131. 131. Department of Infection, Imperial College London, London, United Kingdom
  132. 132. Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
  133. 133. Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Sawangi, India
  134. 134. Department of Biosciences, Saveetha Institute of Medical and Technical Sciences, Chennai, India
  135. 135. Department of Paediatric Surgery, Federal Medical Centre, Umuahia, Nigeria
  136. 136. Department of Internal Medicine, Cheyenne Regional Medical Center, Cheyenne, WY, United States
  137. 137. Public Health Foundation of India, Gurugram, India
  138. 138. Indian Council of Medical Research, New Delhi, India
  139. 139. Department of Medical Microbiology, University of Ghana, Accra, Ghana
  140. 140. Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
  141. 141. Department of Gynecology and Obstetrics, Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran, Iran
  142. 142. Department Implementation Research, Institute of Tropical Medicine, Hamburg, Germany
  143. 143. School of Medicine, University of Colima, Colima, Mexico
  144. 144. Department of Research, Colima State Health Services, Colima, Mexico
  145. 145. Department of Community Medicine, Chettinad Academy of Research and Education, Chennai, India
  146. 146. Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, India
  147. 147. Department of Environmental Health, Harvard University, Boston, MA, United States
  148. 148. Department of Pulmonary and Critical Care, Harvard University, Boston, MA, United States
  149. 149. Department of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Viet Nam
  150. 150. Department of Social Medicine and Health Care Organisation, Medical University Prof Dr Paraskev Stoyanov, Varna, Bulgaria
  151. 151. Oxford Centre for Global Health Research, University of Oxford, Oxford, United Kingdom
  152. 152. Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
  153. 153. Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
  154. 154. Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
  155. 155. Department of Pediatrics, University of Oxford, Oxford, United Kingdom
  156. 156. Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
  157. 157. Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
  158. 158. Department of Conservative Dentistry with Endodontics, Medical University of Silesia, Katowice, Poland
  159. 159. Department of Infectious Disease Epidemiology, Berlin, Germany
  160. 160. Robert Koch Institute, Berlin, Germany
  161. 161. Higher School of Technology, Sultan Moulay Slimane University, Beni Mellal, Morocco
  162. 162. Advanced Nursing Department, Universitas Airlangga, Surabaya, Indonesia
  163. 163. Department of Biochemistry, Ege University, Izmir, Turkey
  164. 164. Azerbaijan State University of Economics (UNEC), Baku, Azerbaijan
  165. 165. Department of Oral Biology, The University of Lahore, Lahore, Pakistan
  166. 166. University Institute of Public Health, The University of Lahore, Lahore, Pakistan
  167. 167. Institute of Molecular Biology and Biotechnology (IMBB), The University of Lahore, Lahore, Pakistan
  168. 168. Research Centre for Health Sciences (RCHS), The University of Lahore, Lahore, Pakistan
  169. 169. Department of Social Medicine and Epidemiology, Guilan University of Medical Sciences, Rasht, Iran
  170. 170. Division of Immunology, Immunity to Infection & Respiratory Medicine, University of Manchester, Manchester, United Kingdom
  171. 171. Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
  172. 172. Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
  173. 173. Department of Midwifery, Adigrat University, Adigrat, Ethiopia
  174. 174. Department of Environmental Health, Wollo University, Dessie, Ethiopia
  175. 175. Institute for Hygiene and Environmental Medicine, Charite University Medical Center Berlin, Berlin, Germany
  176. 176. Department of Neurology, Charite University Medical Center Berlin, Berlin, Germany
  177. 177. Department of Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
  178. 178. Department of Genetics, Sana Institute of Higher Education, Sari, Iran
  179. 179. Universal Scientific Education and Research Network (USERN), Kermanshah University of Medical Sciences, Kermanshah, Iran
  180. 180. Department of Epidemiology and Biostatistics, Anhui Medicla University, Hefei, China
  181. 181. Department of Urban Planning and Design, University of HongKong, Hong Kong
  182. 182. School of Medicine, Deakin University, Geelong, VIC, Australia
  183. 183. Department of Internal Medicine, Bharatpur, India
  184. 184. NGO, Delhi, India
  185. 185. Global Virus Network, Middle East Region, Shiraz, Iran
  186. 186. Department of Clinical Pharmacology and Medicine, University of Kufa, Najaf, Iraq
  187. 187. Department of Public Health, Wollega University, Nekemte, Ethiopia
