Left Behind in the Asthma Transition: The Child-Specific Inequality Penalty in the Global Burden of Asthma at Ages 0–24 Years, 1990–2023

Asthma accounts for the great majority of the chronic respiratory disease burden below 25 years of age, yet pediatric analyses based on the Global Burden of Disease (GBD) 2021 round terminate in 2021, predating the full COVID-19 period. We extracted estimates from the GBD Results Tool, GBD Study 2023, and aggregated six measures (prevalence, incidence, deaths, disability-adjusted life-years [DALYs], years lived with disability, and years of life lost) across ages 0–24 years for 204 countries and territories, 21 GBD regions, and five Socio-demographic Index (SDI) quintiles, with 95% uncertainty intervals (UIs); trends were quantified as estimated annual percentage changes (EAPCs). In 2023, an estimated 150,837,112 (95% UI 103,730,853–218,576,263) individuals aged 0–24 years were living with asthma, with 22,126 (15,409–32,090) deaths and 7,753,206 (5,069,966–11,580,326) DALYs. Between 1990 and 2023, prevalent cases rose by 23.1% while the age-standardized prevalence rate was stable (EAPC +0.01, 95% confidence interval −0.04 to +0.05) and mortality declined (EAPC −1.56); during 2019–2023, prevalence rose significantly (EAPC +1.07, +0.63 to +1.52) and deaths increased by 3.78%. Low-SDI countries concentrated 55.3% of asthma deaths at these ages; the male-to-female ratio of deaths converged from 1.758 (1990) to near parity (1.017; 2023). A country-level case-fatality proxy varied 1,446-fold across 178 countries, and reducing every country’s proxy to the best-quartile threshold would avert an estimated 91.0% of under-20 asthma deaths. Case numbers continue to grow while age-standardized prevalence remains flat, and mortality remains concentrated where health systems are weakest; priorities include inhaled-corticosteroid access in low-SDI settings, surveillance of adolescent girls and young women, and protection of chronic respiratory care continuity in pandemic preparedness.