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Mapping the Global distribution, risk factors, and temporal trends of COPD incidence and mortality (1990–2021): ecological analysis

BMC Medicine volume 23, Article number: 210 (2025) Cite this article

Abstract

Background

Chronic Obstructive Pulmonary Disease (COPD) remains a significant global public health challenge, contributing to substantial morbidity and mortality worldwide. This study aims to analyze global trends in COPD from 1990 to 2021, with a focus on age, sex, and regional variations. By assessing the global burden of COPD and its association with key risk factors, this research provides critical insights into progress toward health-related Sustainable Development Goals (SDGs) and underscores the urgent need to prioritize COPD in public health agendas.

Methods

Utilizing data from the Global Burden of Disease (GBD) study, this research conducted a comprehensive ecological analysis of COPD epidemiology from 1990 to 2021. Key measures included incidence, mortality, and age-standardized rates, alongside an examination of risk factors such as smoking and ambient particulate matter pollution, quantified using country-level summary exposure values (SEV). Statistical analyses, including descriptive analysis, annual rate of change (ARC), and correlation analysis, were applied to assess the burden of COPD and investigate its ecological associations with major risk factors.

Results

In 2021, COPD accounted for 16.90 million new cases and 3.70 million deaths globally. The age-standardized incidence rate was 197.37 (95% UI: 181.6–213.42) per 100,000 person-years, while the age-standardized mortality rate was 45.22 (95% UI: 40.61–49.70) per 100,000 person-years. Although global COPD incidence rates declined by 2% from 1990 to 2021, the pace and extent of this decline varied, with some age groups, sexes, and regions experiencing slower reductions or even increases. Higher COPD burden was observed in areas with elevated smoking prevalence, air pollution and greater socioeconomic development.

Conclusions

This study highlights the ongoing global burden of COPD and its varying trends from 1990 to 2021 across age groups, sexes, and regions. While incidence and mortality rates have slightly declined, disparities persist, particularly among older adults, men, and regions with higher smoking prevalence and air pollution. These findings emphasize the urgent need to integrate COPD into public health priorities, focusing on targeted interventions to reduce key risk factors. Sustained efforts are essential to achieving health-related Sustainable Development Goals (SDGs) and improving global COPD outcomes.

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Background

Chronic obstructive pulmonary disease (COPD) is a prevalent and life-threatening non-communicable disease (NCD) that imposes a significant global health burden [1]. It is the fourth leading cause of death worldwide, causing 3.5 million deaths in 2021, approximately 5% of all global deaths [2]. A recent study projects that the global prevalence of Chronic Obstructive Pulmonary Disease (COPD) could reach 600 million cases by 2050, marking a 23% increase from 2020 levels [3]. Furthermore, COPD is expected to become the leading cause of mortality worldwide within the next decade, underscoring its critical importance as a public health priority [4, 5]. COPD's global impact has resulted in its inclusion in key frameworks such as the WHO Global NCD Action Plan (2013–2030) and the United Nations (UN) 2030 Agenda for Sustainable Development (SDGs) [6]. SDGs are 17 global objectives set by the UN in 2015 to address social, economic, and environmental challenges by 2030 for a more equitable and sustainable world. Among these, SDG-3 aims to promote health and well-being, with targets that include reducing premature mortality, achieving universal health coverage, strengthening tobacco control, and enhancing health risk management [7,8,9]. Therefore, COPD's substantial role in global morbidity and mortality makes its prevention and management vital for achieving SDG-3 targets, especially in reducing premature mortality and enhancing tobacco control.

The understanding of factors that predispose individuals to COPD is reportedly limited due to significant variations in onset, progression, and lung function trajectories across populations at different life stages [10]. Variations in COPD onset and progression are significant for policymaking and healthcare strategies because they inform tailored interventions that address specific demographic needs. Recognizing these differences helps allocate resources effectively, prioritize high-risk populations, and design targeted prevention programs, ultimately enhancing health outcomes and improving the efficiency of healthcare systems [11].