  188. 188. Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
  189. 189. Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
  190. 190. Department of Public Health, Charite Institute of Public Health, Berlin, Germany
  191. 191. Faculty of Health, Southern Cross University, Bilinga, QLD, Australia
  192. 192. Department of Critical Care and Emergency Nursing, Zanjan University of Medical Sciences, Zanjan, Iran
  193. 193. Department of Pharmacy, Palamau Institute of Pharmacy, Daltonganj, India
  194. 194. Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
  195. 195. Institute of Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
  196. 196. School of Dentistry, Hanoi Medical University, Hanoi, Viet Nam
  197. 197. International Master Program for Translational Science, Taipei Medical University, Taipei, Taiwan
  198. 198. Nursing School, Taipei Medical University, Taipei, Taiwan
  199. 199. International Ph D Program in Medicine, Taipei Medical University, Taipei, Taiwan
  200. 200. Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan
  201. 201. School of Public Health, Taipei Medical University, Taipei, Taiwan
  202. 202. Department of Clinical Pharmacy, Taipei Medical University, Taipei, Taiwan
  203. 203. Department of Medical Microbiology, University of Abuja, Abuja, Nigeria
  204. 204. Department of Medical Microbiology, National Hospital, Abuja, Nigeria
  205. 205. Department of Pharmacy, University of Asia Pacific, Dhaka, Bangladesh
  206. 206. Department of Immunology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
  207. 207. Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates
  208. 208. Department of Microbiology, Hamadan University of Medical Sciences, Hamadan, Iran
  209. 209. Department of Microbiology, Abadan School of Medical Sciences, Abadan, Iran
  210. 210. Department of Economics, National Open University, Benin City, Nigeria
  211. 211. Department of Social Work, Pabna University of Science and Technology, Pabna, Bangladesh
  212. 212. Department of Pharmacy, Shaheed Benazir Bhutto University, Dir Upper, Pakistan
  213. 213. School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
  214. 214. Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
  215. 215. Office of the Executive Director, Cephas Health Research Initiative, Ibadan, Nigeria
  216. 216. Campaign for Health and Neck Cancer Education (CHANCE) Programme, Cephas Health Research Initiative, Ibadan, Nigeria
  217. 217. The Hansjorg Wyss Department of Plastic and Reconstructive Surgery, Nab'a Al-Hayat Foundation for Medical Sciences and Health Care, New York, NY, United States
  218. 218. Cleft Lip and Palate Surgery Division, Global Smile Foundation, Norwood, MA, United States
  219. 219. Endocrine Research Center, Iran University of Medical Sciences, Tehran, Iran
  220. 220. Department of Echocardiography, Iran University of Medical Sciences, Tehran, Iran
  221. 221. Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
  222. 222. Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran
  223. 223. Department of ENT, Dr B R Ambedkar State Institute of Medical Sciences (AIMS), Mohali, India
  224. 224. Public Health Foundation of India, New Delhi, India
  225. 225. Population Science Department, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
  226. 226. Department of Public Health, University of Sydney, Sydney, NSW, Australia
  227. 227. Department of Critical Care Medicine, St Luke's Aurora Medical Center, Milwaukee, WI, United States
  228. 228. Department of Health, Nepal Development Society, Chitwan, Nepal
  229. 229. Preventable Non Communicable Disease, Menzies School of Health Research, Alice Springs, NT, Australia
  230. 230. College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
  231. 231. College of Arts and Sciences, Ohio University, Zanesville, OH, United States
  232. 232. Global Consortium for Public Health Research, Datta Meghe Institute of Higher Education and Research, Wardha, India
  233. 233. Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, United States
  234. 234. Division of Pediatric Hospital Medicine, UH Rainbow Babies and Children's Hospital, Cleveland, OH, United States
  235. 235. Department of Preventive Medicine, Yonsei University, Seoul, South Korea
  236. 236. Department of Public Health, Wachemo University, Addis Ababa, Ethiopia
  237. 237. Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
  238. 238. Department of Physiology, Hamedan University of Medical Sciences, Hamedan, Iran
  239. 239. Department of Anthropology, Panjab University, Chandigarh, India
  240. 240. Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
  241. 241. Department of Mathematics, University of Rajshahi, Rajshahi, Bangladesh
  242. 242. Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
  243. 243. Faculty of Medicine and Health Science, Universitas Kristen Satya Wacana, Salatiga, Indonesia
