Burden of chronic obstructive pulmonary disease and risk factors in China from 1990 to 2021: Analysis of global burden of disease 2021

Background: Chronic obstructive pulmonary disease (COPD) is a common chronic disease that imposes tremendous burdens on the general populations in China and other countries worldwide. A comprehensive understanding of the contemporary epidemiological landscape of COPD is crucial for formulating effective prevention and control strategies. This study was designed to systematically evaluate the temporal trends in COPD burden and its associated risk factors in China over recent decades, providing evidence-based insights for targeted interventions. Methods: We conducted a comprehensive analysis of the Global Burden of Disease (GBD) 2021 dataset to systematically evaluate COPD epidemiology in China from 1990 to 2021. Our study quantified key disease burden indicators including incident cases, prevalent cases, deaths, and disability-adjusted life years (DALYs), along with their corresponding crude rates and age-standardized rates, while examining their temporal trends. Furthermore, we stratified these metrics by demographic characteristics (sex and age groups) and assessed the population attributable fractions of major risk factors for COPD in the Chinese population. Results: In 2021, China had an estimated 4.43 (95 % uncertainty interval [UI]: 4.01-4.86) million incident COPD cases and 50.59 (95 % UI: 44.98-57.12) million prevalent cases, accounting for nearly one-quarter of COPD prevalent cases worldwide. The crude COPD incidence and prevalence rates in China were 311.68 (95% UI: 281.75-341.62) per 100,000 and 3555.69 (95% UI: 3161.20-4014.55) per 100,000, respectively. Nearly 1.29 (95 % UI: 1.04-1.54) million individuals died from COPD, representing 10.99 % of deaths in China, and the crude mortality rate was 90.35 (95 % UI: 73.43-108.23) per 100,000. The DALYs were estimated at 23.64 (95 % UI: 20.00-27.92) million person years and the crude DALYs rate was 1661.60 (95 % UI: 1405.64-1962.54) per 100,000. The age-specific COPD incidence and prevalence rates increased substantially at 40 years of age and continued to rise thereafter. The mortality and DALY rates increased tremendously in elderly population. Sex disparities existed in the mortality and DALY rates, with both being markedly higher in men than in women, particularly among older adults aged > 60 years, indicating non-optimal disease management in this population subgroup. Smoking was the leading risk factor for COPD deaths and DALYs, followed by particulate matter pollution and occupational exposure. The age-standardized rates for all metrics decreased substantially from 1990 to 2021, especially the mortality and DALY rates with decreases of 68.40 % and 68.13 %, respectively. Nevertheless, the numbers of incident and prevalent COPD cases increased, with both having doubled in 2021 compared with those in 1990. Conclusions: While the age-standardized rates for COPD incidence, prevalence, mortality, and DALYs decreased over the three decades, the number of individuals with COPD continued to rise, imposing an overwhelming burden on the Chinese population. The rapidly aging general population and population growth might be driving forces. Elderly men were a high-risk population subgroup for COPD deaths and poor quality of life. The disease burden was primarily attributed to smoking and particulate matter pollution, highlighting a need for effective preventive measures and better disease management.