To systematically compare the differences and temporal trends in the burden of lower respiratory infections (LRIs) between China and G20 countries from 2010 to 2023, and to provide scientific evidence for the formulation of targeted prevention and control strategies.

Data on incidence, mortality, and disability-adjusted life years (DALYs) of LRIs in China and G20 countries during 2010-2023 were extracted from the Global Burden of Disease (GBD) 2023 database. Statistical analysis was conducted using R software (version 4.4.2), and the estimated annual percentage change (EAPC) was calculated based on a log-linear regression model to assess time trends. Decomposition analysis was applied to quantify the contributions of population growth, population aging, and epidemiological changes to disease burden. The attributable proportions and temporal variations of major risk factors were also evaluated.

From 2010 to 2023, the burden of lower respiratory infections showed a significant downward trend in both China and G20 countries, with a faster decline observed in China for mortality and DALYs (EAPCs: -5.29 and-8.66 vs-3.17 and-4.07, respectively). Decomposition analysis indicated that epidemiological changes were the primary driver of the reduction in disease burden, while population aging and growth exerted relatively limited positive effects. Risk factor analysis revealed that air pollution and tobacco exposure were the major attributable factors. In China, the proportion attributable to ambient particulate matter pollution showed an increasing trend, whereas that attributable to household solid fuel pollution decreased significantly. Children (<5 years) and older adults (≥75 years) were identified as the key populations bearing the disease burden, with males having a slightly higher burden than females.

The burden of lower respiratory infections in China has declined more rapidly than the G20 average; however, the impacts of ambient particulate matter pollution and tobacco exposure have become increasingly prominent. Strengthening air quality management and tobacco control measures, with particular focus on protecting children and the elderly, is essential to further reduce the disease burden.