However, tobacco smoking, exposure to indoor and ambient air pollution, as well as occupational pollutants, have been identified as leading risk factors in most settings [12]. COPD poses a significant public health problem with substantial financial implications. In 2010, the global cost of COPD was estimated to be $2.1 trillion, and it is projected to rise to $4.8 trillion by 2030. It's important to note that these estimates may be conservative due to underdiagnoses of COPD in many cases [13, 14].

Understanding and monitoring the global burden of COPD is crucial for evidence-based policymaking and targeted prevention efforts. A comprehensive assessment of its distribution, risk factors, and trends in incidence and mortality is essential for informing public health strategies. This study evaluates COPD burden across 204 countries from 1990 to 2021, analyzing incidence, mortality, risk factors, and temporal trends by age, sex, and region. The findings aim to provide valuable insights into global COPD patterns and support progress toward health-related Sustainable Development Goals (SDGs).

Methods

Data source

The secondary analysis used data from the Global Burden of Disease (GBD) study accessed through the Global Health Data Exchange (GHDx) database, covering COPD-related variables from 1990 to 2021, including incidence, death rates, and age-standardized rates (ASRs). GBD 2021 includes estimates for 369 diseases and 87 risk factors from 204 countries, collected through surveys and literature reviews. Methodological details are available elsewhere, [15, 1] and the data quality is widely recognized, with estimates accessible via GBD Compare (http://ghdx.healthdata.org/gbd-results-tool). We also examined the correlation between socioeconomic status and COPD burden using the socio-demographic index (SDI) and human development index (HDI) from public databases. The SDI, which reflects social development, categorizes 204 countries into five quintiles, while the HDI measures income, life expectancy, and education levels (http://hdr.undp.org/en/data) [16]. Since the data is publicly available and anonymized, no ethics board review was required according to our institutional policies.

Estimation of outcome variables

In our study, COPD incidence and mortality were the outcome variables. We employed Bayesian methods to generate population estimates and uncertainty intervals (UIs). For incidence estimation, we utilized data from meta-analyses and surveys, applying the DisMod-MR 2.1 modeling strategy. This approach integrates diverse data sources to provide robust estimates of COPD incidence, accounting for variations across populations and ensuring methodological rigor in the analysis [17].. Mortality estimates were derived using the Global Burden of Disease (GBD) Cause of Death Ensemble model (CODEm), which systematically integrates data from multiple sources. To enhance data accuracy, we applied outlier criteria, ensuring that the estimates accurately reflect true mortality trends and patterns. This methodology allows for a reliable assessment of COPD-related mortality, facilitating informed decision-making in public health initiatives and resource allocation [18].

Risk factors and exposure standardization in COPD study

In this study, smoking and ambient particulate matter pollution were selected as COPD risk factors based on criteria such as causal evidence, data accessibility, and health policy relevance [19]. In GBD study, exposure data are sourced from population surveys for smoking and from satellite observations, ground measurements, and simulations for particulate matter pollution. Country-level summary Exposure Value (SEV) quantifies risk-weighted prevalence by standardizing it according to relative risks, allowing for comparison across locations and years [20]. We standardized yearly SEVs for smoking and ambient particulate matter pollution to address temporal variations, creating year-standardized SEVs for a more comparable exposure estimate over time.

Statistical analysis

To characterize the global burden of COPD, a descriptive analysis was conducted. The number of COPD incident cases and deaths, along with their respective age-standardized rates (ASRs) for both males and females across different years, were measured. ASRs were calculated using the GBD world population age standard and reported per 100,000 population, facilitating comparisons across different populations or the same population over time, regardless of age structure variations. Additionally, annual rates of change (ARC) were utilized to quantify trends in the disease burden of COPD.

