Group A Streptococcus-Attributable Mortality and Disability in Asian Adults Aged 60 Years and Older: Global Burden of Disease Study 2023 and Projections to 2050

Abstract

Background: Group A Streptococcus (GAS) remains a leading cause of preventable mortality and disability among older adults, yet its long-term epidemiological trajectory in Asia’s rapidly ageing populations remains poorly characterised. Methods: Data on GAS-attributable deaths and disability-adjusted life years (DALYs) among adults aged 60 years and older were extracted from the Global Burden of Disease Study 2023 (rei_id 630, all causes [cause_id 294]; within which the attributable burden at ages ≥60 is carried by lower respiratory infections [cause_id 322]) for 34 Asian countries from 1990 to 2023, aggregated into five GBD-defined subregions. Temporal trends were assessed using Joinpoint regression, and future burdens from 2024 to 2050 were projected using a Bayesian age-period-cohort (BAPC) model with retrospective validation and sensitivity analysis. Estimates are reported as age-standardised rates per 100,000 population with 95% uncertainty or prediction intervals. Results: In 2023, the highest age-standardised death rates were observed in Singapore (3.31 per 100,000 [95% UI, 2.61–3.91]), Lao PDR (3.19 [95% UI, 2.20–4.49]), and Taiwan (2.89 [95% UI, 2.47–3.32]), whereas the lowest were in Kyrgyzstan (0.15 [95% UI, 0.13–0.18]) and Turkmenistan (0.19 [95% UI, 0.16–0.22]). From 1990 to 2023, age-standardised death rates increased most markedly in Central Asia (average annual percentage change [AAPC], 3.63% [95% CI, 3.41–3.85%]) and Southeast Asia (AAPC, 3.09% [95% CI, 2.87–3.31%]), while East Asia showed minimal change (AAPC, 0.06% [95% CI, −0.04% to 0.16%]); East Asia was the only subregion with declining DALY rates (AAPC, −0.82% [95% CI, −0.93% to −0.71%]). Males experienced higher death rates than females in all subregions except South Asia (male-to-female ratio 0.98–1.96). Decomposition showed that years lived with disability contribute 0.07–0.90% of GAS-attributable DALYs, indicating that the burden is overwhelmingly mortality-driven. BAPC projections to 2050 indicate a divergent future: death rates in Central Asia are projected to show the largest relative increase, from 0.53 to a median of 2.46 per 100,000 by 2050 (95% PI, 0.93–6.43; +364%), albeit with substantial uncertainty and with retrospective validation indicating that prediction intervals may be underestimated in this subregion; High-income Asia Pacific is projected to retain the highest absolute burden (2.10 to 2.77 per 100,000 [95% PI, 1.18–6.37]); Southeast Asia (0.98 to 1.13 per 100,000 [95% PI, 0.40–3.16]), East Asia (0.40 to 0.49 per 100,000 [95% PI, 0.18–1.41]) and South Asia (0.55 to 0.39 per 100,000 [95% PI, 0.11–1.30]) are projected to change modestly. For DALYs, Central Asia is projected to experience the largest increase (9.78 to a median of 43.49 per 100,000 [95% PI, 15.68–129.46] by 2050), followed by High-income Asia Pacific (24.98 to 28.55 per 100,000 [95% PI, 12.39–68.01]). Conclusions: Asia’s ageing populations face divergent GAS-attributable health burdens. Central Asia is projected to face the largest relative increase in mortality and DALYs by 2050, accompanied by substantial, possibly under-quantified uncertainty, while High-income Asia Pacific carries the highest absolute burden throughout the projection period. These findings underscore the need for targeted prevention strategies, including GAS vaccine development, with particular attention to Central Asia and other rapidly changing subregions of Asia.