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

Abstract

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 (CI): -11.9 to -10.4%; males: AAPC: -8.0%, 95% CI: -9.2 to -6.8%], regions (eastern: AAPC: -10.7%, 95% CI: -11.5 to -9.9%; central: AAPC: -9.9%, 95% CI: -10.9 to -8.9%; western: AAPC: -7.7%, 95% CI: -10.6 to -4.7%), and residential areas (urban: AAPC: -10.9%, 95% CI: -12.3 to -9.5%; rural: AAPC: -8.3%, 95% CI: -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.