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.

Authors

GBD 2023 US Chronic Respiratory Disease Collaborators

Published in

The Lancet. Respiratory medicine. Sep 17, 2026. Epub Sep 17, 2026.

Abstract

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.
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.
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.
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.
Gates Foundation.

PMID:
42753772
Bibliographic data and abstract were imported from PubMed on 18 Sep 2026.

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