What is the true burden of chronic obstructive pulmonary disease in India and what are its implications at a national level?

Burden of chronic obstructive pulmonary disease and risk factors in China from 1990 to 2021: Analysis of global burden of disease 2021.

SummaryBackgroundIndia has 18% of the global population and an increasing burden of chronic respiratory diseases. However, a systematic understanding of the distribution of chronic respiratory diseases and their trends over time is not readily available for all of the states of India. Our aim was to report the trends in the burden of chronic respiratory diseases and the heterogeneity in their distribution in all states of India between 1990 and 2016.MethodsUsing all accessible data from multiple sources, we estimated the prevalence of major chronic respiratory diseases and the deaths and disability-adjusted life-years (DALYs) caused by them for every state of India from 1990 to 2016 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016. We assessed heterogeneity in the burden of chronic obstructive pulmonary disease (COPD) and asthma across the states of India. The states were categorised into four groups based on their epidemiological transition level (ETL). ETL was defined as the ratio of DALYs from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL and vice versa. We also assessed the contribution of risk factors to DALYs due to COPD. We compared the burden of chronic respiratory diseases in India against the global average in GBD 2016. We calculated 95% uncertainty intervals (UIs) for the point estimates.FindingsThe contribution of chronic respiratory diseases to the total DALYs in India increased from 4·5% (95% UI 4·0–4·9) in 1990 to 6·4% (5·8–7·0) in 2016. Of the total global DALYs due to chronic respiratory diseases in 2016, 32·0% occurred in India. COPD and asthma were responsible for 75·6% and 20·0% of the chronic respiratory disease DALYs, respectively, in India in 2016. The number of cases of COPD in India increased from 28·1 million (27·0–29·2) in 1990 to 55·3 million (53·1–57·6) in 2016, an increase in prevalence from 3·3% (3·1–3·4) to 4·2% (4·0–4·4). The age-standardised COPD prevalence and DALY rates in 2016 were highest in the less developed low ETL state group. There were 37·9 million (35·7–40·2) cases of asthma in India in 2016, with similar prevalence in the four ETL state groups, but the highest DALY rate was in the low ETL state group. The highest DALY rates for both COPD and asthma in 2016 were in the low ETL states of Rajasthan and Uttar Pradesh. The DALYs per case of COPD and asthma were 1·7 and 2·4 times higher in India than the global average in 2016, respectively; most states had higher rates compared with other locations worldwide at similar levels of Socio-demographic Index. Of the DALYs due to COPD in India in 2016, 53·7% (43·1–65·0) were attributable to air pollution, 25·4% (19·5–31·7) to tobacco use, and 16·5% (14·1–19·2) to occupational risks, making these the leading risk factors for COPD.InterpretationIndia has a disproportionately high burden of chronic respiratory diseases. The increasing contribution of these diseases to the overall disease burden across India and the high rate of health loss from them, especially in the less developed low ETL states, highlights the need for focused policy interventions to address this significant cause of disease burden in India.FundingBill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

To estimate the prevalence and associated risk factors of chronic obstructive pulmonary disease (COPD) in Saudi adults aged ⩾40 years using standardised post-bronchodilator spirometry according to the Burden of Obstructive Lung Disease (BOLD) protocol. Saudi men and women aged ⩾40 years were recruited by stratified multistage random sampling in Riyadh, Saudi Arabia. Participants completed questionnaires on respiratory symptoms and exposure to risk factors for COPD. Spirometry was performed according to standard methods. COPD was defined as post-bronchodilator FEV1/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio <70% (Global Initiative for Obstructive Lung Disease [GOLD]) or less than the lower limit of normal (LLN) (95(th) percentile) of the population distribution for FEV1/FVC. Seven hundred subjects underwent acceptable post-bronchodilator spirometry. The overall prevalence of GOLD COPD was 4.2% (men 5.7%, women 2.5%). The overall prevalence of COPD stage 1 or higher using the LLN was lower than estimates using the GOLD criteria (3.2%). The overall prevalence of GOLD stage 2 or higher COPD was 3.7%. Male sex, increasing age and smoking were significantly associated with COPD diagnosis. The overall prevalence of COPD in Saudi Arabia is 4.2%. Male, increasing age and smoking were the main risk factors for COPD.

