Burden of Chronic Obstructive Pulmonary Disease in China: A Global Burden of Disease Study on Temporal Trends, Risk Factor Contributions, and Projected Disease Burden from 1990 to 2030

Chronic obstructive pulmonary disease (COPD) is a major public health issue in China, but comprehensive studies on its long-term trends, risk factors, and future projections are limited. This study aimed to assess the COPD burden in China from 1990 to 2021, analyze risk factor contributions across demographic subgroups, and project future trends through 2030 to inform public health interventions. Data from the Global Burden of Disease Study 2021 were analyzed for incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Joinpoint regression was used to calculate age-standardized rates, population attributable fractions (PAFs) assessed risk factor contributions, and ARIMA modeling projected future trends. From 1990 to 2021, the age-standardized incidence, prevalence, mortality, and DALYs rates of COPD showed a declining trend, while the absolute burden increased due to population growth and aging. Men had a higher overall disease burden, but since 2015, women have shown higher age-standardized prevalence. The highest burden was observed in the ≥80 age group, with a worrying rise in age-standardized mortality in the 20-24 age group. Smoking was a major risk factor for men, while ambient particulate matter pollution had a greater impact on women and younger adults (30-34 years). Projections suggest a decreasing trend for most age groups, while the 30-39 and ≥80 age groups will experience an increase in age-standardized incidence rates. These findings highlight the need for targeted public health strategies focusing on tobacco control, air pollution, and climate-related exposures, with emphasis on age and sex differences.