Global burden of lower respiratory infections attributable to cytomegalovirus, 1990-2021: a systematic analysis from the MICROBE database.

Objectives: This study aimed to investigate the global epidemiological characteristics and disease burden of lower respiratory infections (LRIs) attributable to cytomegalovirus (CMV) from 1990 to 2021. Methods: We systematically assessed the global burden and temporal trends of CMV-associated LRIs across different ages, sexes, geographic regions, and socioeconomic statuses using data from the MICROBE database spanning 1990-2021. Key metrics included mortality, disability-adjusted life years (DALYs), and their corresponding age-standardized rates (ASRs). Results: Globally, the number of DALYs due to CMV-attributed LRI decreased from an estimated 734,208 (95% UI: 612,175-856,241) in 1990 to 530,465 (95% UI: 469,046-591,884) in 2021, while the number of deaths increased from 16,141 (95% UI: 14,247-18,034) to 19,235 (95% UI: 17,204-21,266) over the same period. The age-standardized DALY rate (ASDR) declined from 13.89 (95% UI: 11.86-15.93) in 1990 to 6.95 (95% UI: 6.08-7.83) in 2021. Similarly, the age-standardized mortality rate (ASMR) dropped from 0.40 (95% UI: 0.35-0.44) to 0.24 (95% UI: 0.21-0.27). In 2021, the disease burden was highest in regions with low Socio-demographic Index (SDI). From 1990 to 2021, both ASMR and ASDR for CMV-attributable LRI decreased as SDI increased, and projections indicate a continued decline over the next 30 years. Conclusions: The global burden of CMV-attributable LRI has declined significantly from 1990 to 2021. However, targeted and cost-effective interventions are urgently needed to prevent and reduce the burden of CMV-associated LRI, particularly in low-SDI regions, children, and the elderly.