To estimate COPD incidence, the GBD 2021 study used DisMod-MR 2.1, a Bayesian meta-regression tool that synthesizes multiple data sources to generate internally consistent estimates of incidence, prevalence, and mortality. This approach accounts for variations across sex, location, year, and age group, ensuring more accurate and comparable global estimates of COPD incidence. By integrating multiple input data, including population-based surveys, hospital records, and cause-of-death data, DisMod-MR 2.1 helps to address data gaps and improve the reliability of COPD incidence estimates [21].

The age-standardized rate (ASR) was calculated using the following formula:

$$\text{ASR}=\frac{{\sum }_{\textrm{i}=1}^{\textrm{A}}{\text{a}}_{\textrm{i}}{\text{w}}_{\textrm{i}}}{{\sum }_{\textrm{i}=1}^{\textrm{A}}{\textrm{w}}_{\textrm{i}}}\times \text{100,000}$$

where ai and ωi represent the age-specific rate and the number of persons (or weight) of the same age subgroup in the selected reference standard population, respectively.

To measure relative changes in trends over 32 years (1990–2021), we calculated the annual rate of change (ARC) using the formula:

$$\text{ARC}=\frac{\text{ln}(\frac{2021\,Rate}{1990\,Rate})}{2021-1990} \times 100$$

A positive ARC indicates an increase in COPD incidence or mortality, whereas a negative ARC reflects a decline. Uncertainty was estimated using 1,000 bootstrap samples, assuming a log-normal distribution, and point estimates were reported with uncertainty intervals (UIs) [22, 23]. Statistical significance was considered when the 95% UI of the percentage change did not include 0. Age-standardized incidence and mortality rates were analyzed by gender and age groups (25–49, 50–74, 75 + years) to further assess variations in COPD burden.

To assess the correlation between COPD incidence, mortality, and key factors such as the Social Development Index (SDI), Human Development Index (HDI), Summary Exposure Value (SEV) of smoking (SEV-Smoking), and Ambient Particulate Matter Pollution (SEV-APMP) across 204 countries, we employed Pearson correlation analysis to quantify the strength and direction of these associations. To further explore heterogeneity in COPD burden across regions and sociodemographic indices, we applied quantile regression (QR). QR assessed the relationship between COPD burden and these factors across different quantiles (95th, 75th, 50th, 25th, and 5th percentiles), providing insights into how these associations differ at various levels.

QR estimates were derived by minimizing the weighted absolute residuals using the minimum weighted absolute deviation method [24, 25], as shown in the following equation:

$$min\left\{{w}_{t}\left|{y}_{t}-\alpha \right|\right\}=-\sum_{i:{y}_{i}<\alpha }^{T}(1-\tau)({y}_{t}-\alpha)\sum_{i:{y}_{i}\ge \alpha }^{T}\tau ({y}_{t}-\alpha)$$

where, \({y}_{t}\) represents the observed value, \(\alpha\) is the quantile, \(\tau\) is the quantile being estimated, and \({w}_{t}\) are the weights for the observations. All analyses were conducted in R (Version 3.6.0).

Results

COPD incidence and mortality in 2021 and change between 1990–2021

In 2021, an estimated 16.90 million new cases of COPD were reported globally, along with 3.70 million deaths attributed to the disease. The global age-standardized incidence rate (ASIR) was 197.37 per 100,000 people, and the age-standardized mortality rate (ASMR) was 45.22 per 100,000. Between 1990 and 2021, both ASIR [–0.02 (UI: –0.05, –0.01)] and ASMR [–0.37 (UI: –0.43, –0.28)] showed a slight global decline. Regions with the highest ASIR were Nepal (310.58), New Guinea (279.70), and Bhutan (250.12), while Papua New Guinea (156.82), Nepal (146.13), and India (108.39) had the highest ASMR (Table 1, Fig. 1).

