The Burden of COPD in China and its Provinces: Findings from the Global Burden of Disease Study 2019

Background: In China, chronic obstructive pulmonary disease (COPD) was accounted for a quarter of the global COPD population and has become a large economic burden. However, the comprehensive picture of the COPD burden, is not readily available for all of the provinces of China.  Methods: Using the GBD 2019, we analyzed the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) attributable to COPD across China and the corresponding time trends from 1990 to 2019, stratified by age and province. We also presented the contribution of risk factors to COPD-related mortality and DALYs.  Findings: The absolute numbers of incidence and prevalence of COPD increased in 2019 as compared to in 1990, whereas the number of deaths and DALYs owing to COPD decreased from 1990 to 2019. The age-standardized rates (ASRs) of COPD burden continuously decreased from 1990 to 2019. The crude rates of COPD burden dramatically increased with age, and reached a peak at the age group of older than 95 years. In 2019, smoking was the most common risk factor for COPD mortality and DALYs in the whole population, but the most significant risk factor in females was ambient particulate matter pollution. At the provincial level, the ASRs of COPD burden were significantly associated with the SDIs, with the highest ASRs in the western provinces with low SDIs.  Interpretation: China has a disproportionately high burden of COPD, suggesting that geographically targeted considerations should be developed to enhance COPD health and reduce the COPD burden throughout China and in specific provinces. Funding: This work is supported by the Guangdong Basic and Applied Basic Research Foundation (No. 2020B1515020004, No. 2021A1515011056), the National Natural Science Foundation of China (81873404); Project of Young Innovative Talents in Colleges and Universities in Guangdong Province (No. 2018KQNCX095), Affiliated Hospital of Guangdong Medical University Clinical Research Program (LCYJ2018C001, LCYJ2019B011). Declaration of Interest: We declare no competing interests.