Chronic Obstructive Pulmonary Disease-Associated Mortality - China, 2014-2021.

INTRODUCTION

China faces a growing burden of chronic obstructive pulmonary disease (COPD). Previous mortality estimations were primarily based on the underlying cause of death. This study analyzed COPD-associated death and its comorbidities using all COPD cases listed on the chain of events on death certificates.

METHODS

A retrospective analysis of the National Mortality Surveillance System (NMSS) was conducted to estimate COPD-associated mortality from 2014 to 2021. Age-standardized mortality rates (ASMRs) were calculated stratified by sex, region, and residence. Joinpoint regression was used to estimate the average annual percentage change (AAPC) during the study period.

RESULTS

From 2014 to 2021, the ASMR of COPD decreased from 91.85 to 45.90 per 100,000 population. Significant but uneven decreases in COPD mortality were observed across gender [females: AAPC: -11.2%, 95% confidence interval (): -11.9 to -10.4%; males: AAPC: -8.0%, 95% : -9.2 to -6.8%], regions (eastern: AAPC: -10.7%, 95% : -11.5 to -9.9%; central: AAPC: -9.9%, 95% : -10.9 to -8.9%; western: AAPC: -7.7%, 95% : -10.6 to -4.7%), and residential areas (urban: AAPC: -10.9%, 95% : -12.3 to -9.5%; rural: AAPC: -8.3%, 95% : -9.1 to -7.4%). Other than COPD, cardiovascular diseases and respiratory conditions were the major underlying causes of death in COPD-associated mortality.

CONCLUSIONS

COPD is a significant comorbidity of other disorders in China. Although COPD-associated mortality substantially decreased from 2014 to 2021, the burden remained high in underdeveloped regions.