Table 1 Disease Burden of Chronic Obstructive Pulmonary Disease (COPD) in 2021, and Annual rate of change (ARC) between 1990 and 2021 by countries
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Fig. 1
figure 1

Global burden of COPD in 2021, both sexes, age-standardized rate (ASR) of incidence and mortality

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Temporal trends of COPD by age group in both sexes

Incidence trends in Individuals aged 25–49 years, 50–74 years, and 75 + years

We observed a consistent annual rate of change (ARC) in ASIR for most countries across both sexes, with some exceptions in the 25–49 age group (Fig. 2A). In following countries, males showed a decreasing ASIR trend, while females had an increasing trend. Notable decreases in male ASIR were observed in Singapore (ARC = –0.33; 95% UI, –0.45 to –0.18), Australia (ARC = −0.31; 95% UI, –0.44 to –0.14), and Japan (ARC = –0.29; 95% UI, −0.36 to –0.21). Conversely, significant increases in female ASIR were seen in Hungary (ARC = 0.42; 95% UI, 0.10 to 0.85), Morocco (ARC = 0.42; 95% UI, 0.23 to 0.64), and South Korea (ARC = 0.29; 95% UI, 0.08 to 0.55).

Fig. 2
figure 2

Annual rate of change (ARC), 1990–2021 of COPD incidence in individuals A aged 25–49 years; B aged 50–74 years; C aged 75 + years

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In the age group of 50–74 years, both increasing and decreasing trends ASIR were observed for both sexes (Fig. 2B). For males, the country with the highest increasing trend in ASIR was Morocco (male ARC = 0.32; 95% UI, 0.15 to 0.52) and the country with the highest decreasing trend in ASIR was Singapore (male ARC = –0.43; 95% UI, –0.52 to –0.31). Similarly, among females in the same age group, Morocco demonstrated a significant increase in COPD age standardized incidence rates (female ARC = 0.48; 95% UI, 0.27 to 0.75), whereas Singapore exhibited a significant decrease (female ARC = –0.41; 95% UI, –0.51 to –0.27) (Fig. 2B).

In the age group of 75 + years, a combination pattern of trends was observed for both males and females. However, a more noticeable trend was the significant increasing trend in COPD age standardized incidence rates (Fig. 2C). For males, Kuwait (male ARC = 0.60; 95% UI, 0.29 to 1.07 to), Morocco (male ARC = 0.50; 95% UI, 0.28 to 0.78 to), and Egypt (male ARC = 0.45; 95% UI, 0.24 to 0.71) reported the significant increasing trends in age standardized incidence rates. Among females in the same age group, Kuwait (female ARC = 0.66; 95% UI, 0.39 to 1.08), Estonia (female ARC = 0.59; 95% UI, 0.21 to 1.16) and California (female ARC = 0.56; 95% UI, 0.29 to 0.98) exhibited the greatest increases in COPD age standardized incidence rates (Fig. 2C).

Mortality trends in individuals aged 25–49 years, 50–74 years, and 75 + years

In terms of COPD mortality rates, consistent decreasing pattern of annual rate of change (ARC) of ASMR was observed for both males and females across all three age groups (25–49 years, 50–74 years, and 75 + years) in most countries. For males aged 25–49 years, Slovenia (male ARC = –0.79; 95% UI, –0.83 to –0.74), Singapore (male ARC = –0.77; 95% UI, –0.81 to –0.71) and China (male ARC = –0.71; 95% UI, –0.80 to –0.59) exhibited the highest decreasing trends of ASMR. Among females in the same age group, Singapore (female ARC = –0.84; 95% UI, –0.87 to –0.80), China (female ARC = –0.80; 95% UI, –0.87 to –0.64), and Kuwait (female ARC = –0.80; 95% UI, –0.84 to –0.74) showed the greatest decreases in ASMR of COPD (Fig. 3A).