The silent epidemic of COPD in Africa.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and has significant clinical and economic impact on patients and society. While much research has focused on COPD in high-income countries, it’s burden in low-middle-income counties (LMIC) is largely unknown. In this thesis, the prevalence, socioeconomic burden, and pharmacologic treatment of COPD in LMIC was studied, with a focus on the Central Asian country Kyrgyzstan. Using a population-based study, it was revealed that COPD prevalence was much higher in the highlands (37%) of Kyrgyzstan than in the lowlands (10%) and that household air pollution was established as an independent risk factor for COPD in low-resource highlands where indoor-polluting heaters were frequently being used. A subsequent survey highlighted that chronic lung disease in LMIC also heavily impacts on peoples’ work productivity. To reduce the COPD burden in LMIC, evidence-based yet country-tailored guidelines are needed, as was shown in a scoping review of all national COPD guidelines globally. Regarding the economic burden of COPD, over 50% of the total direct medical costs for COPD in Kyrgyzstan were spent on medication, hospitalization and diagnostics and importantly, most patients had to pay for diagnostics and medication out-of-pocket. Medication availability was worrisome with around half of people indicating their medication was not available at the hospital. Even where available, over two thirds of patients indicated that financial barriers prevented them from being adherent. The FRESH AIR project indicates that targeted preventive actions are required to reduce the burden of COPD in LMIC.

Guest Editorial

COPD—more than just tobacco smoke

In China, chronic obstructive pulmonary disease (COPD) was accounted for a quarter of the global COPD population and has become a large economic burden. However, the comprehensive picture of the COPD burden, which could inform health policy, is not readily available for all of the provinces of China. Here, we aimed to describe the burden of COPD in China, providing an up-to-date and comprehensive analysis at the national and provincial levels, and time trends from 1990 to 2019. Following the methodology framework and general analytical strategies used in the GBD 2019, we analyzed the incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years with life lost (YLLs) attributable to COPD across China and the corresponding time trends from 1990 to 2019, stratified by age and province. In order to quantify the secular trends of the burden of COPD, the estimated annual percentage changes were calculated by the linear regression model of age-standardized rates (ASRs) and calendar years. We also presented the contribution of risk factors to COPD-related mortality and DALYs. The association between COPD burden and socio-demographic index (SDI) were also evaluated. From 1990 to 2019, the incidence and prevalence numbers of COPD increased by 61.2 and 67.8%, respectively, whereas the number of deaths and DALYs owing to COPD decreased. The ASRs of COPD burden, including incidence, prevalence, mortality, DALYs, YLDs, and YLLs continuously decreased from 1990 to 2019. The crude rates of COPD burden dramatically increased with age and reached a peak in the older than 95 years age group. In 2019, the leading risk factor for COPD mortality and DALYs was tobacco use in the whole population, but ambient particulate matter pollution was the most significant risk factor in females. At the provincial level, the ASRs of COPD burden was significantly associated with the SDIs, with the highest ASRs in the western provinces with low SDIs. Collectively, our study indicated that COPD remains an important public health problem in China. Geographically targeted considerations should be developed to enhance COPD health and reduce the COPD burden throughout China and in specific provinces.