  244. 244. Department of Health Policy and Strategy, Foundation for People-centric Health Systems, New Delhi, India
  245. 245. SD Gupta School of Public Health, Indian Institute of Health Management Research University, Jaipur, India
  246. 246. Faculty of Medicine, Ho Chi Minh City, Viet Nam
  247. 247. Department of General Medicine, Ho Chi Minh City, Viet Nam
  248. 248. Department of Otolaryngology, Ho Chi Minh City, Viet Nam
  249. 249. University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
  250. 250. Cardiovascular Research Department, Methodist Hospital, Merrillville, IN, United States
  251. 251. Ho Chi Minh City, Viet Nam
  252. 252. Department of Precision Medicine, Sungkyunkwan University, Suwon-si, South Korea
  253. 253. REA-REZO, Hospices Civils de Lyon, Lyon, France
  254. 254. Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID), Centre International de Recherche en Infectiologie (CIRI), Lyon, France
  255. 255. Department of Public Health, Dilla University, Dilla, Ethiopia
  256. 256. Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
  257. 257. Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, India
  258. 258. Department of Clinical Pharmacy, Jouf University, Sakaka, Saudi Arabia
  259. 259. Molecular Laboratory, The CHILDS Trust Medical Research Foundation, Chennai, India
  260. 260. Department of Infectious Diseases, Instituto Nacional de Nutricion Salvador Zubiran (Salvador Zubiran National Institute of Medical Sciences and Nutrition), Mexico City, Mexico
  261. 261. Department of Medicine, Instituto Nacional de Nutricion Salvador Zubiran (Salvador Zubiran National Institute of Medical Sciences and Nutrition), Mexico City, Mexico
  262. 262. Department of International Health, Johns Hopkins University, Baltimore, MD, United States
  263. 263. North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
  264. 264. Department of Social Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
  265. 265. Department of Tropical Medicine, Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
  266. 266. Australian Centre for Health Services Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia
  267. 267. Digital Health and Informatics Directorate, Queensland Health, Brisbane, QLD, Australia
  268. 268. Department of Public Health, Arba Minch University, Arbaminch, Ethiopia
  269. 269. Department of Medical Oncology and Hematology, Kantonsspital St Gallen, St Gallen, Switzerland
  270. 270. Department of Physiology, King Saud University, Riyadh, Saudi Arabia
  271. 271. Pediatric Intensive Care Unit, King Saud University, Riyadh, Saudi Arabia
  272. 272. University Centre Varazdin, University North, Varazdin, Croatia
  273. 273. Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
  274. 274. South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Cape Town, South Africa
  275. 275. Department of Epidemiology, Stellenbosch University, Cape Town, South Africa
  276. 276. National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
  277. 277. College of Healthcare Management and Economics, Gulf Medical University, Ajman, United Arab Emirates
  278. 278. Department of Research and Development, Panacea Institute of Interdisciplinary Research and Education, Varanasi, India
  279. 279. Department of Pharmacology, All India Institute of Medical Sciences, Mangalagiri, India
  280. 280. Molecular Biology Unit, Sirius Training and Research Centre, Khartoum, Sudan
  281. 281. BioStatistical and Molecular Biology Department, Sirius Training and Research Centre, Khartoum, Sudan
  282. 282. Department of Pharmacy, Madda Walabu University, Bale Robe, Ethiopia
  283. 283. QU Health, Qatar University, Doha, Qatar
  284. 284. Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
  285. 285. Centre for Neonatal and Paediatric Infection, St George's University of London, London, United Kingdom
  286. 286. Department of Community Medicine, Manipal Academy of Higher Education, Mangalore, India
  287. 287. Department of Internal Medicine, Manipal Academy of Higher Education, Mangalore, India
  288. 288. Department of Surgery, General University Hospital of Patras, Patras, Greece
  289. 289. Faculty of Medicine, University of Thessaly, Larissa, Greece
  290. 290. Department of Emergency Medicine, University of Thessaly, Larissa, Greece
  291. 291. Department of Nursing, Injibara University, Injibara, Ethiopia
  292. 292. Department of Computer and Information Science and Engineering, University of Florida, Gainesville, FL, United States
  293. 293. College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
  294. 294. Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
  295. 295. Department of Community Medicine, MOSC Medical College, Kolenchery, India
  296. 296. Tehran, Iran