Fig. 3
figure 3

Annual rate of change (ARC), 1990–2021 of COPD mortality in individuals A aged 25–49 years; B aged 50–74 years; C aged 75 + years

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For males aged 50–74 years, the countries with the highest decreasing trends in ASMR of COPD were Singapore (male ARC = –0.86; 95% UI, –0.88 to –0.84), Belarus (male ARC = –0.73; 95% UI, –0.89 to –0.66), and China (male ARC = –0.73; 95% UI, –0.82 to –0.62). Among females in the same age group, Singapore (female ARC = –0.89; 95% UI, –0.90 to –0.87), Belarus (female ARC = –0.86; 95% UI, –0.90 to –0.83 to). and China (female ARC = –0.80; 95% UI, –0.87 to –0.68 to), exhibited the greatest decreases in ASMR of COPD (Fig. 3B).

For males aged 75 + years, the countries with the highest decreasing trends in ASMR of COPD were Singapore (male ARC = –0.84; 95% UI, –0.85 to –0.82), Belarus (male ARC = –0.81; 95% CI, –0.84 to –0.78), and Lithuania (male ARC = –0.62; 95% UI, –0.68 to –0.56). Among females in the same age group, Belarus (female ARC = –0.92; 95% UI, –0.93 to –0.90), Singapore (female ARC = –0.82; 95% UI, –0.85 to –0.80), and Lithuania (female ARC = –0.72; 95% UI, –0.75 to –0.69) exhibited the greatest decreases in ASMR of COPD (Fig. 3C).

Association between COPD and key risk factors

Correlation analysis revealed a significant linear association between SEV-smoking and the Sociodemographic Index (SDI) for both sexes, males, and females [(both sexes; p < 0.001, r = 0.634), (males; p < 0.001, r = 0.468), and (females; p < 0.001, r = 0.609)], indicating that higher SDI levels are associated with increased SEV-smoking rates. These findings suggest that countries with higher SDI levels tend to have higher smoking exposure, which could contribute to higher COPD incidence and mortality. Similarly, a significant association was found between SEV ambient particulate matter pollution (APMP) and SDI for both sexes, males, and females [(both sexes; p < 0.001, r = 0.232), (males; p = 0.003, r = 0.203), and (females; p < 0.001, r = 0.258)], suggesting that higher SDI levels are associated with higher levels of air pollution, potentially leading to increased COPD incidence and mortality (Fig. 4).

Fig. 4
figure 4

The correlation between summary exposure value (SEV) smoking and SEV Ambient particulate matter (AMPM) pollution with sociodemographic index, in 204 countries or territories, 2021, by sex. (where circle size represents incidence and death cases of COPD in 2021: the blue line and grey shadows represent the overall 95%CIs in age-standardized rates associated with SDI, and the dashed lines represent quantile regression estimated fit quantile/95th, 75th, 50th, 25th and 5th percentiles. The r indices and p values presented were derived from pearson correlation analysis.). * indicate the significant correlation coefficient between two variables on 0.1% level of significance. A circle represent the incident cases 2021, B circle represent the death cases 2021

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Further, we examined the relationship between the Sociodemographic Index (SDI), Human Development Index (HDI), SEV-smoking, and SEV-APMP with the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of COPD in 204 countries or territories in 2021. The results indicated that higher ASIR of COPD was positively correlated with higher levels of SDI [(female; p = 0.046, r = 0.140)], HDI [(both sexes; p < 0.001, r = 0.204), (male; p = 0.008, r = 0.192) and (female; p = 0.005, r = 0.203)], and SEV-smoking [(both sexes; p < 0.001, r = 0.406), (male; p < 0.001, r = 0.391) and (female; p < 0.001, r = 0.300)] (Fig. 5 top panel).

