Global trends and future projections of COPD burden under low-temperature risk: a 1990–2041 analysis based on GBD 2021

Low temperatures are an important risk factor for chronic obstructive pulmonary disease (COPD). However, trends and projections of the global burden of COPD at low temperatures are unclear. Based on data from the 2021 Global Burden of Disease Study (GBD), this study assessed trends in the global and regional burden of death and disability-adjusted life years (DALYs) due to COPD from 1990 to 2021, and identified patterns of change in different regions. A Bayesian Age-Period-cohort (BAPC) model was used to predict the burden of COPD over the next 20 years. Although the number of COPD deaths worldwide in 2021 increased from 242,170 in 1990 to 300,849, and the number of DALYs increased from 4,749,734 to 4,981,981, the age-standardized deaths rate decreased from 7.04 to 3.69 per 100,000, and the DALYs rate decreased from 126.69 to 59.22 per 100,000. Up to 2021, men consistently bore a higher burden than women, though their age-standardized deaths rate declined more sharply (54.2% vs. 39.2%). COPD burden increased notably after age 45, with those aged 65 and older contributing most to the total and showing the steepest rise. By SDI level, middle and middle-high SDI regions had the highest burden but saw the fastest declines, while low and low-middle SDI areas carried heavier burdens with slower reductions. High SDI regions maintained low and stable burden levels. BAPC projections suggest a continued but slower decline in COPD mortality linked to low temperature by 2041, with a projected drop of 1.39 per 100,000, less than the 3.35 per 100,000 reduction observed from 1990 to 2021. Global age-standardized mortality and DALYs for COPD at risk of low temperatures have declined over the past 30 years, with absolute burden numbers, BAPC predicting a slower rate of decline in the future, and persistent cross-country health inequalities. More precise interventions should be developed to target the resistance to low-temperature risk in older age groups and areas with low SDI.