A Systemic Review and Meta-analysis Section of the Prevalence of Chronic Obstructive Pulmonary Disease in India

Introduction: The increased prevalence of Chronic Obstructive Pulmonary Disease (COPD) worldwide, and particularly in India, is of major concern as it causes a high economic burden. It also leads to disability, impairs the quality of life, loss of productivity, increased hospital admissions, and premature death. Therefore, understanding the true burden of COPD to plan healthcare policies and provide disease-specific strategies for prevention and management, an accurate estimate of the prevalence of COPD in India is critical for healthcare planning. Aim: To estimate the pooled prevalence of COPD in India (2012- 2025) and to examine patterns by region and population type. Materials and Methods: This systematic review and metaanalysis followed the PRISMA 2020 guidelines. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Google Scholar, and local journals for studies published between 2012 and 2025, using relevant MeSH terms and Boolean operators. Eligible studies included populationbased, spirometry-confirmed, or questionnaire-based prevalence reports. Hospital-based studies, disease-specific cohorts, reviews, conference abstracts, and those without complete prevalence data were excluded. Data extraction and Joanna Briggs Institute (JBI) risk-of-bias assessment were performed independently by two reviewers. A meta-analysis was performed to estimate the pooled prevalence of COPD across Indian studies using a random-effects model with 95% confidence intervals. Subgroup analyses were conducted by region, age group, gender, population setting, exposure type (biomass fuel use, smoking, occupational dust), and diagnostic criteria (post-bronchodilator spirometry versus symptom-based diagnosis). Statistical heterogeneity was assessed using the I² statistic, and potential publication bias was evaluated through funnel plot inspection and Egger’s regression test. Results: Out of 1,462 records identified, 26 studies met the inclusion criteria and were included in both the qualitative synthesis and meta-analysis. The pooled prevalence of COPD was estimated to be 11.3% (95% CI 9.4-13.4%), with the highest estimates in northern and eastern regions of India. Subgroup analyses revealed a higher prevalence among the elderly, smokers, and households exposed to biomass fuel. Conclusion: Early diagnosis of COPD at the primary healthcare level is essential to initiate timely management and reduce disease burden. Reliable estimate of the true prevalence of COPD in India is required, for which a nationwide populationbased survey for screening of COPD with adequate training and resources.