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

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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.

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, Jörres 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.	郭姗姗, 殷征, 万军. 1990—2019年中国归因于固体燃料来源的家庭空气污染的心血管疾病负担分析. 中国循证医学, 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.	. 史晨阳. 赣州市环境温度和空气污染及其交互作用对COPD死亡风险的研究. 赣州: 赣南医科大学, 2024.
9.	. 吴欣欣. 海口地区气象因素、空气污染物与慢性阻塞性肺疾病急性加重的关联性研究. 海口: 海南医学院, 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 回归模型及其在传染病流行趋势分析中的应用. 中国卫生统计, 2019, 36(5): 787-791.
14.	蒋露, 张志东, 吴建军, 等. 1990—2021年我国精神障碍疾病负担分析与预测. 医学新知, 2025, 35(1): 14-21.
15.	杨明, 汪舒文, 宇传华. 1990—2019年中国皮肤恶性肿瘤疾病负担状况及发病趋势预测. 中国肿瘤, 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, 郭晓莉, 丁云, 等. 1990—2021年慢性阻塞性肺疾病归因于各类危险因素的疾病负担分析与模型预测. 环境与健康杂志, 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.	龙政, 刘威, 齐金蕾, 等. 1990—2019年中国慢性呼吸系统疾病死亡情况及变化趋势. 中华流行病学杂志, 2022, 43(1): 14-21.
21.	王文星, 王璐, 邬超, 等. 1990—2019年中国慢性阻塞性肺疾病的疾病负担分析及未来10年发病预测. 新疆医科大学学报, 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.	赵伟森. 基于GBD 2019数据库分析1990—2019年全球COPD疾病负担及其归因危险因素的时空趋势. 长春: 吉林大学, 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, 严刚, 李娜. 美国清洁空气战略规划. 环境科学研究, 2005, 18(2): 68-69.
29.	李洁. 从“制度”到“生活”: 新中国70年来公共卫生政策演变. 中国公共卫生, 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, Jörres 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. 郭姗姗, 殷征, 万军. 1990—2019年中国归因于固体燃料来源的家庭空气污染的心血管疾病负担分析. 中国循证医学, 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. . 史晨阳. 赣州市环境温度和空气污染及其交互作用对COPD死亡风险的研究. 赣州: 赣南医科大学, 2024.
9. . 吴欣欣. 海口地区气象因素、空气污染物与慢性阻塞性肺疾病急性加重的关联性研究. 海口: 海南医学院, 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 回归模型及其在传染病流行趋势分析中的应用. 中国卫生统计, 2019, 36(5): 787-791.
14. 蒋露, 张志东, 吴建军, 等. 1990—2021年我国精神障碍疾病负担分析与预测. 医学新知, 2025, 35(1): 14-21.
15. 杨明, 汪舒文, 宇传华. 1990—2019年中国皮肤恶性肿瘤疾病负担状况及发病趋势预测. 中国肿瘤, 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, 郭晓莉, 丁云, 等. 1990—2021年慢性阻塞性肺疾病归因于各类危险因素的疾病负担分析与模型预测. 环境与健康杂志, 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. 龙政, 刘威, 齐金蕾, 等. 1990—2019年中国慢性呼吸系统疾病死亡情况及变化趋势. 中华流行病学杂志, 2022, 43(1): 14-21.
21. 王文星, 王璐, 邬超, 等. 1990—2019年中国慢性阻塞性肺疾病的疾病负担分析及未来10年发病预测. 新疆医科大学学报, 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. 赵伟森. 基于GBD 2019数据库分析1990—2019年全球COPD疾病负担及其归因危险因素的时空趋势. 长春: 吉林大学, 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, 严刚, 李娜. 美国清洁空气战略规划. 环境科学研究, 2005, 18(2): 68-69.
29. 李洁. 从“制度”到“生活”: 新中国70年来公共卫生政策演变. 中国公共卫生, 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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