Fig. 5
figure 5

The correlation between the covariates (A: socio-demographic index (SDI), B: human development index (HDI), C: Summary exposure value (SEV) smoking, D: Summary exposure value (SEV) Ambient particulate matter pollution(APMP)) with age-standardized incidence, and deaths of COPD, in 204 countries or territories, 2021, by sex. (where circle size represent incidence and death cases of COPD in 2021: the blue line and grey shadows represent the overall 95%CIs in age-standardized rates associated with covariate, and the dashed lines represent quantile regression estimated fit quantile/95th, 75th, 50th, 25th and 5th percentiles. The r indices and p values presented were derived from pearson correlation analysis.). * indicate the significant correlation coefficient between two variables on mentioned level of significance

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Additionally, higher ASMR of COPD was negatively correlated with higher levels of SDI [(both sexes; p < 0.001, r = −0.418), (male; p < 0.001, r = −0.408) and (female; p < 0.001, r = −0.380)], HDI [(both sexes; p < 0.001, r = −0.418), (male; p < 0.001, r = −0.408) and (female; p < 0.001, r = −0.380)], SEV-smoking [(both sexes; p < 0.023, r = −0.158)], and SEV-APMP [(both sexes; p < 0.001, r = −0.255), (male; p < 0.001, r = −0.251) and (female; p < 0.001, r = −0.231)]. This indicates that higher socioeconomic development and lower exposure to smoking and air pollution are associated with lower COPD mortality rates (Fig. 5 bottom panel).

Discussion

Summary of the current study findings

In 2021, approximately 16.9 million new cases of COPD were reported worldwide, resulting in 3.7 million deaths. The global age-standardized incidence rate (ASIR) for COPD was 197.37 per 100,000 people, while the age-standardized mortality rate (ASMR) was 45.22 per 100,000 people. From 1990 to 2021, global COPD incidence and mortality rates showed a slight decline. Nepal had the highest ASIR, while Papua New Guinea had the highest ASMR. Trends in COPD incidence and mortality varied across different age groups and countries. Smoking exposure and particulate matter were strongly associated with higher incidence and mortality rates, especially in countries with higher levels of sociodemographic development.

Explanation of findings and comparison with existing literature

This study highlights the global burden of COPD and the progress made in combating it. Between 1990 and 2021, there was a slight decline in the global age-standardized incidence (ASIR) and mortality rates (ASMR) for COPD, which aligns with previous research showing a decrease in COPD mortality worldwide [26]. This decline is likely due to several factors, including reductions in smoking rates, the implementation of tobacco control policies, and improved air quality regulations. Smoking continues to be the primary cause of COPD incidence, and evidence from countries such as Sweden indicates that decreasing smoking prevalence can lead to a significant reduction in COPD rates [27]. This finding underscores the strong association between smoking reduction and the decline in COPD incidence [28]. Additionally, improved air quality regulations and occupational safety measures may have played a role in reducing COPD incidence related to environmental and occupational exposures [29]. Overall, these findings demonstrate encouraging progress in addressing COPD as a significant public health concern. They highlight the potential impact of targeted interventions and policies that align with the Sustainable Development Goals (SDGs) in achieving successful outcomes.

Geographical analysis revealed that Nepal had the highest age-standardized incidence rate (ASIR) of COPD, while New Guinea had the highest age-standardized mortality rate (ASMR). In Nepal, smoking and traditional firewood cooking, which leads to air pollution, are major contributors to COPD-related deaths, with air pollution accounting for 26% of cases [30]. The high prevalence of smoking and the use of firewood for cooking expose individuals to respiratory irritants and pollutants, causing chronic lung damage and increasing the risk of developing COPD [31]. The country faces challenges in regulating air quality. In New Guinea, high COPD mortality is linked to biomass smoke exposure, air pollution, and genetic predispositions [32]. Addressing these risk factors through tobacco control, clean cooking technologies, and air pollution reduction is essential for improving respiratory health and aligns with the Sustainable Development Goals (SDGs).

The annual rate of change (ARC) in COPD incidence revealed mixed trends across different age groups and sexes, reflecting diverse exposures to risk factors, variations in healthcare access, and the effects of an aging population. Notably, there was a concerning upward trend in COPD incidence among individuals aged 75 and older for both sexes. This increase may be attributed to multiple factors, including prolonged exposure to smoking and air pollution, as well as the natural decline in lung function that accompanies aging [33]. Understanding these trends is crucial for developing targeted interventions aimed at this vulnerable population, ensuring that healthcare resources are effectively allocated to mitigate the growing burden of COPD in older adults. Our finding aligns with previous research that also identified a similar trend in the elderly population [34, 35]. Addressing these risk factors through preventive measures and better management is crucial to reducing COPD in older adults [36].