Chronic obstructive pulmonary disease (COPD) is an important differential diagnosis in patients with heart failure (HF). The primary aims were to determine the prevalence of COPD and to test the accuracy of self-reported COPD in patients admitted with HF. Secondary aims were to study a possible relationship between right and left ventricular function and pulmonary function. Prospective substudy. Systematic screening at 11 centres. Consecutive patients (n = 532) admitted with HF requiring medical treatment with diuretics and an episode with symptoms corresponding to New York Heart Association class III-IV within a month prior to admission. Forced expiratory volume in 1 s (FEV(1)) and forced vital capacity (FVC) were measured by spirometry and ventricular function by echocardiography. The diagnosis of COPD and HF were made according to established criteria. The prevalence of COPD was 35%. Only 43% of the patients with COPD had self-reported COPD and one-third of patients with self-reported COPD did not have COPD based on spirometry. The prevalence of COPD in patients with preserved left ventricular ejection fraction (i.e. LVEF >or=45%) was significantly higher than in patients with impaired LVEF (41% vs. 31%, P = 0.03). FEV(1) and FVC were negatively correlated with right ventricular end-diastolic diameter and tricuspid annular plane systolic excursion and FVC positively correlated with systolic gradient across the tricuspid valve. Chronic obstructive pulmonary disease is frequent in patients admitted with HF and self-reported COPD only identifies a minority. The prevalence of COPD was high in both patients with systolic and nonsystolic HF.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally, with significant disparities in disease burden across countries and socioeconomic regions. Despite advancements in public health, the global burden of COPD remains substantial, particularly in low- and middle-income countries. This study aims to provide a comprehensive analysis of global, regional, and national trends in COPD-related prevalence, deaths, and disability-adjusted life years (DALYs) from 1990 to 2021 using an age-period-cohort (APC) model. Data from the Global Burden of Disease Study 2021 were analyzed for 204 countries and territories, stratified by five Sociodemographic Index (SDI) levels. An APC model was employed to assess the temporal effects of age, time periods, and birth cohorts on COPD burden. Trends in prevalence, deaths, and DALYs were evaluated through metrics such as Net Drift, Local Drift, and risk ratios. Globally, from 1990 to 2021, the age-standardized rates of COPD demonstrated a decline of -1.46% (95% UI: -3.36 to 0.39%) in prevalence, -37.12% (95% UI: -43.37% to -27.68%) in deaths, and -36.98% (95% UI: -42.37% to -28.54%) in DALYs. After adjusting for age and cohort effects, the annual changes were -0.35% (95% UI: -0.39% to -0.32%) in prevalence, -3.87% (95% UI: -4.00% to -3.74%) in deaths, and - 2.95% (95% UI: -3.02% to -2.89%) in DALYs. Notably, in middle, low-middle, and low SDI regions, the age-standardized prevalence rates in 2021 showed an increase compared to 1990, with respective changes of 4.03% (95% UI: 2.00-5.89%), 0.13% (95% UI: -2.90 to 2.84%), and 6.71% (95% UI: 4.25-8.91%). However, age-standardized deaths and DALYs significantly decreased across all five SDI regions. From an age effect perspective, globally, over 50% of COPD prevalence is concentrated among individuals aged 65 years and older, particularly in middle, low-middle, and high-middle SDI regions. COPD-related deaths and DALYs have shown a declining trend across all age groups. Globally, the period effect indicates that earlier periods were associated with a higher burden of disease, while cohort effects highlight that birth cohorts around 1920 had a particularly pronounced impact on the COPD burden. Both period and cohort effects exhibited notable heterogeneity across different SDI regions and countries. The prevalence of COPD remains concerning. Compared to 1990, the global prevalence of COPD in 2021 showed a stable or slightly increasing trend, with over half of the countries experiencing an annual increase in prevalence during the 1990-2021 period. Global mortality and DALYs associated with COPD showed a notable decline in 2021 compared to 1990. However, this trend exhibited significant heterogeneity across countries and regions, likely linked to differences in socioeconomic development. Countries in the high-middle and middle SDI regions were found to be more affected by period effects. From an age effect perspective, population aging has undoubtedly exacerbated the COPD burden. Regarding cohort effects, earlier birth cohorts demonstrated a stronger contribution to the increasing disease burden. While Higher levels of socioeconomic development can mitigate the adverse effects associated with earlier birth cohorts.

PurposeThe Continuing to Confront COPD International Patient Survey aimed to estimate the prevalence and burden of COPD globally and to update findings from the Confronting COPD International Survey conducted in 1999–2000.Materials and methodsChronic obstructive pulmonary disease (COPD) patients in 12 countries worldwide were identified through systematic screening of population samples. Telephone and face-to-face interviews were conducted between November 2012 and May 2013 using a structured survey that incorporated validated patient-reported outcome instruments. Eligible patients were adults aged 40 years and older who were taking regular respiratory medications or suffered with chronic respiratory symptoms and reported either 1) a physician diagnosis of COPD/emphysema, 2) a physician diagnosis of chronic bronchitis, or 3) a symptom-based definition of chronic bronchitis. The burden of COPD was measured with the COPD Assessment Test (CAT) and the modified Medical Research Council (mMRC) Dyspnea Scale.ResultsOf 106,876 households with at least one person aged ≥40 years, 4,343 respondents fulfilled the case definition of COPD and completed the full survey. COPD prevalence ranged from 7% to 12%, with most countries falling within the range of 7%–9%. In all countries, prevalence increased with age, and in all countries except the US was greater among men (range 6%–14%) than among women (range 5%–11%). A significant disease burden was observed when considering COPD symptoms or health status, and showed wide variations across countries. Prevalence of moderate-to-severe dyspnea (mMRC scale ≥2) ranged from 27% to 61%, and mean CAT score ranged from 16.0 to 24.8, indicating medium-to-high impairment.ConclusionThis survey, representing 12 countries, showed similar rates of estimated COPD prevalence across countries that were higher than those reported a decade ago in the original Confronting COPD International Survey. A significant burden of COPD was demonstrated by symptoms and health care-resource use, similar to that reported in the original survey.

