Objective  To analyze the current disease burden of fungal lower respiratory tract infection (LRTI) in China from 1990 to 2021 and predict its future trends, in order to provide reference for formulating prevention and control strategies for fungal LRTI.

Methods  Data on the disease burden of fungal LRTI in China from 1990 to 2021 was obtained from the Global Burden of Disease Study 2021 (GBD 2021) database, including mortality and disability-adjusted life year (DALY). Age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were calculated using the age-standardization method, and the time trend of the disease burden of fungal LRTI was analyzed using the Joinpoint regression model. The annual percent change (APC) and average annual percent change (AAPC) and their 95% confidence intervals (CI) were calculated. The impacts of aging, population growth and epidemiological changing trend on the disease burden of fungal LRTI were evaluated through decomposition analysis, and the disease burden of fungal LRTI from 2022 to 2036 was predicted using the autoregressive integrated moving average model (ARIMA).

Results  In 2021, the number of deaths due to fungal LRTI in China was 3 856 (95%CI: 3 126-4 831), with an ASMR of 0.237/100 000; the DALY was 71 006 person-years, and the ASDR was 4.374/100 000. The ASMR (AAPC=-3.682, 95%CI: -4.033- -3.331) and ASDR (AAPC=-5.025, 95%CI: -5.353- -4.695) of fungal LRTI in China from 1990 to 2021 showed a general downward trend, but they increased slightly from 2019 to 2021 (APC:4.61 and 5.50, respectively). The age distribution of the disease burden of fungal LRTI in China from 1990 to 2021 was U-shaped, with higher disease burden in individuals under 9 years old and over 50 years old, and the disease burden was significantly higher in males than that in females. Decomposition analysis showed that aging and population growth drove the increase in the disease burden of fungal LRTI in China, while the epidemiological changing trend slowed down this trend. The prediction results showed that the ASMR and ASDR of fungal LRTI in China from 2022 to 2036 were both on the rise.

Conclusion  The disease burden of fungal LRTI in China from 1990 to 2021 showed a general downward trend, but it has increased in recent years and may continue to worsen in the future. Personalized prevention and intervention measures should be implemented according to different age groups and gender characteristics to reduce the disease burden of fungal LRTI in China.

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