  297. 297. Department of Internal Medicine, Ardabil University of Medical Science, Ardabil, Iran
  298. 298. Faculty of Medicine, Duy Tan University, Da Nang, Viet Nam
  299. 299. Institute for Research and Training in Medicine, Biology and Pharmacy, Duy Tan University, Da Nang, Viet Nam
  300. 300. Department of Medical Engineering, University of South Florida, Tampa, FL, United States
  301. 301. Department of General Surgery, University Hospital of Heraklion, Heraklion, Greece
  302. 302. Department of Laboratory of Toxicology, University of Crete, Heraklion, Greece
  303. 303. Department of Applied Microbiology, Taiz University, Taiz, Yemen
  304. 304. Faculty of Applied Sciences and Technology, Universiti Tun Hussein Onn Malaysia, Johor, Malaysia
  305. 305. Department of Paediatrics, Nnamdi Azikiwe University, Awka, Nigeria
  306. 306. Department of Veterinary Public Health and Preventive Medicine, University of Ilorin, Ilorin, Nigeria
  307. 307. Department of Medical Physiology, Babcock University, Ilisan-Remo, Nigeria
  308. 308. Department of Medical Physiology, University of Lagos, Lagos, Nigeria
  309. 309. Department of Microbiology, Immunology and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
  310. 310. Department of Medical Laboratory Sciences, Ambo University, Ambo, Ethiopia
  311. 311. Helath Information Research Unit, McMaster University, Hamilton, ON, Canada
  312. 312. Department of Pharmacotherapy and Pharmaceutical Care, Medical University of Warsaw, Warsaw, Poland
  313. 313. Department of Biochemistry and Pharmacogenomics, Medical University of Warsaw, Warsaw, Poland
  314. 314. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
  315. 315. Division of Infectious Diseases, University Hospital of Setif, Setif, Algeria
  316. 316. Department of Forensic Medicine and Toxicology, Kasturba Medical College, Mangalore, Mangalore, India
  317. 317. Centre for the Business and Economics of Health, The University of Queensland, Brisbane, QLD, Australia
  318. 318. Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
  319. 319. Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
  320. 320. Department of Emergency Medicine, University of Bern, Bern, Switzerland
  321. 321. Department of Community Medicine, All India Institute of Medical Sciences, Jammu, India
  322. 322. Department of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States
  323. 323. Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
  324. 324. Department of Radiology, Stanford University, Stanford, CA, United States
  325. 325. Center for Pharmacoepidemiology and Treatment Science, Rutgers University, New Brunswick, NJ, United States
  326. 326. Research Center, Allergy Asthma and Chest Center, Mysore, India
  327. 327. School of Nursing, University of British Columbia, Vancouver, BC, Canada
  328. 328. Centre for Primary Health Care and Equity, University of New South Wales, Kensington, NSW, Australia
  329. 329. School of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
  330. 330. Department of Medicine, Nazarbayev University, Astana, Kazakhstan
  331. 331. Clinical Academic Department of Pediatrics, University Medical Center (UMC), Astana, Kazakhstan
  332. 332. Department of Microbiology, Manipal Academy of Higher Education, Manipal, India
  333. 333. Department of Nephrology, Manipal Academy of Higher Education, Manipal, India
  334. 334. Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
  335. 335. College of Health Sciences, VinUniversity, Hanoi, Viet Nam
  336. 336. Department of Health Sciences, Cihan University-Sulaymaniyah, Sulaymaniyah, Iraq
  337. 337. Cihan University Sulaimaniya Research Center (CUSRC), Sulaymaniyah, Iraq
  338. 338. Department of Physical Education and Sport Sciences, Lorestan University, Khoramabad, Iran
  339. 339. School of Humanities and Social Sciences, Indian Institute of Technology Mandi, Mandi, India
  340. 340. Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
  341. 341. Emergency Department, Savannakhet Provincial Hospital, Savannakhet, Laos
  342. 342. Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United States
  343. 343. Department Biological Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
  344. 344. Department of Protein Research, Research and Academic Institution, Alexandria, Egypt
  345. 345. Unisabana Center for Translational Science, Universidad de La Sabana (Savannah), Chia, Colombia
  346. 346. Critical Care Department, Clinica Universidad De La Sabana (Savannah University Clinic), Chia, Colombia
  347. 347. Department of Microbiology, Lao- OxfordMahosot Hospital Wellcome Trust Research Unit, Vientiane, Laos
  348. 348. Department of Geography and Demography, University of Coimbra, Coimbra, Portugal
  349. 349. Department of Public Health Sciences, University of Miami, Miami, FL, United States
