The burden of chronic obstructive pulmonary disease and its attributable risk factors in the Middle East and North Africa region, 1990-2019

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. The present study reported the burden of COPD, and its attributable risk factors, in the Middle East and North Africa (MENA) region between 1990 and 2019, by age, sex and socio-demographic index (SDI).

Methods: Data from the Global Burden of Disease (GBD) 2019 study were used to report the burden of COPD in the MENA countries. The prevalence, deaths, and disability-adjusted life-years (DALYs) were presented as counts and age-standardised rates per 100,000 population, with their associated 95% uncertainty intervals (UIs).

Results: In 2019, the regional age-standardised point prevalence and rates of death due to COPD were 2333.9 (2230.1, 2443.6) and 26.1 (22.2, 29.5) per 100,000, which represent a 30.6% (28.2%, 33.0%) increase and an 18.0% (2.8%, 30.9%) decrease, respectively, since 1990. The regional age-standardised DALY rate in 2019 was 649.1 (574.6, 717.7) per 100,000, which had decreased by 11.8% (0.9%, 21.1%) since 1990. Turkey had the highest age-standardised point prevalence in 2019 [3287.1 (3187.4, 3380.3)], while Afghanistan had the highest age-standardised death [40.4 (24.2, 52.6)] and DALY [964.5 (681.8, 1203.2)] rates. The regional age-standardised point prevalence, death and DALY rates in 2019 increased with advancing age and were higher in males in almost all age groups. There was a U-shaped association between SDI and the burden of COPD over the period 1990 to 2019. Moreover, in 2019 smoking (43.7%), ambient particulate matter pollution (22.8%) and occupational particulate matter (11.4%) had the largest proportion of attributable DALYs for both sexes.

Conclusions: COPD is one of the leading causes of death and disability in the MENA region, although the age-standardised burden has decreased over the last 30 years. Nevertheless, COPD accounted for a substantial number of deaths and DALYs, especially among the elderly. Programs targeting risk factors, like smoking, should be taken into consideration.

Keywords: Chronic obstructive pulmonary disease; Epidemiology; Global burden of disease; Middle East and North Africa; Risk factor; Socio-demographic index.

Fig. 1

Age-standardised point prevalence (A), death (B), and DALYs (C) of chronic obstructive pulmonary disease (per 100,000 population) in the Middle East and North Africa region in 2019, by sex and country. DALY disability-adjusted-life-years (Generated from data available from http://ghdx.healthdata.org/gbd-results-tool)

Fig. 2

Numbers of prevalent cases and prevalence (A), number of deaths and death rate (B) and the number of DALYs and DALY rate (C) for chronic obstructive pulmonary disease per 100,000 population in the Middle East and North Africa region, by age and sex in 2019; dotted and dashed lines indicate 95% upper and lower uncertainty intervals, respectively. DALY disability-adjusted-life-years (Generated from data available from http://ghdx.healthdata.org/gbd-results-tool)

Fig. 3

Ratio of the Middle East and North Africa region to the global chronic obstructive pulmonary disease DALY rate according to age group and sex, 1990–2019. DALY disability-adjusted-life-years (Generated from data available from http://ghdx.healthdata.org/gbd-results-tool)

Fig. 4

Age-standardised DALY rates of chronic obstructive pulmonary disease for 21 countries and territories in the Middle East and North Africa region, by SDI in 2019; Expected values based on the Socio-demographic Index and disease rates in all locations are shown as the black line. Each point shows the observed age-standardised DALY rate for each country in 2019. DALY disability-adjusted-life-years, SDI Socio-demographic Index (Generated from data available from http://ghdx.healthdata.org/gbd-results-tool)

Fig. 5

Percentage of DALYs due to chronic obstructive pulmonary disease attributable to risk factors for the Middle East and North Africa countries in 2019. DALY disability-adjusted-life-years (Generated from data available from http://ghdx.healthdata.org/gbd-results-tool)