Burden of Chronic Obstructive Pulmonary Disease and Its Attributable Risk Factors in China from 1990 to 2021, with Projections to 2050: An Analysis of Data from the Global Burden of Disease Study

Min Liu^1*Shuoshuo Wei²Xin Yang³Zhuoyuan Lu⁴Wanwan Zhang²Emmanuel Mensah²Lei Zha²Yun Zhou³

• ¹Department of Graduate School of Bengbu Medical University, Bengbu Medical College, Bengbu, China
• ²Yijishan Hospital of Wannan Medical College, Wuhu, China
• ³Wuhu Hospital Affiliated to East China Normal University, Wuhu, China
• ⁴Lanzhou University, Lanzhou, China

This is a provisional file, not the final typeset article Background: Chronic Obstructive Pulmonary Disease (COPD) has become the third leading cause of death worldwide. This disease not only results in high mortality rates but also triggers substantial medical expenditures, significant loss of labor productivity, and a marked decline in patients' quality of life. Despite its severity, COPD is a preventable condition and has now emerged as a significant public health burden that cannot be overlooked. This study aimed to assess the burden of COPD and its attributable risk factors from 1990 to 2021 and to project trends through 2050, to provide an evidence basis for the development of a comprehensive COPD prevention and treatment strategy in China. Methods: Data were extracted from the Global Burden of Disease (GBD) 2021 study, including COPD-related incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Age-standardized rates (ASRs) were calculated, and temporal trends were analyzed using estimated annual percentage change (EAPC) through linear regression modeling. A Bayesian age-period-cohort (BAPC) model was used to forecast trends up to 2050. Results: In 2021, China recorded 50.6 million prevalent COPD cases, 4.4 million incident cases, 1.29 million deaths, and 23.6 million DALYs. Between 1990 and 2021, the age-standardized incidence rate (ASIR) declined from 271.2 to 215.6 per 100,000 population; the age-standardized prevalence rate (ASPR) from 2,761.8 to 2,499.4 per 100,000; age-standardized mortality rate (ASMR) from 231.8 to 73.2 per 100,000; and age-standardized DALYs (ASDALYs) from 3,852.6 to 1,227.7 per 100,000. These reflect relative reductions of 20.5%, 9.5%, 68.4%, and 68.1%, respectively. Conclusions: Despite substantial reductions in the COPD burden over the past three decades, the disease continues to pose a major health challenge in China, particularly among the aging population. Projections to 2050 indicate continued, though uneven, declines. These findings underscore the urgent need for strengthened diagnostic capacity, risk-targeted prevention efforts, and more effective long-term management strategies tailored to China's aging population.