Analysis On The Temporal And Spatial Trends Of The Global Disease Burden Of COPD And Its Attributable Risk Factors From 1990 To 2019 Based On The GBD 2019 Database

Chronic obstructive pulmonary diseases(COPD)is a common respiratory disease characterized by persistent airflow limitation.COPD has an insidious onset and most patients fail to seek treatment in a timely manner,worsening the condition and increasing the risk of hospitalization,disability and death in COPD patients,causing a huge health and economic burden to patients,families and society.The development of COPD is the result of the interaction of environmental and genetic factors,and its main risk factors include smoking,indoor and outdoor air pollution,occupational environment,and temperature.The Global Burden of Disease Study 2019(GBD 2019)database contains data on the global disease burden and associated risk factors for COPD from 1990-2019,providing data to support the analysis on spatial and temporal trends of global disease burden of COPD and its attributable risk factors.Objective:Analyze data from the GBD 2019 database on the global disease burden of COPD from 1990-2019 to clarify the temporal and spatial distribution trends of the global COPD disease burden from 1990 to 2019,to elucidate the current situation of the global disease burden of COPD attributable to various risk factors,and to provide a scientific basis for the rational formulation and implementation of policies to control COPD risk factors and reduce the global burden of COPD.Methods:Download data related to the global disease burden of COPD from the GBD 2019 database for 1990-2019.The demographic characteristics of data include age,gender,country(territory),GBD region and social demographic index(SDI);data disease burden indicators include age-standardized mortality rate(ASMR)per 100000 population and age-standardized DALY rate(ASDR)per 100000 population;COPD risk factors include ambient particulate matter pollution(APMP),household air pollution from solid fuels(HAP),ambient ozone pollution(AOP),occupational particulate matter,gases,fumes(OPMGF),smoking,secondhand smoke(SHS),High temperature(HT),and low temperature(LT).The log-linear model in the Joinpoint regression model(JRM)was used to analyze the temporal trend in the COPD total disease burden and disease burden attributable to various risk factors,and calculate the average annual percentage change(AAPC)from1990 to 2019 and annual percentage change(APC)of each time period.Use R softwire(4.1.2)to collate and visualize the percentage change of COPD disease burden of various age,GBD region and country(territory)from 1990 to 2019.Arc Map 10.8 and Geo Da 1.20 were used to conduct global spatial autocorrelation analysis and hot spot analysis on the total number of COPD and ASMR and ASDR attributed to each risk factor,and hotspot maps were made using R softwire(4.1.2).Results:1.Temporal change trend of global COPD disease burden: from 1990 to 2019,the ASMR and ASDR of global COPD showed a downward trend,and the AAPC was-1.85% and-1.74%,respectively.In 2019,the ASMR and ASDR were 42.52/100000 and 926.08/100000,respectively.From 1990 to 2019,the disease burden of COPD in men was always higher than that in women,and increased with age.The burden of COPD disease in High-income North America,Caribbean and Southern Latin America increased from 1990 to 2019.The three GBD regions with the highest burden in 2019 were Oceania,South Asia and East Asia.From 1990 to 2019,23 and 33 countries(territories)had an increase in ASMR and ASDR,respectively,with the largest increase in Nicaragua;Nepal was the country with the highest burden in 2019.From 1990 to2019,the disease burden of COPD dropped the fastest in regions with High-middle SDI levels;The regions with Low-middle SDI levels are the regions with the highest burden in 2019.2.Spatial change trend of global COPD disease burden: Moran’s I of COPD disease burden in 1990 and 2019 were greater than 0.In 2019,there were 9 hot spots for ASMR and ASDR,and 26 and 25 cold spots for ASMR and ASDR,respectively.3.Risk factors for the global burden of COPD disease: The top three risk factors of ASMR and ASDR of COPD are smoking,APMP and OPMGF.4.Temporal change trend of COPD disease burden attributable to risk factors:from 1990 to 2019,the disease burden attributable to HT showed an increasing trend;the disease burden attributable to the other 7 risk factors showed a downward trend,of which the disease burden attributable to APMP decreased the slowest and HAP decreased the fastest;except for AOP,the disease burden of COPD caused by the other6 risk factors decreased to increase or decreased slowly in the last time period of JRM.From 1990 to 2019,except HT and APMP,the death rate and DALY rate of COPD caused by other 6 risk factors decreased in all age groups;the disease burden of COPD due to HAP has a downward trend in all SDI level regions,GBD regions and countries(territories).The countries with the largest increases in disease burden attributable to AOP,APMP,LT,and OPMGF were,in order,Madagascar,Nicaragua,Norway,and Honduras;the largest increases in ASMR and ASDR attributable to HT are Myanmar and India,respectively;the largest increases in ASMR and ASDR attributable to SHS are Nicaragua and Belize,respectively;and the largest increases in ASMR and ASDR attributable to smoking are Belize and Georgia,respectively.2019,The regions with Low-middle SDI levels are those with the highest disease burden for risk factors other than HAP and LT.5.Spatial change trend of COPD disease burden attributable to risk factors:Moran’s I of disease burden attributable to risk factors was greater than 0 in 1990 and2019.India and China are the common hotspots of the burden of COPD due to risk factors.Conclusions:1.The global COPD disease burden from 1990-2019 showed a decreasing trend,consistently higher in men than in women,and increasing with age.From 1990 to 2019,the disease burden of COPD increased in High-income North America,Caribbean and Southern Latin America;ASMR and ASDR increased in 23 and 33 countries(territories),respectively;the fastest decline in the burden of COPD is in regions with High-middle SDI levels.2.The COPD disease burden in 1990 and 2019 is spatially aggregated.In 2019,there were 9 hotspots of COPD disease burden.3.The top three risk factors of ASMR and ASDR of COPD are smoking,APMP and OPMGF.4.From 1990 to 2019,only the disease burden attributable to HT showed an increasing trend;in addition to AOP,the burden of COPD caused by the other 6 risk factors decreased to increase or decreased slowly in the last time period of JRM.From1990 to 2019,except HT and APMP,the death rate and DALY rate of COPD caused by other 6 risk factors decreased in all age groups;The disease burden of COPD attributable to HAP has a downward trend in all SDI level regions,GBD regions and countries(territories).5.The disease burden attributable to risk factors has spatial aggregation in both1990 and 2019.India and China are the common hotspots of the burden of COPD attributable to risk factors.