Global burden of respiratory infections and tuberculosis attributable to risk factors, 1990-2021: demographic and SDI analysis.

INTRODUCTION: Respiratory infections and tuberculosis are leading causes of global morbidity and mortality; yet comprehensive research on their associated risk factors remains limited, hindering the development of effective preventive strategies. METHODOLOGY: The 2021 Global Burden of Disease data from 204 countries (1990-2021) was used to measure deaths, disability-adjusted life years (DALYs), and their age-standardized rates (ASMR and ASDR) tied to 9 risk factors. The trends were analyzed by age, gender, and socio-demographic index (SDI) regions, with annual and average annual percentage changes (APC, AAPC) used to track changes over time. RESULTS: Globally, mortality rates (ASMR) for respiratory infections and tuberculosis linked to traditional risks-malnutrition, air pollution, and alcohol use-declined significantly; annual decreases of 4.46%, 3.18%, and 3.35%, respectively. Deaths attributed to metabolic risks like high BMI and blood sugar increased, despite falling ASMR. Geographic disparities were notable: Lesotho saw the sharpest rise in BMI-related mortality (3.92%), while Hungary had the steepest decline (-7.4%). Men faced a higher burden from behavioral risks, with tobacco-related mortality 3.6 times higher than in women. Children under 5 years were especially vulnerable to environmental risks, with unsafe water and sanitation contributing to a 4.55% annual decline in mortality rates. CONCLUSIONS: This study highlights the need for targeted actions, such as tobacco control in high-middle SDI regions, air quality improvements in South Asia, and nutrition programs in Sub-Saharan Africa. It offers a precise public health framework to reduce respiratory infections and tuberculosis, and promote global health equity by analyzing sociodemographic and time trends.