Global Temporal Trends and Projections of DALY Burden in COPD Patients Aged ≥ 55 Years: Age–Period–Cohort Analysis and Frontiers 2021

Household air pollution from solid fuels (HAPSF) is a significant contributor to chronic obstructive pulmonary disease (COPD). Using the Global Burden of Disease (GBD) 2021, this study focuses on the burden of COPD caused by HAPSF in high-risk individuals aged ≥ 55 years, aimed at filling the research gap concerning exposure risk in the elderly population. From 1990 to 2021, the age standardized disability-adjusted life year (DALY) rate for COPD due to HAPSF declined across all five sociodemographic index (SDI) regions, with the most pronounced reduction in high SDI areas (AAPC: −14.5%). The age–period–cohort (APC) model revealed distinct trends: net drift showed a continuous decline in most regions except low SDI areas, where DALY rates increased significantly after age 75. In addition, the APC model also reveals sex and inequality issues: the risk ratio of men in the middle SDI region is always higher than that of women, whereas the risk of men in all other SDI regions is lower. Decomposition analysis revealed that epidemiological shifts—primarily reduced HAPSF exposure due to cleaner energy transitions, improved healthcare access, and public health interventions—were the key drivers of declining DALYs (316.35%), outweighing pressures from population growth and aging. Frontier analysis highlighted countries such as Samoa, Pakistan, and India as underperformers relative to their SDI levels, signaling an urgent need for targeted policies. Projections using the Nordpred model suggest a continued decline in DALYs from 2022 to 2044, underscoring the potential for sustained progress. This study provides key insights into reducing the global burden of COPD caused by HAPSF, emphasizing a comprehensive strategy to address socioeconomic and sex issues to achieve health equity.