Machine learning insights into the burden and risk factors of lower respiratory infections in East Asia (1990–2033)
Xian Su, Wu Xu, Wenwen Lv, Jinxin Zheng, Yuebin Wang, Tingting Wu, Li Sun, Huirong Hu, Yiping Liu, Yaolin LiObjectives
This study quantified trends in the burden of lower respiratory infections from 1990 to 2023 in five East Asian countries, projected disease trajectories from 2024 to 2033 using machine learning, and identified key risk factors and their associations with the sociodemographic index.
Methods
Based on the Global Burden of Disease Study (2023) estimates, we calculated the age-standardized incidence, prevalence, mortality, and disability-adjusted life year rates of lower respiratory infections for five East Asian countries. A multistage machine learning framework with Shapley additive explanations was used to screen exposure-related risk factors, and machine learning time-series models were used to project the future burden of lower respiratory infections.
Results
Lower respiratory infection incidence and prevalence declined universally; however, mortality trends were heterogeneous (rising in South Korea and falling in others). China demonstrated the largest reduction in incidence. Mongolia demonstrated the steepest decline in prevalence; however, it continued to have a high burden of disability-adjusted life years in 2023. Exposure to secondhand smoke was the most important risk factor, whereas zinc/iron deficiency prevailed in low sociodemographic index settings; the lower respiratory infections burden had a nonlinear inverse association with the sociodemographic index, with population aging as a key driver. Projections demonstrated a continued decline in the overall burden of lower respiratory infections, although mortality rates were projected to increase in South Korea.
Conclusion
The burden of lower respiratory infections has reduced substantially in East Asia over three decades; however, population aging has resulted in divergent mortality trends. High-sociodemographic index regions require age-responsive, integrated strategies targeting both exposure reduction and host vulnerability to sustain declines in mortality rates.