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This study aims to provide a comprehensive analysis of the burden of COPD by age, sex and Sociodemographic Index (SDI), in addition to its attributable risk factors across 204 countries and territories from 1990 to 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study is a systematic analysis of data from the Global Burden of Disease (GBD) 2021 from 1990 to 2021 across 204 countries and territories. The study calculates age-standardised rates (ASRs) for prevalence, deaths and disability-adjusted life-years (DALYs) by adjusting rates to a global age distribution and computed estimated annual percentage changes (EAPC) for these ASRs and the relative COPD burden, while also exploring the relationships between the SDI and age-standardised DALYs per 1000 population via linear regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 2021, there were an estimated 213.4\u2009million prevalent COPD cases globally, with an ASR of 2512.9 per 100\u2009000. From 1990 to 2021, the EAPC for ASRs in prevalence was \u22120.044%, while the EAPC for percentage in prevalence was 1.224%. COPD caused 3.7\u2009million deaths, with an ASR of 45.2 per 100 000, and 79.8\u2009million DALYs, with an ASR of 940.7 per 100\u2009000. The leading risk factor for COPD globally was particulate matter pollution, where it accounted for 41.7% of the global DALYs. Appreciable geographical and demographic variations were observed, with North America exhibiting the greatest ASRs for prevalence and South Asia showing the greatest ASRs for death rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study highlights the persistent and evolving global burden of COPD, emphasising the significant impact of environmental factors such as particulate matter pollution. It underscores the need for targeted public health interventions and resource allocation, particularly in low-income and middle-income countries, to mitigate the growing COPD challenge. To enhance COPD management, the recommendations include implementing regional plans to mitigate particulate pollution, strengthening surveillance of air quality and health outcomes, developing integrated health strategies and supporting a global framework for air quality improvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2024-002489","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T15:48:21Z","timestamp":1768319301000},"page":"e002489","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990\u20132021: results from the Global Burden of Disease Study 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