{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:22:48Z","timestamp":1789399368220,"version":"build-2803163510"},"reference-count":41,"publisher":"Elsevier BV","issue":"1","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2016YFC1303905"],"award-info":[{"award-number":["2016YFC1303905"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Chinese Medical Journal Pulmonary and Critical Care Medicine"],"published-print":{"date-parts":[[2026,3]]},"DOI":"10.1016\/j.pccm.2026.02.002","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T13:17:00Z","timestamp":1773407820000},"page":"72-80","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":3,"title":["Incidence of acute exacerbation and its related factors among chronic obstructive pulmonary disease patients aged 40 years and older in China"],"prefix":"10.1016","volume":"4","author":[{"given":"Qi","family":"Luo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu","family":"Cong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shige","family":"Qi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueting","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3406-358X","authenticated-orcid":false,"given":"Liwen","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.pccm.2026.02.002_bib0001","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.5588\/ijtld.19.0397","article-title":"The GOLD Summit on chronic obstructive pulmonary disease in low- and middle-income countries","volume":"23","author":"Halpin","year":"2019","journal-title":"Int J Tuberc Lung Dis"},{"key":"10.1016\/j.pccm.2026.02.002_bib0002","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.46598","article-title":"Global burden of chronic obstructive pulmonary disease through 2050","volume":"6","author":"Boers","year":"2023","journal-title":"JAMA Netw Open"},{"key":"10.1016\/j.pccm.2026.02.002_bib0003","doi-asserted-by":"crossref","first-page":"e442","DOI":"10.1371\/journal.pmed.0030442","article-title":"Projections of global mortality and burden of disease from 2002 to 2030","volume":"3","author":"Mathers","year":"2006","journal-title":"PLoS Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0004","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.pccm.2025.05.004","article-title":"Burden of chronic obstructive pulmonary disease and risk factors in China from 1990 to 2021: analysis of global burden of disease 2021","volume":"3","author":"Dong","year":"2025","journal-title":"Chin Med J Pulm Crit Care Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0005","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2022.859499","article-title":"The burden of COPD in China and its provinces: findings from the global burden of disease study 2019","volume":"10","author":"Yin","year":"2022","journal-title":"Front Public Health"},{"key":"10.1016\/j.pccm.2026.02.002_bib0006","first-page":"264","article-title":"Study on trend analysis and forecast of incidence, disease and mortality of chronic obstructive pulmonary disease in China, 1990\u20132021","volume":"29","author":"Chen","year":"2026","journal-title":"Chin Gen Pract"},{"key":"10.1016\/j.pccm.2026.02.002_bib0007","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/S2213-2600(18)30103-6","article-title":"Chronic obstructive pulmonary disease in China: a nationwide prevalence study","volume":"6","author":"Fang","year":"2018","journal-title":"Lancet Respir Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0008","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1016\/S0140-6736(18)30841-9","article-title":"Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study","volume":"391","author":"Wang","year":"2018","journal-title":"Lancet"},{"key":"10.1016\/j.pccm.2026.02.002_bib0009","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1164\/ajrccm.157.5.9709032","article-title":"Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease","volume":"157","author":"Seemungal","year":"1998","journal-title":"Am J Respir Crit Care Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0010","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.rmed.2017.04.013","article-title":"Effect of a single exacerbation on decline in lung function in COPD","volume":"128","author":"Halpin","year":"2017","journal-title":"Respir Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0011","first-page":"895","article-title":"Risk factors analysis for one-year and long-term mortality in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease","volume":"42","author":"Zhang","year":"2019","journal-title":"Chin J Tuberc Respir Dis"},{"key":"10.1016\/j.pccm.2026.02.002_bib0012","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1136\/thx.2005.040527","article-title":"Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease","volume":"60","author":"Soler-Catalu\u00f1a","year":"2005","journal-title":"Thorax"},{"key":"10.1016\/j.pccm.2026.02.002_bib0014","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1378\/chest.08-2081","article-title":"Frequency of