National Trends in Clean-Cooking Access Track ILD Burden Across 204 Countries

Researchers linked Global Burden of Disease 2021 estimates with World Bank and WHO indicators for 204 countries over 2000–2021. They examined 23 exposures at multiple time lags using country and year fixed-effects models, with false-discovery-rate correction, and tested results using several sensitivity analyses. The team also projected future burden conditional on past trends.

Global ILD disability-adjusted life years (DALYs) increased from 2.09 million in 2000 to 4.04 million in 2021. Higher clean-cooking access was associated with a 0.93% lower DALY rate per within-country standard-deviation increase, with a 10-year lag (95% CI, 0.34%–1.52% lower; q=0.019). This association persisted with subregion-by-year fixed effects. Higher tuberculosis incidence and societal poverty were also associated with higher rates in some analyses, but the tuberculosis association did not persist after additional adjustments. Trend-conditional projections estimated 6.15 million DALYs in 2050 (95% uncertainty interval, 4.12–9.38).

The analysis is ecological: its national-level associations cannot establish individual-level causation or the effect of interventions. Projections depend on assumptions about continuation of past trends, and country-specific slopes varied. The findings identify potential population-level hypotheses rather than evidence for changing clinical care.