Trends in the Asthma Burden Attributable to High Body Mass Index in Children Across 204 Countries and Territories, 1990-2021: An Analysis of the 2021 Global Burden of Disease Study.

High body mass index (BMI) has been identified as a significant risk factor for childhood asthma. Given the rising prevalence of childhood obesity, assessing the impact of high BMI on asthma burden trends is imperative. Utilizing Global Burden of Disease (GBD) data, we estimated age-, sex-, geography-, and sociodemographic index (SDI)-stratified asthma-related deaths and disability-adjusted life years (DALYs) attributable to high BMI in children (0-14 years old) (1990-2021). Health inequality was assessed by integrating SDI with the slope index of inequality and the relative concentration index. Bayesian age-period-cohort analysis projected asthma burden trends from 2022 to 2035. From 1990 to 2021, global asthma mortality due to high BMI declined, while DALYs rose. Females had higher mortality rates, whereas males exhibited greater DALY burdens. Mortality burden correlated negatively with SDI, whereas DALYs correlated positively. Cross-national inequality analyses revealed higher mortality burdens in low-SDI countries and elevated DALY burdens in high-SDI regions. Frontier analyses indicated greater mortality reduction potential in low-and low - middle - SDI areas and higher DALY mitigation opportunities in high-SDI settings. Projections suggest a continued decline in asthma mortality but a rising DALY trend from 2022 to 2035. These findings highlight persistent sex- and SDI-related disparities and support targeted strategies to reduce the global burden of childhood asthma attributable to high BMI.