Conversely, the annual rate of change (ARC) in COPD mortality rates demonstrated a consistent decline across all age groups and sexes. This consistent decrease can be attributed to several factors, including advancements in healthcare delivery, successful smoking cessation efforts, and effective public health initiatives aimed at raising awareness and improving management of the disease. According to recent evidence, optimal management of COPD requires a comprehensive approach, beginning with timely diagnosis and thorough disease assessment to identify high-risk patients. Early and optimal management, combining both pharmacological and non-pharmacological treatments to prevent exacerbations and reduce mortality risk, is crucial for improving patient outcomes. Regular patient follow-up, including symptom monitoring and ongoing treatment optimization, also plays a critical role in sustaining these improvements. These improvements in healthcare practices have likely contributed to the observed reduction in mortality rates, highlighting the importance of continued investment in healthcare and preventive measures to further decrease COPD-related deaths [33, 37].

A key finding of this study is the strong relationship between smoking exposure (SEV) and the SDI. Countries with higher SDI levels tend to have higher smoking rates, which in turn increases their COPD incidence and mortality [38]. This highlights the critical need for effective smoking prevention and cessation programs, particularly in high SDI countries. Smoking continues to be the primary cause of COPD, with approximately 90% of COPD cases occurring among current or former smokers [39].

The association between higher SDI, Human Development Index (HDI), and smoking prevalence emphasizes the need for targeted tobacco control measures in more developed countries, where smoking is often driven by affordability, cultural factors, tobacco marketing, and stress-related coping mechanisms. Reducing smoking in these countries through public health campaigns and policies is essential to mitigating the COPD burden [40, 41]. Moreover, several studies also indicate consistent associations between COPD outcomes and factors such as the Social Development Index (SDI), Human Development Index (HDI), Smoking Exposure Value (SEV), and Ambient Particulate Matter Pollution (SEV-APMP). These studies suggest that lower socioeconomic and higher exposure levels correlate with increased incidence and mortality of COPD [42,43,44].

From a clinical relevance perspective, this study underscores the urgent need for targeted interventions in the management of Chronic Obstructive Pulmonary Disease (COPD). The strong associations identified between smoking, air pollution, and COPD highlight the critical importance of implementing effective smoking cessation programs and initiatives aimed at improving air quality. Furthermore, the observed disparities across various age groups and regions call for tailored clinical approaches that address the unique risk factors and healthcare needs of different populations. By prioritizing early detection and effective management strategies, healthcare providers can significantly alleviate the burden of COPD and enhance patient outcomes. This proactive approach not only aligns with the Sustainable Development Goals (SDGs) but also fosters a comprehensive strategy for combating this pervasive public health challenge.

Strengths and limitations

A key strength of our study is its alignment with the Sustainable Development Goals (SDGs), which makes it highly relevant to global health priorities and useful for guiding COPD-related interventions. The study provides a comprehensive view of COPD trends, offering valuable insights into the global burden of the disease and highlighting areas in need of policy attention.

However, several limitations should be considered. First, the study relies on secondary data from the Global Burden of Disease (GBD) study, which may not capture the most recent trends and could be subject to regional data quality differences. While the GBD database includes critical risk factors like smoking and air pollution, it may not comprehensively account for other significant factors such as occupational exposures, genetics, or comorbidities, which are important in understanding COPD's full burden. Moreover, the global scope of the study may limit the generalizability of the findings to specific countries or populations with unique characteristics or healthcare contexts. Additionally, the model used in the GBD study may not adequately capture variations in healthcare infrastructure or access to care across regions, which can influence COPD incidence and outcomes. Finally, given the study's reliance on historical data, more recent trends and shifts in COPD patterns may not be fully represented.

