A Subnational Analysis of Mortality and Prevalence of COPD in China From 1990 to 2013: Findings From the Global Burden of Disease Study 2013.

BACKGROUND The trends of COPD mortality and prevalence over the past 2 decades across all provinces remain unknown in China. We used data from the Global Burden of Disease Study 2013 (GBD 2013) to estimate the mortality and prevalence of COPD during 1990 to 2013 at a provincial level. METHODS Following the general analytic strategy used in GBD 2013, we analyzed the age- sex- and province-specific mortality and prevalence of COPD in China. Levels of and trends in COPD mortality and prevalence were assessed for 33 province-level administrative units during 1990 to 2013. RESULTS In 2013, there were 910,809 deaths from COPD in China, accounting for 31.1% of the total deaths from COPD in the world. From 1990 to 2013, the age-standardized COPD mortality rate decreased in all provinces, with the highest reduction in Heilongjiang (70.2%) and Jilin (70.0%) and the lowest reduction in Guizhou (26.8%). In 2013, the death rate per 100,000 was highest in Guizhou (196.0) and lowest in Tianjin (34.0) among men and highest in Gansu (141.1) and lowest in Beijing (23.7) among women. The number of COPD cases increased dramatically from 32.4 million in 1990 to 54.8 million in 2013. The age-standardized prevalence rate of COPD remained stable overall and varied little for all provinces. CONCLUSIONS COPD remains a huge health burden in many western provinces in China. The substantial increase in COPD cases represents an ongoing challenge given the rapidly aging Chinese population. A targeted control and prevention strategy should be developed at a provincial level to reduce the burden caused by COPD.

[1]  A. Mahayiddin,et al.  COPD prevalence in 12 Asia-Pacific countries and regions: projections based on the COPD prevalence estimation model. , 2003, Respirology.

[2]  Kristin Aunan,et al.  Internal migration and urbanization in China: impacts on population exposure to household air pollution (2000-2010). , 2014, The Science of the total environment.

[3]  Bernadette A. Thomas,et al.  Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 , 2015, The Lancet.

[4]  Shengming Liu,et al.  Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. , 2007, American journal of respiratory and critical care medicine.

[5]  J. Hsia,et al.  Prevalence of smoking in China in 2010. , 2011, The New England journal of medicine.

[6]  Peng Yin,et al.  The associations between ambient air pollution and adult respiratory mortality in 32 major Chinese cities, 2006-2010. , 2015, Environmental research.

[7]  N. Zhong,et al.  Lung Function and Incidence of Chronic Obstructive Pulmonary Disease after Improved Cooking Fuels and Kitchen Ventilation: A 9-Year Prospective Cohort Study , 2014, PLoS medicine.

[8]  Jiang He,et al.  Major causes of death among men and women in China. , 2005, The New England journal of medicine.

[9]  Yichong Li,et al.  Prevalence of COPD and its association with socioeconomic status in China: Findings from China Chronic Disease Risk Factor Surveillance 2007 , 2011, BMC public health.

[10]  F. Martinez,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. , 2007, American journal of respiratory and critical care medicine.

[11]  M. Naghavi,et al.  Global and regional trends in COPD mortality, 1990–2010 , 2015, European Respiratory Journal.

[12]  Alan D. Lopez,et al.  A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[13]  J. Soriano,et al.  Mortality trends in chronic obstructive pulmonary disease in Europe, 1994-2010: a joinpoint regression analysis. , 2014, The Lancet. Respiratory medicine.

[14]  Dan J Stein,et al.  Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 , 2015, The Lancet.

[15]  Shiwei Liu,et al.  Health reform and mortality in China: Multilevel time-series analysis of regional and socioeconomic inequities in a sample of 73 million , 2015, Scientific Reports.

[16]  Rob J Hyndman,et al.  Forecasts of COPD mortality in Australia: 2006-2025 , 2012, BMC Medical Research Methodology.

[17]  Bernadette A. Thomas,et al.  Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[18]  Alan D. Lopez,et al.  Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[19]  Bernadette A. Thomas,et al.  Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[20]  P. Burney,et al.  Determinants of underdiagnosis of COPD in national and international surveys. , 2015, Chest.

[21]  Jin-Nan Wang,et al.  China tackles the health effects of air pollution , 2013, The Lancet.

[22]  Alan D. Lopez,et al.  Cause-specific mortality for 240 causes in China during 1990–2013: a systematic subnational analysis for the Global Burden of Disease Study 2013 , 2016, The Lancet.

[23]  Z. Zhang,et al.  [Analysis of basic data of the study on prevention and treatment of COPD and chronic cor pulmonale]. , 1998, Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases.

[24]  Dirkje S Postma,et al.  Risk factors and early origins of chronic obstructive pulmonary disease , 2015, The Lancet.

[25]  Jie Chen,et al.  Long-Term Exposure to Ambient Air Pollution and Respiratory Disease Mortality in Shenyang, China: A 12-Year Population-Based Retrospective Cohort Study , 2011, Respiration.

[26]  S. Salvi,et al.  Chronic obstructive pulmonary disease in non-smokers , 2009, The Lancet.

[27]  G. Brusselle,et al.  Early origins of chronic obstructive lung diseases across the life course , 2014, European Journal of Epidemiology.

[28]  Alan D. Lopez,et al.  Mortality registration and surveillance in China: History, current situation and challenges , 2005, Population health metrics.

[29]  Kirk R. Smith,et al.  Household Air Pollution from Coal and Biomass Fuels in China: Measurements, Health Impacts, and Interventions , 2007, Environmental health perspectives.

[30]  D. Mannino,et al.  Changes in mortality among US adults with COPD in two national cohorts recruited from 1971-1975 and 1988-1994. , 2012, Chest.

[31]  Alan Maynard,et al.  Early appraisal of China's huge and complex health-care reforms , 2012, The Lancet.

[32]  Alan D. Lopez,et al.  Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010 , 2013, The Lancet.

[33]  Mohsen Naghavi,et al.  GBD 2010: design, definitions, and metrics , 2012, The Lancet.

[34]  Michael Brauer,et al.  Associations of ambient air pollution with chronic obstructive pulmonary disease hospitalization and mortality. , 2013, American journal of respiratory and critical care medicine.

[35]  J. Soriano,et al.  Global burden of COPD , 2016, Respirology.

[36]  T. Lam,et al.  Past dust and GAS/FUME exposure and COPD in Chinese: the Guangzhou Biobank Cohort Study. , 2011, Respiratory medicine.