Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2021: results from the Global Burden of Disease Study 2021

Zhong Cao; Xunliang Tong; Liu He; Yuheng Luo; Ke Huang; Wei Li; Hongtao Niu; Qiushi Chen; Lirui Jiao; Sebastian Vollmer; Blake Thompson; Pascal Geldsetzer; Rifat Atun; Till Bärnighausen; Chen Wang; Ting Yang; Simiao Chen

doi:10.1136/bmjph-2024-002489

Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2021: results from the Global Burden of Disease Study 2021

BMJ Public Health. 2026 Jan 13;4(1):e002489. doi: 10.1136/bmjph-2024-002489. eCollection 2026.

Authors

Zhong Cao¹, Xunliang Tong², Liu He³, Yuheng Luo⁴, Ke Huang⁵, Wei Li⁵, Hongtao Niu⁵, Qiushi Chen⁶, Lirui Jiao⁷, Sebastian Vollmer⁸, Blake Thompson^{9

10}, Pascal Geldsetzer¹¹, Rifat Atun¹², Till Bärnighausen^{1

13}, Chen Wang^{3

5}, Ting Yang⁵, Simiao Chen^{1

3}

Affiliations

¹ Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
² Department of Pulmonary and Critical Care Medicine, National Center of Gerontology, Beijing Hospital, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
³ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
⁴ School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
⁵ Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.
⁶ Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, Illinois, USA.
⁷ Department of Health Policy and Management, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.
⁸ Department of Economics & Centre for Modern Indian Studies, University of Gottingen, Gottingen, Germany.
⁹ Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA.
¹⁰ Stanford University School of Medicine, Stanford, California, USA.
¹¹ Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
¹² Harvard T H Chan School of Public Health, Boston, Massachusetts, USA.
¹³ Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) remains a major global health challenge, contributing significantly to morbidity and mortality. This study aims to provide a comprehensive analysis of the burden of COPD by age, sex and Sociodemographic Index (SDI), in addition to its attributable risk factors across 204 countries and territories from 1990 to 2021.

Methods: This study is a systematic analysis of data from the Global Burden of Disease (GBD) 2021 from 1990 to 2021 across 204 countries and territories. The study calculates age-standardised rates (ASRs) for prevalence, deaths and disability-adjusted life-years (DALYs) by adjusting rates to a global age distribution and computed estimated annual percentage changes (EAPC) for these ASRs and the relative COPD burden, while also exploring the relationships between the SDI and age-standardised DALYs per 1000 population via linear regression.

Results: In 2021, there were an estimated 213.4 million prevalent COPD cases globally, with an ASR of 2512.9 per 100 000. From 1990 to 2021, the EAPC for ASRs in prevalence was -0.044%, while the EAPC for percentage in prevalence was 1.224%. COPD caused 3.7 million deaths, with an ASR of 45.2 per 100 000, and 79.8 million DALYs, with an ASR of 940.7 per 100 000. The leading risk factor for COPD globally was particulate matter pollution, where it accounted for 41.7% of the global DALYs. Appreciable geographical and demographic variations were observed, with North America exhibiting the greatest ASRs for prevalence and South Asia showing the greatest ASRs for death rates.

Conclusions: The study highlights the persistent and evolving global burden of COPD, emphasising the significant impact of environmental factors such as particulate matter pollution. It underscores the need for targeted public health interventions and resource allocation, particularly in low-income and middle-income countries, to mitigate the growing COPD challenge. To enhance COPD management, the recommendations include implementing regional plans to mitigate particulate pollution, strengthening surveillance of air quality and health outcomes, developing integrated health strategies and supporting a global framework for air quality improvement.

Keywords: Epidemiologic Factors; Epidemiology; Public Health.