Epidemiological Trends and Projections of PM2.5-Attributable COPD Burden in China Over 1990–2035

Objective: This study investigated long-term trends in the burden of chronic obstructive pulmonary disease (COPD) attributable to PM 2.5 in China from 1990 to 2021 and projected future patterns through 2035. Methods: Data were obtained from the Global Burden of Disease Study 2021. Key indicators included disability-adjusted life years (DALYs), deaths, age-standardized disability-adjusted life years rates (ASDR), and age-standardized mortality rates (ASMR), which together characterize both individual-level and population-level disease burden. Analyses were stratified by sex and age group. Future trends were projected using a Bayesian age–period–cohort (BAPC) model. Results: From 1990 to 2021, the COPD burden in China showed a sustained downward trend. The overall ASDR decreased from 2692.65 to 473.09 per 100,000 population (approximately an 82.4% reduction), while the ASMR declined from 162.33 to 28.22 per 100,000 population (approximately an 82.6% reduction). More pronounced declines were observed during the mid-1990s to early 2000s. A modest increase in PM 2.5 -attributable COPD burden was noted in 2020, which may be associated with disruptions related to the COVID-19 pandemic. In 2021, COPD attributable to PM 2.5 accounted for an estimated 9.16 million DALYs and 497,000 deaths, with a consistently higher burden observed among males. Projections indicate a continued overall decline in COPD burden by 2035, although a slight upward trend in ASMR is projected among males. Conclusion: COPD attributable to PM 2.5 continues to impose a substantial public health burden in China. Despite long-term declines in age-standardized rates, the observed fluctuation in 2020 suggests ongoing vulnerability among individuals with chronic respiratory diseases. Continued efforts targeting air quality improvement and smoking reduction may contribute to further mitigation of COPD burden, particularly among high-risk populations. Keywords: chronic obstructive pulmonary disease, air pollution, disease burden, epidemiology, global burden of disease, disability-adjusted life years, smoking