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. 2025 Feb 10:23.
doi: 10.18332/tid/200196. eCollection 2025.

Chronic obstructive pulmonary disease burden attributable to tobacco and the trend change from 1990 to 2021 in China

Zhenhong Zhang #  1 , Kai Wang #  2 , Guoxiang Xu  2   3 , Rumin Zhang  2
Affiliations

Chronic obstructive pulmonary disease burden attributable to tobacco and the trend change from 1990 to 2021 in China

Zhenhong Zhang et al. Tob Induc Dis. .

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) poses a serious disease burden in China, and tobacco control is considered an effective and feasible means to reduce this burden. This study analyzes the impact of tobacco on the burden of COPD in China from 1990 to 2021.

Methods: This study conducted a comprehensive secondary dataset analysis of COPD attributable to tobacco in China using data from the Global Burden of Disease (GBD) database. This covers a range of statistics, including number of deaths, mortality rates, disability-adjusted life years (DALYs), and DALY rates. Using Joinpoint regression analysis methods, we calculated the annual percentage change (APC) and average annual percentage change (AAPC) to assess trends in COPD attributable to tobacco for various age groups and gender in China.

Results: In 2021, the age-standardized mortality rate (ASMR) of COPD attributable to tobacco in China was 35.46 per 100000, and the age-standardized DALY rate (ASDR) was 589.75 per 100000, both of which were higher than global levels. In China, the ASMR attributable to tobacco showed a consistent decline from 1990 to 2021 (AAPC= -3.69%, p<0.001), as did the ASDR (AAPC= -3.73%, p<0.001), consistent with trends observed globally and across five SDI regions, with China experiencing the fastest decline. In both 1990 and 2021, the burden of COPD attributable to tobacco was greater in males compared to females. During the years from 1990 to 2021, the ASMR of COPD attributable to tobacco and the ASDR showed a declining trend in males (AAPC= -3.29% and -3.41%, respectively) and in females (AAPC= -4.99% and -4.62%, respectively) (all p<0.001). The impact of COPD linked to tobacco use in China increased with age from 1990 to 2021, with the highest mortality and DALY rates observed in the population aged ≥70 years. Regarding secondhand smoke exposure, ASMR for females was 6.29 per 100000 and the ASDR was 119.03 per 100000, while the corresponding values for males were 7.80 per 100000 and 113.10 per 100000 , indicating a higher burden among females.

Conclusions: From 1990 to 2021, the age-standardized mortality rate and age-standardized DALY rate of COPD attributable to tobacco in China showed a declining trend; however, there remains a slight gap compared to global levels. Significant differences in smoking exposure were observed based on gender and age, with a heavier burden among males and the elderly.

Keywords: China; Global Burden of Disease; chronic obstructive pulmonary disease.

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Conflict of interest statement

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.

Figures

Figure 1
Figure 1
Age-standardized DALY rate and mortality of COPD attributed to tobacco in China, globally, and across SDI regions (1990–2021): A) Trends in DALY rates attributable to tobacco use in China and different SDI regions globally; B) Trends in death rate attributable to tobacco use in China and different SDI regions globally
Figure 2
Figure 2
APC of COPD attributed to tobacco in China (1990–2021): A) APC of COPD-related DALYs attributable to tobacco use in China; B) APC of COPD-related deaths attributable to tobacco use in China
See this image and copyright information in PMC

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