Despite these limitations, this study provides important insights into the global burden of COPD and offers useful guidance for policymakers aiming to address COPD's impact on public health.

Conclusions

In conclusion, this study provides critical insights into global COPD trends from 1990 to 2021, highlighting significant variations across age, sex, and regions. While there has been a slight global decline in COPD incidence and mortality, this reduction has been uneven, with notable disparities, especially among older adults, men, and regions with higher smoking prevalence and air pollution. The findings underscore the urgent need to prioritize COPD in public health agendas, with a focus on addressing these disparities and targeting key risk factors like smoking and air pollution. Continued efforts are essential to progress toward the health-related Sustainable Development Goals (SDGs) and improve global COPD outcomes.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

COPD:

Chronic obstructive pulmonary disease

SDGs:

Sustainable Development Goals

GBD:

Global Burden of Disease study

SEV:

Summary exposure value

SDI:

Sociodemographic index

HDI:

Human development index

NCD:

Non-communicable disease

GHDx:

Global Health Data Exchange

ASRs:

Age-standardized rates

CODEm:

Cause of Death Ensemble model

ARC:

Annual rate of changes

ASIR:

Age-standardized incidence rate

ASMR:

Age-standardized mortality rate

APMP:

Ambient Particulate Matter Pollution

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Acknowledgements

We appreciate the contributions made by GBD study in Data.

Funding

This research was funded by the National Natural Science Foundation of China (Grant No. 72204211). The funders had no role in the study design, data collection, analysis, decision to publish or preparation of the manuscript.

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Author notes

  1. Shafaq Naeem and Fang Wang contributed equally to this research and share first authorship.

Authors and Affiliations

  1. Unit Pharmacotherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands

    Xuechun Li, Irene Mommers, Eelko Hak & Sumaira Mubarik

  2. Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, China

    Shafaq Naeem

  3. Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China

    Fang Wang

  4. Department of Economics, PMAS, Arid Agriculture University, Rawalpindi, Pakistan

    Rabia Mubarak

  5. Wuhan Center for Disease Control and Prevention, Wuhan, Hubei, China

    Hui Shen

  6. Rawalpindi Medical University, Rawalpindi, Pakistan

    Syeda Rija Hussain

  7. Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, 77030, USA

    Saima Shakil Malik

  8. Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, 430071, China

    Chuanhua Yu

  9. School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310058, China

    Xiaolin Xu & Muhammad Fawad

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Contributions

SN: Data curation, Methodology, Formal analysis, Software, Visualization, Writing—review & editing; FW: Investigation, Formal analysis, Validation, Visualization, Funding acquisition; RM: Formal analysis, Investigation, Software, Data curation, Validation, Visualization; HS: Formal analysis, Investigation, Writing—review & editing, Data curation; XL: Investigation, Methodology, Software, Visualization; IM: Investigation, Data curation, Validation, Visualization; SRH: Data curation, Validation, Visualization; SSM: Data curation, Validation, Visualization; CY: Conceptualization, Investigation, Resources, Validation; EH: Conceptualization, Investigation, Validation, Visualization, Supervision; XX: Validation, Visualization, Investigation, Software; MF: Investigation, Data curation, Validation, Visualization, Funding acquisition; SM: Conceptualization, Data curation, Formal analysis, Methodology, Validation, Visualization, Funding acquisition, Writing—review & editing, Supervision, Project administration. All authors read and approved the final manuscript.

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Correspondence to Muhammad Fawad or Sumaira Mubarik.

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Naeem, S., Wang, F., Mubarak, R. et al. Mapping the Global distribution, risk factors, and temporal trends of COPD incidence and mortality (1990–2021): ecological analysis. BMC Med 23, 210 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12916-025-04014-0

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BMC Medicine

ISSN: 1741-7015

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