Long-term burden, trends, and inequality of lower respiratory infections attributable to Mycoplasma pneumoniae among children and adolescents in low- and middle-income countries, 1990-2023: a Global Burden of Disease Study 2023 analysis.

BACKGROUND

Mycoplasma pneumoniae (M. pneumoniae) is an under-recognised contributor to paediatric lower respiratory infection (LRI) burden in low- and middle-income countries (LMICs), where progress in child survival remains uneven and pneumonia control continues to be shaped by international child-health targets, including the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD). This study aimed to quantify the fatal and non-fatal burden of LRIs attributable to M. pneumoniae among individuals aged 0-19 years in LMICs from 1990 to 2023.

METHODS

Using estimates from the Global Burden of Disease (GBD) Study 2023 for 93 LMICs, we extracted deaths, disability-adjusted life years (DALYs), and corresponding rates for LRIs attributable to M. pneumoniae, using GBD population estimates as denominators. Analyses were stratified by age, sex, socio-demographic index (SDI), and geographic region. Temporal trends were assessed using joinpoint regression and summarised by average annual percentage changes. Inequality, decomposition, and frontier analyses were conducted to evaluate socioeconomic gradients, drivers of change, and performance gaps.

RESULTS

In 2023, M. pneumoniae accounted for an estimated 24,019 deaths and 2,098,712 DALYs among children and adolescents in LMICs. The burden was heavily concentrated in low-SDI regions, with mortality and DALY rates approximately three to four times higher than those in middle-SDI regions. Western Sub-Saharan Africa had the highest regional burden. Infants (<1 year) accounted for the highest proportion of severe outcomes, with notable sex-based variations across SDI groups. From 1990 to 2023, mortality and DALY rates declined significantly, but the pace of improvement slowed around 2010-2016 in several settings. In low-SDI regions, population growth contributed +110,933 DALYs and age-structure change contributed approximately +60,144 DALYs, whereas epidemiological improvement contributed -117,946 DALYs, yielding a net increase of about +53,131 DALYs. Frontier analysis identified substantial health-system efficiency gaps, particularly in Sub-Saharan Africa.

CONCLUSIONS

M. pneumoniae is a major and inequitably distributed contributor to the LRI burden among children and adolescents in LMICs, with the highest risk in infancy and in low-resource settings. The 2023 estimates should be interpreted in the context of the emerging post-pandemic resurgence. Accelerated progress will require earlier diagnosis, stronger community-to-facility pneumonia care pathways, and regionally adapted antimicrobial stewardship.