  350. 350. Department of Labour, Directorate of Factories, Government of West Bengal, Kolkata, India
  351. 351. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
  352. 352. Multidisciplinary Laboratory, Foundation University School of Health Sciences (FUSH), Foundation University, Islamabad, Pakistan
  353. 353. International Center of Medical Sciences Research (ICMSR), Islamabad, Pakistan
  354. 354. Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bathinda, India
  355. 355. Department of Preventive & Social Medicine, Kolkata, India
  356. 356. Institute for Employment Research, Nuremberg, Germany
  357. 357. Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Ibadan, Nigeria
  358. 358. Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
  359. 359. Department of Pathology, Microbiology and Forensic Medicine, Amman, Jordan
  360. 360. Department of Clinical Laboratories and Forensic Medicine, Amman, Jordan
  361. 361. Department of Neurology, University of Southern Denmark, Odense, Denmark
  362. 362. Department of Pediatrics, Pravara Institute of Medical Sciences, Loni, India
  363. 363. Pharmacy Study Program, Udayana University, Badung, Indonesia
  364. 364. Indira Gandhi Medical College and Research Institute, Puducherry, India
  365. 365. Department of Medical Informatics, Kagawa University, Miki-cho, Japan
  366. 366. Food Processing and Nutrition, Karnataka State Akkamahadevi Women's University, Vijayapura, India
  367. 367. Department of Pathology and Laboratory Medicine, Northwell Health, New York, NY, United States
  368. 368. Department of Pathobiology, Shahid Bahonar University of Kerman, Kerman, Iran
  369. 369. Department of Microbiology, Yenepoya University, Mangalore, India
  370. 370. Department of Biology, Morgan State University, Baltimore, MD, United States
  371. 371. Department of Environmental Health Sciences, Tulane University, New Orleans, LA, United States
  372. 372. Department of Public Health, Dambi Dollo University, Dembi Dollo, Ethiopia
  373. 373. Department of Veterinary Public Health and Preventive Medicine, Usmanu Danfodiyo University, Sokoto, Nigeria
  374. 374. Department of Medical Microbiology and Infectious Diseases, Erasmus University, Rotterdam, Netherlands
  375. 375. Department of Internal Medicine, University of Indonesia, Jakarta Pusat, Indonesia
  376. 376. Department of Internal Medicine, Dr Cipto Mangunkusumo National Hospital, Jakarta Pusat, Indonesia
  377. 377. Internal Medicine Department, The Wright Center for Graduate Medical Education, Scranton, PA, United States
  378. 378. Department of Microbiology and Virology, Medical University of Varna, Varna, Bulgaria
  379. 379. Microbiology Laboratory, University Hospital, Varna, Bulgaria
  380. 380. Department of Analytical and Applied Economics, Utkal University, Bhubaneswar, India
  381. 381. Department of Clinical Outcomes, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
  382. 382. Department of Clinical Research and Development, LUXMED Group, Warsaw, Poland
  383. 383. Department of Medicine, Northlands Medical Group, Omuthiya, Namibia
  384. 384. Department of Microbiology and Immunology, University of Maryland, Baltimore, MD, United States
  385. 385. Department of Pharmacology, All India Institute of Medical Sciences, Raipur, India
  386. 386. Department of Health, Children's Hospital 1, Ho Chi Minh City, Viet Nam
  387. 387. Department of Physiology, East Carolina University, Greenville, NC, United States
  388. 388. Department of Pharmacology, All India Institute of Medical Sciences, Deoghar, India
  389. 389. Department of Biosciences and Biotechnology, University of Medical Sciences, Ondo, Ondo, Nigeria
  390. 390. Health Department, Ministry of Health, Peshawar, Pakistan
  391. 391. Health Department, Directorate General of Health Services, Peshawar, Pakistan
  392. 392. Division of Surgery and Interventional Science, University College London, London, United Kingdom
  393. 393. Department of Public Health, Dire Dawa University, Dire Dawa, Ethiopia
  394. 394. College of Health and Sport Sciences, University of Bahrain, Salmanya, Bahrain
  395. 395. Department of Cardiovascular Sciences, Katholieke Universiteit Leuven (University of Leuven), Leuven, Belgium
  396. 396. Natural and Medical Sciences Research Center, University of Nizwa, Nizwa, Oman
  397. 397. Department of Biotechnology and Genetic Engineering, Hazara University Mansehra, Mansehra, Pakistan
  398. 398. Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
  399. 399. Department of Microbiology, Central University of Punjab, Bathinda, India
  400. 400. Department of Microbiology and Immunology, Zagazig University, Zagazig, Egypt
  401. 401. Department of Cells and Tissues, Molecular Biology Institute of Barcelona, Barcelona, Spain
  402. 402. Department of Pediatrics, Kyung Hee University, Seoul, South Korea
