Global, regional, and national burden of interstitial lung disease in middle-aged and older adults from 1990 to 2021 with projections to 2050: a systematic analysis of the 2021 Global Burden of Disease Study

Abstract

Background: Interstitial lung disease (ILD) constitutes a significant global health challenge. However, existing epidemiological studies predominantly focus on worldwide and regional distribution patterns, while a substantial knowledge gap persists regarding the epidemiological characteristics of ILD among middle-aged and older adults (50-74 years). Therefore, this investigation comprehensively evaluates the disease burden of interstitial lung disease across global, regional, and national levels within the specified population.

Methods: Utilizing data from the 2021 Global Burden of Disease (GBD) study, we employed key age-standardized metrics prevalence rate (ASPR), incidence rate (ASIR), death rate (ASDR), and disability-adjusted life years (DALYs) rate-to quantify the disease burden. Temporal patterns from 1990 to 2021 were assessed using Joinpoint regression analysis, deriving both the annual percentage change (APC) and (AAPC). Frontier analysis benchmarked national regional performance against optimal achievers and projected disease trajectories over the next 25 years.

Results: In 2021, a global total of 2,524,796 prevalent ILD cases occurred among adults aged 50-74 years, concurrent with sustained increases in ASPR, ASIR, ASDR, and DALY rates. Andean Latin America exhibited the highest ASIR, ASDR, and DALY rates, while High-Income Asia Pacific registered the peak ASPR. Uniform upward trajectories in prevalence, incidence, mortality, and DALYs were consistently observed across all age groups during 1990-2021. Joinpoint regression analysis revealed that while ASPR and ASIR increased from 1990 to 2010 but subsequently decreased from 2010 to 2021, conversely, ASDR and DALYs increased from 1990 to 2011 before declining after 2011, frontier analysis highlighted Canada, Ireland, the United States, Japan, and the United Kingdom as nations with significant improvement potential. By 2050, we project that the burden of ILD among middle-aged and elderly populations will remain substantial, with only a slight decline in the ASPR.

Conclusion: Globally, the burden of ILD in middle-aged and older populations exhibits a progressive increase; however, marked geographical variations are evident. The Andean Latin American region exhibits particularly elevated burden rates. Consequently, multifaceted interventions-including air quality improvement, tobacco cessation promotion, enhanced availability of high-resolution computed tomography (HRCT), and increased public health awareness of ILD-represent essential strategies to address this burden.

Keywords: disease epidemiology; forecast; frontal analysis; global disease burden; interstitial lung disease.