Global, regional and national temporal trends in prevalence deaths and disability-adjusted life years for chronic pulmonary disease, 1990–2021: an age-period-cohort analysis based on the Global Burden of Disease Study 2021

Caobing Wu Jun Zhen Qun Li ^* Dabin Guo Xianzhi Fan Guoning Zhu Xiao Yuan

• People's hospital of Longyou, Quzhou, China

This study analyzes global trends in chronic obstructive pulmonary disease (COPD) burden using data from the Global Burden of Disease Study 2021 across 204 countries, stratified by Sociodemographic Index (SDI). Through age-period-cohort (APC) modeling, we assessed prevalence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021.Globally, age-standardized rates declined by -1.46% (95% UI: -3.36% to 0.39%) for prevalence, -37.12% (-43.37% to -27.68%) for deaths, and -36.98% (-42.37% to -28.54%) for DALYs. After adjusting for age/cohort effects, annual reductions accelerated to -3.87% (-4.00% to -3.74%) for mortality and -2.95% (-3.02% to -2.89%) for DALYs. Notably, middle/low SDI regions exhibited increased age-standardized prevalence (up 6.71% [4.25-8.91%] in low SDI), contrasting with universal mortality/DALY declines across all SDI strata.Age effects dominated COPD epidemiology: 50%+ of global prevalence involved adults ≥65 years, particularly in middle/high-middle SDI regions. Period effects revealed higher historical burdens in early study periods, while cohort analysis identified 1920s-born populations as high-risk groups. These patterns showed significant geographic heterogeneity, with high-middle/middle SDI countries disproportionately influenced by period effects.Despite global mortality/DALY reductions of >36% since 1990, 2021 prevalence remained stable or increased in 50%+ countries. Socioeconomic development mitigated cohort-related risks, yet population aging exacerbated disease burden. The findings underscore persistent disparities, with middle/low SDI regions experiencing rising prevalence alongside inadequate healthcare capacity.This study highlights the dual challenge of aging populations and uneven development in COPD management. Prioritizing prevention in middle/low SDI countries and addressing cohort-specific risks through targeted interventions are critical for achieving equitable global COPD control.