  403. 403. Faculty of Medicine and Health Sciences, Hodeidah University, Hodeidah, Yemen
  404. 404. Department of Virology, University of Helsinki, Helsinki, Finland
  405. 405. School of Nursing, Hawassa University, Hawassa, Ethiopia
  406. 406. Department of Epidemiology and Biostatistics, Anhui Medical University, Hefei, China
  407. 407. Department of Nutrition and Food Hygiene, Peking University, Beijing, China

Source: The Lancet Infectious Diseases Published:2024


Abstract

Background: Lower respiratory infections (LRIs) are a major global contributor to morbidity and mortality. In 2020–21, non-pharmaceutical interventions associated with the COVID-19 pandemic reduced not only the transmission of SARS-CoV-2, but also the transmission of other LRI pathogens. Tracking LRI incidence and mortality, as well as the pathogens responsible, can guide health-system responses and funding priorities to reduce future burden. We present estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 of the burden of non-COVID-19 LRIs and corresponding aetiologies from 1990 to 2021, inclusive of pandemic effects on the incidence and mortality of select respiratory viruses, globally, regionally, and for 204 countries and territories. Methods: We estimated mortality, incidence, and aetiology attribution for LRI, defined by the GBD as pneumonia or bronchiolitis, not inclusive of COVID-19. We analysed 26 259 site-years of mortality data using the Cause of Death Ensemble model to estimate LRI mortality rates. We analysed all available age-specific and sex-specific data sources, including published literature identified by a systematic review, as well as household surveys, hospital admissions, health insurance claims, and LRI mortality estimates, to generate internally consistent estimates of incidence and prevalence using DisMod-MR 2.1. For aetiology estimation, we analysed multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature data using a network analysis model to produce the proportion of LRI deaths and episodes attributable to the following pathogens: Acinetobacter baumannii, Chlamydia spp, Enterobacter spp, Escherichia coli, fungi, group B streptococcus, Haemophilus influenzae, influenza viruses, Klebsiella pneumoniae, Legionella spp, Mycoplasma spp, polymicrobial infections, Pseudomonas aeruginosa, respiratory syncytial virus (RSV), Staphylococcus aureus, Streptococcus pneumoniae, and other viruses (ie, the aggregate of all viruses studied except influenza and RSV), as well as a residual category of other bacterial pathogens. Findings: Globally, in 2021, we estimated 344 million (95% uncertainty interval [UI] 325–364) incident episodes of LRI, or 4350 episodes (4120–4610) per 100 000 population, and 2·18 million deaths (1·98–2·36), or 27·7 deaths (25·1–29·9) per 100 000. 502 000 deaths (406 000–611 000) were in children younger than 5 years, among which 254 000 deaths (197 000–320 000) occurred in countries with a low Socio-demographic Index. Of the 18 modelled pathogen categories in 2021, S pneumoniae was responsible for the highest proportions of LRI episodes and deaths, with an estimated 97·9 million (92·1–104·0) episodes and 505 000 deaths (454 000–555 000) globally. The pathogens responsible for the second and third highest episode counts globally were other viral aetiologies (46·4 million [43·6–49·3] episodes) and Mycoplasma spp (25·3 million [23·5–27·2]), while those responsible for the second and third highest death counts were S aureus (424 000 [380 000–459 000]) and K pneumoniae (176 000 [158 000–194 000]). From 1990 to 2019, the global all-age non-COVID-19 LRI mortality rate declined by 41·7% (35·9–46·9), from 56·5 deaths (51·3–61·9) to 32·9 deaths (29·9–35·4) per 100 000. From 2019 to 2021, during the COVID-19 pandemic and implementation of associated non-pharmaceutical interventions, we estimated a 16·0% (13·1–18·6) decline in the global all-age non-COVID-19 LRI mortality rate, largely accounted for by a 71·8% (63·8–78·9) decline in the number of influenza deaths and a 66·7% (56·6–75·3) decline in the number of RSV deaths. Interpretation: Substantial progress has been made in reducing LRI mortality, but the burden remains high, especially in low-income and middle-income countries. During the COVID-19 pandemic, with its associated non-pharmaceutical interventions, global incident LRI cases and mortality attributable to influenza and RSV declined substantially. Expanding access to health-care services and vaccines, including S pneumoniae, H influenzae type B, and novel RSV vaccines, along with new low-cost interventions against S aureus, could mitigate the LRI burden and prevent transmission of LRI-causing pathogens. Funding: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care (UK). © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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