IntroductionChronic respiratory diseases cause a significant health and economic burden around the world. In Canada, Aboriginal populations are at increased risk of asthma and chronic obstructive pulmonary disease (COPD). There is little known, however, about these diseases in the Canadian Métis population, who have mixed Aboriginal and European ancestry. A population-based study was conducted to quantify asthma and COPD prevalence and health services use in the Métis population of Ontario, Canada’s largest province.MethodsThe Métis Nation of Ontario Citizenship Registry was linked to provincial health administrative databases to measure and compare burden of asthma and COPD between the Métis and non-Métis populations of Ontario between 2009 and 2012. Asthma and COPD prevalence, health services use (general physician and specialist visits, emergency department visits, hospitalizations), and mortality were measured.ResultsPrevalences of asthma and COPD were 30% and 70% higher, respectively, in the Métis compared to the general Ontario population (p<0.001). General physician and specialist visits were significantly lower in Métis with asthma, while general physician visits for COPD were significantly higher. Emergency department visits and hospitalizations were generally higher for Métis compared to non-Métis with either disease. All-cause mortality in Métis with COPD was 1.3 times higher compared to non-Métis with COPD (p = 0.01).ConclusionThere is a high burden of asthma and COPD in Ontario Métis, with significant prevalence and acute health services use related to these diseases. Lower rates of physician visits suggest barriers in access to primary care services.

To assess the global burden of chronic obstructive pulmonary disease (COPD) and cross-country inequalities from 1990 to 2021 and project changes until 2045. Data on prevalence, mortality, and disability-adjusted life-years (DALYs) for COPD were extracted from the Global Burden of Disease Study 2021 (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. 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 age-standardized 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 age-standardized 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 middle-sociodemographic index regions, underscore the need for targeted prevention and management strategies.

Background Chronic Obstructive Pulmonary Disease (COPD) is a progressive and irreversible lung disease. According to the World Health Organization (WHO), COPD has become one of the leading causes of death globally. This study provides a comprehensive analysis of the COPD burden in the Asia region. Methods This study utilizes data on incidence, mortality, and Disability-Adjusted Life Years (DALY) from the 2021 Global Burden of Disease Study (GBD 2021), combined with the Socio-Demographic Index (SDI), to comprehensively assess the burden of COPD. The study also calculates the Annual Percentage Change (APC) and the Average Annual Percentage Change (AAPC), along with their 95% confidence intervals (95% CI). In addition, the main risk factors for COPD were evaluated Results In 2021, the number of COPD incidences in Asia was 10,512,843 cases (95% UI: 9,610,006–11,432,970), with an age-standardized incidence rate of 210.79 per 100,000 persons (95% UI: 193.52–227.94). The number of deaths was 2,885,059 cases (95% UI: 2,571,267–3,218,689), with an age-standardized death rate of 64.10 per 100,000 persons (95% UI: 56.74–71.66). The number of Disability-Adjusted Life Years (DALYs) was 60,507,100 cases (95% UI: 55,319,463–66,518,282), with a disability-adjusted life years rate of 1253.15 per 100,000 persons (95% UI: 1148.26–1376.29). At the regional level, South Asia exhibited the highest COPD burden among all regions in Asia. Furthermore, particulate matter pollution (PM), smoking, secondhand smoke, and occupational exposure to particulate matter, gases, and fumes (OP-MGF) were identified as the main risk factors for COPD in Asia. Conclusions This study reveals the burden of Chronic Obstructive Pulmonary Disease (COPD) in the Asia region, with particulate matter pollution, smoking, and occupational exposure identified as the primary risk factors. Given the significant disease burden observed in the region, future public health interventions should focus on targeted measures to reduce the COPD burden and improve overall health outcomes.

COPD Surveillance—United States, 1999-2011