Global, regional and national trends in burden of chronic obstructive pulmonary disease (COPD) from 2000 to 2021 and the prediction for 2030: An analysis of the Global Burden of Disease Study 2021

<b>Background</b> Chronic obstructive pulmonary disease (COPD) has been becoming a great public health concern worldwide. However, few studies employed retrospective and predictive approaches to assess the global burden of COPD. Thus, this study aimed to estimate the global burden of COPD by age, gender and socioeconomic status in the past decades of this century, and then make a prediction to 2030.<b>Methods </b>The data analyzed in this study were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The outcome variables, the disease burden of COPD, referred to absolute numbers of COPD case and age-standardized rates (ASRs) per 100,000 individuals per year. The temporal trends from 2000 to 2021 were examined using Joinpoint models. And, Bayesian age-period-cohort models were introduced to project the burden of COPD to 2030. Finally, a decomposition analysis was conducted to reveal the contributions of aging, population growth and epidemiological changes to trends in COPD burden.<b>Results</b> From 2000 to 2021, absolute numbers of incident cases, prevalent cases, deaths and disability-adjusted life years (DALYs) for COPD continued to increase at the global level. However, ASRs of incidence, prevalence, deaths and DALYs decreased, and, moreover, such a declining trend would continue to 2030. Additionally, in 2021, the ASR of COPD burden was higher in males than females, and the rate increased with age among global population. Interestingly, the disease burden varied significantly across different regions, with a comparatively high burden in low socio-demographic index region. Decomposition analysis revealed that the increasing burden of COPD was primarily driven by rapid aging and population growth.<b>Conclusions</b> The global ASRs of COPD burden would continue to decline, but the crude burden would remain increasing to 2030, which was mainly attributed to population aging and growth. This study has significant public health implications that precision intervention strategies shall be initiated for population-based campaigns against COPD with consideration of residents’ age, gender and area as well as economic development.

<b>背景</b> 慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease，COPD）已成为全球范围内备受关注的重大公共卫生问题。然而，目前鲜有研究采用回顾性与预测性结合的方法评估COPD的全球疾病负担。为此，本研究旨在分析本世纪近数十年来按年龄、性别与社会经济状况分层的COPD全球疾病负担，并对2030年的负担情况进行预测。
<b>方法</b> 本研究分析的数据来源于2021年全球疾病、伤害和危险因素负担研究（Global Burden of Diseases, Injuries, and Risk Factors Study，GBD）。本研究的结局变量为COPD疾病负担，具体包括COPD绝对病例数以及每10万人口每年的年龄标化率（age-standardized rates，ASRs）。采用连接点回归模型（Joinpoint models）分析2000年至2021年的时间变化趋势，并引入贝叶斯年龄-时期-队列模型（Bayesian age-period-cohort models）对2030年的COPD疾病负担进行预测。最后，通过分解分析揭示人口老龄化、人口增长与流行病学变化对COPD疾病负担趋势的贡献程度。
<b>结果</b> 2000年至2021年，全球范围内COPD的新发病例数、现患病例数、死亡数以及伤残调整寿命年（disability-adjusted life years，DALYs）均呈持续上升趋势。但COPD的发病、患病、死亡及伤残调整寿命年的年龄标化率均有所下降，且这一下降趋势将持续至2030年。此外，2021年全球男性的COPD负担年龄标化率高于女性，且该比率随年龄增长而升高。值得注意的是，不同地区的COPD疾病负担存在显著差异，低社会人口学指数（socio-demographic index）地区的负担相对较高。分解分析结果显示，COPD负担的增加主要由人口快速老龄化与人口增长所驱动。
<b>结论</b> 未来至2030年，全球COPD疾病负担的年龄标化率将持续下降，但粗疾病负担仍将持续升高，这一现象主要归因于人口老龄化与人口增长。本研究具有重要的公共卫生意义：应针对不同年龄、性别、地区及经济发展水平的人群，制定精准的干预策略，开展基于人群的COPD防控工作。