Smoking-attributable burden of chronic obstructive pulmonary disease from 1990 to 2021: Temporal trends and evidence from the global burden of disease study

Background Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability worldwide, with smoking being the primary contributor. This study aims to assess the temporal and spatial trends in the burden of smoking-related COPD from 1990 to 2021 and project future trajectories. The results aim to provide insights and methodological references for COPD prevention and control strategies. Methods The data were sourced from the Global Burden of Disease (GBD) 2021 database, incorporating estimates and uncertainty intervals ( UI ) for deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) of smoking-related COPD across 204 countries and regions worldwide. The present study employed a variety of statistical methodologies, including estimated annual percentage change (EAPC) to measure trend shifts, frontier analysis to assess the association between the Socio-demographic Index (SDI) and COPD disease burden, decomposition analysis to clarify the impacts of population aging, population growth, and epidemiological changes, and Bayesian age-period-cohort (BAPC) modeling for future disease burden projections. Results From 1990 to 2021, global smoking-related COPD deaths increased from 10,538 (95% UI : 8,724 − 12,339) hundred to 13,350 (95% UI : 10,533 − 15,966) hundred, and DALYs rose from 23,601 (95% UI : 19,648 − 27,495) thousand to 27,795 (95% UI : 22,234 − 32,884) thousand. However, both age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years rates (ASDR) demonstrated a decline across most regions. The largest decreases were observed in High-middle SDI regions. Males consistently bore a higher burden than females. The burden increased with age, peaking at 70–74 years. Aging and population growth were the main contributors to the rise in DALYs, while epidemiological changes had a negative effect. Projections indicate a continued decline in ASMR and ASDR through 2040. Conclusions Despite global progress in reducing the ASRs burden of smoking-related COPD, the absolute burden continues to rise. The findings underscore the necessity for targeted public health interventions in these regions, with a focus on enhancing tobacco control policies, improving healthcare access, and addressing age- and gender-specific risk factors.