J Glob Health. 2024 Sep 27;14:04213. doi: 10.7189/jogh.14.04213.
Chronic obstructive pulmonary disease (COPD) is one of the primary causes of significant morbidity and mortality worldwide. This study aimed to explore the cross-country inequalities by age, sex, and region in COPD's burden and care quality from 1990 to 2021.
We obtained data from the Global Burden of Disease 2021. Using age-standardised disability-adjusted life years rate (ASDR) per 100 000 population and quality of care index (QCI), we quantified the COPD burden and care quality, respectively. Applying the principal component analysis method, we calculated QCI scores, ranging from 0 to 100, where higher values indicate better care quality. We quantified temporal trends from 1990 to 2021 for ASDR and QCI by estimated annual percentage change (EAPC). Finally, we assessed the absolute and relative disparities in ASDR and QCI across countries using the slope index of inequality (SII) and concentration index.
Between 1990 and 2021, there was a notable decline in ASDR of COPD globally (1990 = 1492.64; 2021 = 940.66; EAPC = -1.71), accompanied by an increase in QCI (1990 = 58.42; 2021 = 73.86; EAPC = 0.89). Regions with middle sociodemographic index (SDI) consistently demonstrated the highest ASDR and the lowest QCI in 1990 (ASDR = 2332.91; QCI = 31.70), whereas by 2021, low-middle SDI regions exhibited similar trends (ASDR = 1707.90; QCI = 57.50). In 2021, the highest ASDR was among individuals aged 95 years and above (16251.22), while the lowest QCI was among people aged 70-74 years (72.18). Papua New Guinea recorded the highest ASDR and the lowest QCI in 2021 (ASDR = 3004.36; QCI = 19.18). Compared to 1990, where the SII for ASDR was -612.44 and for QCI was 21.78, with concentration indices of -0.14 for ASDR and 0.11 for QCI, the absolute values of both SII and concentration index were smaller in 2021, with ASDR's SII at -555.90, QCI's at 16.72, ASDR's concentration index at -0.13, and QCI's at 0.04.
The global burden of COPD decreases and care quality increases over time, with notable variations across ages, sexes and SDI regions. Countries with lower SDI had disproportionately higher burden and poorer care quality for COPD.
慢性阻塞性肺疾病（COPD）是全球导致发病率和死亡率显著上升的主要原因之一。本研究旨在探讨 1990 年至 2021 年 COPD 负担和护理质量在年龄、性别和地区方面的跨国不平等情况。
我们从全球疾病负担 2021 年研究中获取数据。使用每 100000 人口年龄标准化残疾调整生命年率（ASDR）和护理质量指数（QCI），分别量化 COPD 负担和护理质量。采用主成分分析方法，计算 QCI 评分，范围为 0 至 100，其中数值越高表示护理质量越好。我们通过估计的年变化百分比（EAPC）计算了 1990 年至 2021 年 ASDR 和 QCI 的时间趋势。最后，我们使用斜率指数不平等（SII）和集中指数评估了各国 ASDR 和 QCI 的绝对和相对差异。
1990 年至 2021 年间，全球 COPD 的 ASDR 显著下降（1990 年=1492.64；2021 年=940.66；EAPC=-1.71），同时 QCI 上升（1990 年=58.42；2021 年=73.86；EAPC=0.89）。中社会人口指数（SDI）地区在 1990 年始终表现出最高的 ASDR 和最低的 QCI（ASDR=2332.91；QCI=31.70），而到 2021 年，中低 SDI 地区则呈现出类似的趋势（ASDR=1707.90；QCI=57.50）。2021 年，95 岁及以上人群的 ASDR 最高（16251.22），70-74 岁人群的 QCI 最低（72.18）。2021 年，巴布亚新几内亚的 ASDR 和 QCI 最高（ASDR=3004.36；QCI=19.18）。与 1990 年相比，ASDR 的 SII 为-612.44，QCI 的 SII 为 21.78，ASDR 的集中指数为-0.14，QCI 的集中指数为 0.11，2021 年的 SII 和集中指数绝对值均较小，ASDR 的 SII 为-555.90，QCI 的 SII 为 16.72，ASDR 的集中指数为-0.13，QCI 的集中指数为 0.04。
随着时间的推移，全球 COPD 的负担呈下降趋势，护理质量呈上升趋势，在年龄、性别和 SDI 地区方面存在显著差异。SDI 较低的国家 COPD 的负担和护理质量较差。
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