The Study for Asthma in Older Adults: a combined analysis of the effects of Occupational Asthmagens, High Body-Mass Index and Smoking

Jia-Qi Wang¹Yuan-Yu Liang¹Zhong-Xue Zhao¹Wei Xie²Wan-Ning Sun¹Ji-Yu Zou¹Xiao-Dong Lv¹Youfu He^3*Li-Jian Pang^1*

• ¹Liaoning University of Traditional Chinese Medicine, Shenyang, China
• ²Tianjin University of Sport, Tianjin, China
• ³Guizhou Provincial People's Hospital, Guiyang, China

Background: Asthma remains a significant public health challenge globally, particularly among older adults who face diagnostic complexity, atypical symptom profiles, and frequent comorbidities. Despite global advances in asthma control, little attention has been paid to the evolving composition and geographic disparity of modifiable risk factors in this age group.Methods: We utilized data from the Global Burden of Disease Study 2021 to evaluate the long-term trends in asthma burden attributable to high bodymass index (BMI), smoking, and occupational asthmagens among adults aged 60 years and older. Key metrics included age-standardized mortality rates (ASMR), agestandardized DALY rates (ASDR), and estimated annual percentage change (EAPC).Stratified analyses were conducted across Socio-demographic Index (SDI) quintiles, gender, and detailed 5-year age subgroups (60-64 to ≥95 years) to assess disparities across socioeconomic development, gender, and aging patterns, with additional stratification by geographic region.Results: From 1990 to 2021, asthma burden attributable to smoking and occupational asthmagens among older adults declined globally, while high BMI-related burden increased in several middle and low SDI regions. In terms of attribution proportion, the proportion of asthma deaths attributable to high BMI increased from 10.89% to 14.4%, with this upward trend being particularly pronounced in high SDI regions. Occupational asthmagens-related burden showed limited decline and remained elevated in low SDI regions. Gender-stratified analysis showed that the risk burden of smoking was higher in older men in Asia, whereas the high BMI-related burden was higher in women in more developed regions.This study demonstrates a structural shift in the composition of asthma risk factors among older adults, with high BMI emerging as a dominant contributor amid declining traditional behavioral risks such as smoking. There are significant differences among regions, age groups and genders. Targeted, regionspecific strategies are essential to address these evolving risks and reduce inequities in asthma burden among aging populations.