self-reported COPD exacerbation and airflow obstruction in five Latin American cities: the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar (PLATINO) study","volume":"136","author":"Montes de Oca","year":"2009","journal-title":"Chest"},{"key":"10.1016\/j.pccm.2026.02.002_bib0015","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/S2213-2600(17)30207-2","article-title":"Frequency of exacerbations in patients with chronic obstructive pulmonary disease: an analysis of the SPIROMICS cohort","volume":"5","author":"Han","year":"2017","journal-title":"Lancet Respir Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0016","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1513\/AnnalsATS.202209-751OC","article-title":"Risk factors for chronic obstructive pulmonary disease exacerbations among individuals without a history of recent exacerbations: a COPDGene analysis","volume":"21","author":"Ferrera","year":"2024","journal-title":"Ann Am Thorac Soc"},{"key":"10.1016\/j.pccm.2026.02.002_bib0017","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1038\/s41533-021-00243-x","article-title":"Phenotype and management of chronic obstructive pulmonary disease patients in general population in China: a nationally cross-sectional study","volume":"31","author":"Bao","year":"2021","journal-title":"NPJ Prim Care Respir Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0018","first-page":"115","article-title":"Epidemiological characteristics of chronic obstructive pulmonary disease (COPD) and influencing factors of acute exacerbation in Ma\u2019anshan Area, 2020\u20132022","volume":"35","author":"Tao","year":"2024","journal-title":"J Public Health Prev Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0019","first-page":"639","article-title":"Risk factors for frequent acute exacerbations of chronic obstructive pulmonary disease","volume":"43","author":"Li","year":"2023","journal-title":"Int J Respiration"},{"key":"10.1016\/j.pccm.2026.02.002_bib0020","article-title":"Exacerbation in patients with stable COPD in China: analysis of a prospective, 52-week, nationwide, observational cohort study (REAL)","volume":"17","author":"Yang","year":"2023","journal-title":"Ther Adv Respir Dis"},{"key":"10.1016\/j.pccm.2026.02.002_bib0021","doi-asserted-by":"crossref","DOI":"10.1136\/bmjhci-2024-101323","article-title":"Characteristics and risk factors of patients with undiagnosed COPD in China: results of a nationwide study from the \u2018Happy Breathing\u2019 programme with mixed methods evaluation","volume":"32","author":"Tang","year":"2025","journal-title":"BMJ Health Care Inform"},{"key":"10.1016\/j.pccm.2026.02.002_bib0022","first-page":"546","article-title":"A summary of item and method of national chronic obstructive pulmonary disease surveillance in China","volume":"39","author":"Fang","year":"2018","journal-title":"Chin J Epidemiol"},{"key":"10.1016\/j.pccm.2026.02.002_bib0023","doi-asserted-by":"crossref","DOI":"10.1016\/j.envint.2020.106042","article-title":"Neighborhood greenness associated with chronic obstructive pulmonary disease: a nationwide cross-sectional study in China","volume":"144","author":"Fan","year":"2020","journal-title":"Environ Int"},{"key":"10.1016\/j.pccm.2026.02.002_bib0024","first-page":"557","article-title":"Analysis on passive smoking exposure in adults aged 40 years and older in China, 2014","volume":"39","author":"Cong","year":"2018","journal-title":"Chin J Epidemiol"},{"key":"10.1016\/j.pccm.2026.02.002_bib0025","first-page":"580","article-title":"Survey and analyses of population at high risk of chronic obstructive pulmonary disease in China, 2014","volume":"39","author":"Bao","year":"2018","journal-title":"Chin J Epidemiol"},{"key":"10.1016\/j.pccm.2026.02.002_bib0026","first-page":"1617","article-title":"Prevalence and influencing factors of severe respiratory infections in childhood among residents of China, 2019\u20132020","volume":"45","author":"Song","year":"2024","journal-title":"Chin J Epidemiol"},{"key":"10.1016\/j.pccm.2026.02.002_bib0027","doi-asserted-by":"crossref","first-page":"4538","DOI":"10.21037\/jtd.2017.10.110","article-title":"Reference values for spirometry in Chinese aged 4\u201380 years","volume":"9","author":"Jian","year":"2017","journal-title":"J Thorac Dis"},{"key":"10.1016\/j.pccm.2026.02.002_bib0028","first-page":"597","article-title":"Continuing to confront COPD international patient survey: methods, COPD prevalence, and disease burden in 2012\u20132013","volume":"9","author":"Landis","year":"2014","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"10.1016\/j.pccm.2026.02.002_bib0029","first-page":"177","article-title":"Clinical characteristics of respiratory diseases in the elderly","volume":"13","author":"Qian","year":"2011","journal-title":"Chin J Health Care Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0030","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1164\/rccm.201007-1125OC","article-title":"Risk factors for chronic obstructive