Chronic Obstructive Pulmonary Disease Across Three Decades: Trends, Inequalities, and Projections from the GBD 2021 Study

Yan Wang Ruiyang Han 晓 丁 Wenjia Feng Runguo Gao ^* Anning Ma ^*

• Shandong Second Medical University, Weifang, China

Objective: To assess the global burden of chronic obstructive pulmonary disease (COPD) and cross-country inequalities from 1990 to 2021 and project changes until 2045. Methods: Data on prevalence, mortality, and disability-adjusted life-years (DALYs) for COPD were extracted from the 2021 Global Burden of Disease Study(https://vizhub.healthdata.org/gbd-results/). Trends were analyzed globally, regionally, and nationally, considering population growth, aging, and epidemiological changes. Inequalities were quantified using the World Health Organization's health equity framework. Future projections were estimated to 2045. Results: From 1990 to 2021, global age-standardized rates of COPD prevalence, mortality, and DALYs declined annually by -0.04%, -1.75%, and -1.71%, respectively. However, absolute cases, deaths, and DALYs increased by 112.23%, 49.06%, and 40.23%, driven by population growth and aging. Men consistently showed higher agestandardized rates. East Asia reported the highest absolute cases and deaths, while South Asia had the largest DALYs. High-income North America and Oceania had the highest age-standardized rates, while Australasia and Eastern Europe saw the steepest declines in prevalence and mortality, respectively. Disparities in COPD burden across sociodemographic index levels widened over time. By 2045, absolute numbers of COPD cases, deaths, and DALYs are projected to rise despite declining agestandardized rates.While global age-standardized rates of COPD prevalence, mortality, and DALYs have declined, the absolute burden has increased due to demographic shifts. Persistent disparities in COPD burden, particularly in low-and middlesociodemographic index regions, underscore the need for targeted prevention and management strategies.