Analysis and projection of chronic obstructive pulmonary disease (COPD) burden attributable to air pollution in China, 1990–2021_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Wei ¹ , YIN Yueqin ² ,  XU Shenggang ³ , CAO Yuqing ³ , YUE Nana ³

1. Department of General Practice, Zhangye People’s Hospital Affiliated to Hexi University, Zhangye 734000, P. R. China;
2. Editorial Department of Journal of Hexi University, Zhangye 734000, P. R. China;
3. Department of Preventive Medicine, Hexi University, Zhangye 734000, P. R. China;

Corresponding?author：

XU Shenggang, Email: 45196808@qq.com

Keywords：

Chronic Obstructive Pulmonary Disease; Air Pollution; Mortality Rate; Disability-Adjusted Life Years; Disease Burden

DOI：

10.7507/1672-2531.202504054

Video：

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Objective To analyze the disease burden and temporal trends of chronic obstructive pulmonary disease (COPD) attributable to air pollution in China from 1990 to 2021. Methods Utilizing data from the Global Burden of Disease Study 2021 (GBD 2021), we assessed the burden of COPD attributable to air pollution in China through metrics including death counts, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), age-standardized DALY rate (ASDR), annual percentage change (APC), and average annual percentage change (AAPC). A Bayesian Age-Period-Cohort (BAPC) model was employed to project future trends in COPD burden attributable to air pollution. Results In 2021, China’s ASMR and ASDR for COPD attributable to air pollution were 32.57 and 533.84 per 100,000 population, respectively, exceeding global averages. From 1990 to 2021, both ASMR and ASDR exhibited significant declining trends, with AAPCs of ?5.24% (95% CI ?5.78% to ?4.70%) and ?5.28% (95% CI ?5.75% to ?4.81%), respectively. The burden intensified with advancing age and was disproportionately higher among males compared to females. BAPC projections indicate a continued decline in COPD burden from 2022 to 2035, with ASMR expected to decrease from 56.40 to 23.02 per 100,000 and ASDR from 900.14 to 408.64 per 100,000. Conclusion Despite sustained reductions in the burden of COPD attributable to air pollution in China from 1990 to 2021, with further declines anticipated through 2035, national rates remain elevated relative to global benchmarks. Male and elderly populations bear the highest burden, underscoring the urgency for targeted interventions to mitigate air pollution exposure and address health disparities in vulnerable demographics.

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25.	Landrigan PJ, Fuller R, Acosta NJR, et al. The Lancet commission on pollution and health. Lancet, 2018, 391(10119): 462-512.
26.	Zhang Q, Zheng Y, Tong D, et al. Drivers of improved PM2. 5 air quality in China from 2013 to 2017. Proc Natl Acad Sci USA, 2019, 116(49): 24463-24469.
27.	Pope CA, Ezzati M, Dockery DW. Fine-particulate air pollution and life expectancy in the United States. N Engl J Med, 2009, 360(4): 376-386.
28.	田仁生, 嚴剛, 李娜. 美國清潔空氣戰略規劃. 環境科學研究, 2005, 18(2): 68-69.
29.	李潔. 從“制度”到“生活”: 新中國70年來公共衛生政策演變. 中國公共衛生, 2019, 35(10): 1281-1284.

