Trends in upper respiratory infection burden among children and adolescents in East Asia, 1990 to 2023, with projections to 2035: An observational study based on the Global Burden of Disease 2023

To evaluate temporal trends in upper respiratory infection (URI) burden among children and adolescents in East Asia from 1990 to 2023 and project trajectories through 2035 using Global Burden of Disease 2023 data. URI incidence, mortality, and disability-adjusted life years (DALYs) for ages 5 to 19 years were extracted for China, DPR of Korea, Japan, Mongolia, Republic of Korea, and globally. Age-standardized rates (age-standardized incidence rate, age-standardized mortality rate, and age-standardized DALYs rate [ASDR]) and estimated annual percentage change were used to assess temporal trends. The socio-demographic index evaluated burden relative to development. Decomposition, age-period-cohort, and Bayesian APC (BAPC) analyses quantified drivers and projected trends through 2035. In 2023, Japan had the highest age-standardized incidence rate (253,071.04 per 100,000) and Mongolia the lowest (105,719.25 per 100,000). Age-standardized mortality rate declined significantly across all countries, most markedly in China (EAPC = −10.97). Burden was greatest at ages 5 to 9 and slightly higher in males. Japan and Republic of Korea showed ASDR substantially exceeding socio-demographic index -expected levels (eff_diff = 43.09 and 37.31). Globally, absolute DALYs increased, driven by population growth and age structure change, partially offset by epidemiological improvement; in East Asian countries, epidemiological improvement was the primary driver of DALYs reduction. Cohort analysis showed generational risk reduction, with a transient period-effect upturn in China during 2019 to 2023. BAPC projections indicate continued global ASDR decline through 2035, rising trends in Japan and Democratic People’s Republic of Korea, and a rebound followed by a plateau in China. URI burden among East Asian children and adolescents has broadly declined but with marked country heterogeneity; Japan and Republic of Korea bear a disproportionately high burden relative to their development level, highlighting the need for targeted prevention strategies.