该项研究，使用全球疾病负担研究（GBD 2019）的数据，分析了全球慢性阻塞性肺疾病（简称“慢阻肺”，COPD）的疾病负担和风险因素。研究从GBD 2019研究中获得1990年至2019年204个国家和地区的慢阻肺患病率、死亡人数和残疾调整生命年（DALYs）等数据。

2019年，东亚、南亚和西欧的慢阻肺患病人数和死亡人数最多。北美、南亚和澳大利亚的慢阻肺年龄标化患病率最高；大洋洲、南亚和东亚的慢阻肺年龄标化死亡率最高。年龄标化患病率的变化（1990年到2019年）：埃及（62.0%）、格鲁吉亚（54.9%）和尼加拉瓜（51.6%）的增幅最大；土库曼斯坦（-47.9%）、新加坡（-47.3%）和乌克兰（-45.6%）的降幅最大。

尽管慢性阻塞性肺病的负担在减轻，但这一疾病仍然是一个重大的公共卫生问题，特别是在社会人口指数较低的国家。预防规划应侧重于戒烟、改善空气质量和减少职业接触，以进一步减轻慢性阻塞性肺病的负担。

Abstract

Objective: To report the global, regional, and national burden of chronic obstructive pulmonary disease (COPD) and its attributable risk factors between 1990 and 2019, by age, sex, and sociodemographic index.

Design: Systematic analysis.

Data source: Global Burden of Disease Study 2019.

Main outcome measures: Data on the prevalence, deaths, and disability adjusted life years (DALYs) of COPD, and its attributable risk factors, were retrieved from the Global Burden of Disease 2019 project for 204 countries and territories, between 1990 and 2019. The counts and rates per 100 000 population, along with 95% uncertainty intervals, were presented for each estimate.

Results: In 2019, 212.3 million prevalent cases of COPD were reported globally, with COPD accounting for 3.3 million deaths and 74.4 million DALYs. The global age standardised point prevalence, death, and DALY rates for COPD were 2638.2 (95% uncertainty intervals 2492.2 to 2796.1), 42.5 (37.6 to 46.3), and 926.1 (848.8 to 997.7) per 100 000 population, which were 8.7%, 41.7%, and 39.8% lower than in 1990, respectively. In 2019, Denmark (4299.5), Myanmar (3963.7), and Belgium (3927.7) had the highest age standardised point prevalence of COPD. Egypt (62.0%), Georgia (54.9%), and Nicaragua (51.6%) showed the largest increases in age standardised point prevalence across the study period. In 2019, Nepal (182.5) and Japan (7.4) had the highest and lowest age standardised death rates per 100 000, respectively, and Nepal (3318.4) and Barbados (177.7) had the highest and lowest age standardised DALY rates per 100 000, respectively. In men, the global DALY rate of COPD increased up to age 85-89 years and then decreased with advancing age, whereas for women the rate increased up to the oldest age group (≥95 years). Regionally, an overall reversed V shaped association was found between sociodemographic index and the age standardised DALY rate of COPD. Factors contributing most to the DALYs rates for COPD were smoking (46.0%), pollution from ambient particulate matter (20.7%), and occupational exposure to particulate matter, gases, and fumes (15.6%).

Conclusions: Despite the decreasing burden of COPD, this disease remains a major public health problem, especially in countries with a low sociodemographic index. Preventive programmes should focus on smoking cessation, improving air quality, and reducing occupational exposures to further reduce the burden of COPD.

文章连接：https://www.bmj.com/content/378/bmj-2021-069679.long

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