1. Zhu Y, Shen T, Guo R, et al. Global, regional, and national burden of young COPD, 1990-2021, with forecasts to 2050: a systematic analysis for the global burden of disease study 2021. BMC Public Health, 2025, 25(1): 276.
2. Kahnert K, J?rres RA, Behr J, et al. The diagnosis and treatment of COPD and its comorbidities. Dtsch Arztebl Int, 2023, 120(25): 434-444.
3. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD Executive Summary. Am J Respir Crit Care Med, 2017, 195(5): 557-582.
4. Chen S, Kuhn M, Prettner K, et al. The global economic burden of chronic obstructive pulmonary disease for 204 countries and territories in 2020-50: a health-augmented macroeconomic modelling study. Lancet Glob Health, 2023, 11(8): e1183-e1193.
5. Li M, Hanxiang C, Na Z, et al. Burden of COPD in China and the global from 1990 to 2019: a systematic analysis for the global burden of disease study 2019. BMJ Open Respir Res, 2023, 10(1): e001698.
6. 郭姍姍, 殷征, 萬軍. 1990—2019年中國歸因于固體燃料來源的家庭空氣污染的心血管疾病負擔分析. 中國循證醫學, 2022, 22(12): 1386-1392.
7. Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol, 2020, 76(25): 2982-3021.
8. . 史晨陽. 贛州市環境溫度和空氣污染及其交互作用對COPD死亡風險的研究. 贛州: 贛南醫科大學, 2024.
9. . 吳欣欣. 海口地區氣象因素、空氣污染物與慢性阻塞性肺疾病急性加重的關聯性研究. 海口: 海南醫學院, 2023.
10. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet Neurol, 2021, 20(10): 795-820.
11. Balmes JR. Household air pollution from domestic combustion of solid fuels and health. J Allergy Clin Immunol, 2019, 143(6): 1979-1987.
12. Fan YX, Zhang W, Li W, et al. Global, regional, and national impact of air pollution on stroke burden: changing landscape from 1990 to 2021. BMC Public Health, 2024, 24(1): 2786.
13. 曾四清. Joinpoint 回歸模型及其在傳染病流行趨勢分析中的應用. 中國衛生統計, 2019, 36(5): 787-791.
14. 蔣露, 張志東, 吳建軍, 等. 1990—2021年我國精神障礙疾病負擔分析與預測. 醫學新知, 2025, 35(1): 14-21.
15. 楊明, 汪舒文, 宇傳華. 1990—2019年中國皮膚惡性腫瘤疾病負擔狀況及發病趨勢預測. 中國腫瘤, 2022, 31(11): 853-861.
16. Zhang Z, Wang K, Xu G, et al. Chronic obstructive pulmonary disease burden attributable to tobacco and the trend change from 1990 to 2021 in China. Tob Induc Dis, 2025, 10: 23.
17. Chen B, Jin F. Spatial distribution, regional differences, and dynamic evolution of the medical and health services supply in China. Front Public Health, 2022, 10: 1020402.
18. 施春娜, 郭曉莉, 丁云, 等. 1990—2021年慢性阻塞性肺疾病歸因于各類危險因素的疾病負擔分析與模型預測. 環境與健康雜志, 2025, 42(2): 131-135.
19. Cao W, Zheng J, Li Q, et al. 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. Front Med (Lausanne), 2025, 12: 1554442.
20. 龍政, 劉威, 齊金蕾, 等. 1990—2019年中國慢性呼吸系統疾病死亡情況及變化趨勢. 中華流行病學雜志, 2022, 43(1): 14-21.
21. 王文星, 王璐, 鄔超, 等. 1990—2019年中國慢性阻塞性肺疾病的疾病負擔分析及未來10年發病預測. 新疆醫科大學學報, 2024, 47(1): 135-140.
22. Ingole V, Sheridan SC, Juvekar S, et al. Mortality risk attributable to high and low ambient temperature in Pune city, India: a time series analysis from 2004 to 2012. Environ Res, 2022, 204(Pt C): 112304.
23. Aryal S, Diaz-Guzman E, Mannino DM. COPD and gender differences: an update. Transl Res, 2013, 162(4): 208-218.
24. 趙偉森. 基于GBD 2019數據庫分析1990—2019年全球COPD疾病負擔及其歸因危險因素的時空趨勢. 長春: 吉林大學, 2023.
25. Landrigan PJ, Fuller R, Acosta NJR, et al. The Lancet commission on pollution and health. Lancet, 2018, 391(10119): 462-512.
26. Zhang Q, Zheng Y, Tong D, et al. Drivers of improved PM2. 5 air quality in China from 2013 to 2017. Proc Natl Acad Sci USA, 2019, 116(49): 24463-24469.
27. Pope CA, Ezzati M, Dockery DW. Fine-particulate air pollution and life expectancy in the United States. N Engl J Med, 2009, 360(4): 376-386.
28. 田仁生, 嚴剛, 李娜. 美國清潔空氣戰略規劃. 環境科學研究, 2005, 18(2): 68-69.
29. 李潔. 從“制度”到“生活”: 新中國70年來公共衛生政策演變. 中國公共衛生, 2019, 35(10): 1281-1284.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesAnalysis and projection of chronic obstructive pulmonary disease (COPD) burden attributable to air pollution in China, 1990–2021

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