pulmonary disease in a European cohort of young adults","volume":"183","author":"de Marco","year":"2011","journal-title":"Am J Respir Crit Care Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0031","doi-asserted-by":"crossref","first-page":"389","DOI":"10.5588\/ijtld.15.0441","article-title":"Risk factors for exacerbation in chronic obstructive pulmonary disease: a prospective study","volume":"20","author":"Montserrat-Capdevila","year":"2016","journal-title":"Int J Tuberc Lung Dis"},{"key":"10.1016\/j.pccm.2026.02.002_bib0032","doi-asserted-by":"crossref","first-page":"169","DOI":"10.2147\/COPD.S4681","article-title":"The impact of SHS exposure on health status and exacerbations among patients with COPD","volume":"4","author":"Eisner","year":"2009","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"10.1016\/j.pccm.2026.02.002_bib0033","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.pccm.2024.05.003","article-title":"Prevalence of nicotine dependence among smokers aged 40 years and older in China","volume":"2","author":"Ji","year":"2024","journal-title":"Chin Med J Pulm Crit Care Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0034","first-page":"131","article-title":"Joinpoint regression model based analysis of the trend of influenza epidemics in the surveillance years during 2010\u20132019 in China","volume":"30","author":"Guo","year":"2023","journal-title":"Int J Virol"},{"key":"10.1016\/j.pccm.2026.02.002_bib0035","first-page":"982","article-title":"Influenza-like illness outbreaks in China during 2017\u20132018 surveillance season","volume":"53","author":"Liu","year":"2019","journal-title":"Chin J Prev Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0036","first-page":"1273","article-title":"Low temperature affects airway mucin secretion and promotes acute exacerbation of chronic obstructive pulmonary disease","volume":"32","author":"Zhang","year":"2020","journal-title":"Chin Crit Care Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0037","doi-asserted-by":"crossref","first-page":"857","DOI":"10.2147\/COPD.S238457","article-title":"Malnutrition, airflow limitation and severe emphysema are risks for exacerbation of chronic obstructive pulmonary disease in Japanese subjects: a retrospective single-center study","volume":"15","author":"Yamaya","year":"2020","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"10.1016\/j.pccm.2026.02.002_bib0038","doi-asserted-by":"crossref","first-page":"483","DOI":"10.2147\/COPD.S392070","article-title":"Factors associated with the non-exacerbator phenotype of chronic obstructive pulmonary disease","volume":"18","author":"Bouhuis","year":"2023","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"10.1016\/j.pccm.2026.02.002_bib0039","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.rmed.2014.12.006","article-title":"Characterisation of the frequent exacerbator phenotype in COPD patients in a large UK primary care population","volume":"109","author":"McGarvey","year":"2015","journal-title":"Respir Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0040","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1056\/NEJMoa0909883","article-title":"Susceptibility to exacerbation in chronic obstructive pulmonary disease","volume":"363","author":"Hurst","year":"2010","journal-title":"N Engl J Med"},{"key":"10.1016\/j.pccm.2026.02.002_bib0041","first-page":"578","article-title":"Chinese guideline for management of chronic obstructive pulmonary disease in primary care (2024)","volume":"23","year":"2024","journal-title":"Chin J Gen Pract"},{"key":"10.1016\/j.pccm.2026.02.002_bib0042","first-page":"349","article-title":"The associations between comorbidity and exacerbation risk in patients with chronic obstructive pulmonary disease","volume":"41","author":"Huang","year":"2018","journal-title":"Chin J Tuberc Respir Dis"}],"container-title":["Chinese Medical Journal Pulmonary and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2772558826000022?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2772558826000022?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T23:30:57Z","timestamp":1776209457000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2772558826000022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":41,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["S2772558826000022"],"URL":"https:\/\/doi.org\/10.1016\/j.pccm.2026.02.002","relation":{},"ISSN":["2772-5588"],"issn-type":[{"value":"2772-5588","type":"print"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Incidence of acute exacerbation and its related factors among chronic obstructive pulmonary disease patients aged 40 years and older in China","name":"articletitle","label":"Article Title"},{"value":"Chinese Medical Journal Pulmonary and Critical Care Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.pccm.2026.02.002","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier B.V. on behalf of Chinese Medical Association.","name":"copyright","label":"Copyright"}]}}