Burden and risk factors of chronic obstructive pulmonary disease in Sub-Saharan African countries, 1990-2019: a systematic analysis for the Global Burden of disease study 2019

Abstract

Background: Sub-Saharan Africa (SSA) has experienced a surge of non-communicable diseases (NCDs) including chronic obstructive pulmonary disease (COPD) over the past two decades. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), in this study we have estimated the burden and attributable risk factors of COPD across SSA countries between 1990 and 2019.

Methods: COPD burden and its attributable risk factors were estimated using data from the 2019 GBD. Percentage change was estimated to show the trend of COPD estimates from 1990 to 2019. COPD estimates attributable by risk factors were also reported to ascertain the risk factor that brings the greatest burden by sex and locations (at country and regions level).

Findings: In 2019, all-age prevalent cases of COPD in SSA were estimated to be 10.3 million (95% Uncertainty Intervals (UI) 9.7 million to 10.9 million) showing an increase of 117% compared with the number of all-age COPD cases in 1990. From 1990 to 2019, SSA underwent an increased percentage change in all-age YLDs due to COPD ranging from 41% in Lesotho to 203% in Equatorial Guinea. The largest premature mortality due to COPD was reported from Central SSA accounting for 729 subjects (95% UI, 509-1078). The highest rate of DALYs attributable to COPD was observed in Lesotho. Household air pollution from solid fuel was the primary contributor of the age standardized YLDs, death rate, and DALYs rate per 100,000 population.

Interpretation: The prevalence of COPD in SSA has had a steady increase over the past three decades and has progressively become a major public health burden across the region. Household air pollution from solid fuel is the primary contributor to COPD related burden, and its percentage contribution showed a similar trend to the reduction of COPD attributed age-standardized DALY rate. The methodological limitations of surveys and datapoints included in the GBD need to be considered when interpreting these associations.

Funding: There are no specific fundings received for this study. The Global Burden of Disease study was supported by funding from the Bill & Melinda Gates Foundation.

Keywords: Burden; COPD; Chronic respiratory diseases; DALYs; Global burden of disease; Risk factors.

Fig. 1

Flowchart shows risk factor attributable estimation using GBD comparative risk assessment framework.

Fig. 2

Age-standardized prevalence of COPD across Sub-Saharan African countries (World Bank Classification) in 2019.

Fig. 3

Age-specific prevalence of COPD by sex in Sub-Saharan Africa, 2019 (percentage difference was estimated to show percentage increase or decrease in male compared to female by age-specific).

Fig. 4

Trend in age-standardized prevalence rate of COPD by region in Sub-Saharan Africa, 1990–2019.

Fig. 5

Age-standardized YLDs due to COPD attributable to risk factors by sex in sub–Saharan Africa in 2019 (the shaded area indicates the age-standardized years lived with disability rate attributable to the specific risk factor by sex).

Fig. 6

Trends in age standardized death due to COPD across Sub Saharan African regions, 1990–2019.

Fig. 7

Contribution risk factors age-standardized Death rate due to COPD in 2019 (the shaded area indicates the age-standardized deaths rate attributable to the specific risk factor by sex).

Fig. 8

Age standardized DALYs due to COPD by sex across sub–Saharan Africa, 2019.

Fig. 9

Age standardized DALYs rate (per 100,000) due to COPD attributable by risk factors among Sub-Saharan Africa regions in 2019.

Fig. 10

Trend in age-standardized DALYs rate due to COPD and risk factors percentage contribution in age-standardized DALYs rate in Sub-Saharan Africa, 1990–2019.