The pathogenesis of chronic obstructive pulmonary disease (COPD) is complex. Analyzing and forecasting the epidemiological status can provide valuable insights for COPD prevention and control.

To examine COPD incidence, prevalence, and mortality in China from 1990 to 2021, and predict the incidence and mortality rates for 2022-2032 to inform COPD prevention and treatment efforts.

Based on the 2021 Global Burden of Disease (GBD) database, the incidence, prevalence, and mortality of COPD in China from 1990 to 2021 were collected. The change rate and estimated annual percentage change (EAPC) were used to describe the changing trends of COPD. The autoregressive integrated moving average model (ARIMA) was used to predict the incidence, prevalence and mortality of COPD in China from 2022 to 2032.

The standardized incidence and prevalence of COPD in the whole Chinese population from 1990 to 2021 showed an increasing trend (EAPC were 2.25% and 2.53%, respectively, t values of 71.35 and 165.91, respectively, P<0.001); whereas the standardized mortality rate showed a decreasing trend compared with that in 1990 (EAPC=-0.31%, P<0.05). In 2021, the standardized incidence rate of COPD in Chinese men was 308.68/100 000 and the prevalence rate was 3 358.06/100 000; both the incidence and prevalence rates of COPD in men showed an increasing trend compared with 1990 (EAPC were 2.32%, 2.48%, t values of 64.23 and 39.67, respectively, P<0.001); whereas the standardized mortality rate in men increased from 97.13/100 000 to 101.05/100 000, but was not statistically significant in terms of trend (EAPC=0.05%, t=0.62, P=0.54). In 2021, the standardized incidence rate of COPD in Chinese women was 320.70/100 000, and the standardized prevalence rate was 3 829.79/100 000; compared with 1990, the standardized incidence and prevalence rates of COPD in women showed an increasing trend (EAPC were 2.19% and 2.59%, t values of 25.29 and 33.19, respectively, P<0.001); the standardized mortality rate in women showed a decreasing trend (EAPC=-0.77%, t=-3.36, P<0.01), from 91.43/100 000 in 1990 to 74.18/100 000. In 2021, the standardized incidence and prevalence of COPD in Chinese females were 1.04 and 1.14 times higher than that of males, respectively; and the standardized mortality rate of COPD in males was 1.36 times higher than that of females. In the age-stratified analysis, there was a weak increasing trend in the age group of 25-29 years (EAPC=0.05%, P<0.01), and fluctuations in the incidence of standardization in the age group of 30-44 years, but there was no statistical significance (P>0.05). The standardized prevalence of the population over 50 years of age showed an increasing trend and the increase was further widened with age, with the highest rise in the ≥80 years age group (EAPC=4.46%, t=89.92, P<0.001). The age-stratified trend of COPD prevalence showed significant differentiation: a significant decline in prevalence was observed in the 25-34 year olds (25-29 year olds: EAPC=-1.52%, P<0.001; 30-34 year olds: EAPC=-0.57%, P=0.045), while the prevalence of the 35-39 year olds group showed a statistically insignificant change (EAPC=-0.40%, P=0.187), whereas the 40-44 year old group showed a turnaround increase (EAPC=0.60%, P=0.047), and the 50+ year old group showed a rapid increasing trend (EAPC>2.00%, P<0.001). COPD mortality showed a significant increasing trend in the ≥80 years age group (EAPC=0.95%, P<0.001); COPD mortality continued to decrease in the under 80 years age group (all EAPC<-0.50%, P<0.001). The results of ARIMA model showed that the incidence and prevalence of COPD in China from 2022 to 2032 showed an upward trend, and the overall mortality rate declined, but the male mortality rate showed an upward trend, and the female mortality rate fluctuated but generally declined.The incidence rate of COPD in 2032 was estimated to be up to 409.39/100 000, and the prevalence rate was estimated to be up to 4 675.48/100 000. In 2032, the overall mortality rate was projected to reach 71.39/100 000, with the male mortality rate expected to reach 112.10/100 000, and the female mortality rate expected to reach 77.32/100 000.

From 1990 to 2021, the standardized incidence and prevalence of COPD in the whole population, male and female populations in China showed an overall increasing trend. In the elderly population, the standardized incidence and prevalence of COPD showed a growing trend, and the mortality rate of the population aged 80 years or older showed an increasing trend, whereas the mortality rate of COPD for people under 80 years of age showed a decreasing trend. Incidence and prevalence of COPD in China from 2022 to 2032 showed an increasing trend, and the overall mortality rate was decreasing, but the mortality rate of males showed an increasing trend, and the mortality rate of females fluctuates.

慢性阻塞性肺疾病（以下简称慢阻肺）发病机制复杂，分析和预测其流行现状能够为慢阻肺的防控提供一定参考。

了解1990—2021年中国慢阻肺的发病、患病以及死亡情况，并预测该病2022—2032年的发病率及死亡率，为慢阻肺的防治提供参考。

基于2021全球疾病负担数据库（GBD 2021），收集1990—2021年中国慢阻肺的发病、患病以及死亡数据，根据变化率和年估计变化百分比（EAPC）分析中国慢阻肺的变化趋势。利用自回归移动平均（ARIMA）模型预测2022—2032年中国慢阻肺的发病率、患病率及死亡率。

1990—2021年中国全人群慢阻肺的标化发病率、患病率呈上升趋势（EAPC分别为2.25%、2.53%，t值分别为71.35、165.91，P<0.001）；而标化死亡率与1990年相比，呈下降趋势（EAPC=-0.31%，P<0.05）。2021年中国男性慢阻肺的标化发病率为308.68/10万，患病率为3 358.06/10万；与1990年相比，男性慢阻肺标化发病率和患病率均呈上升趋势（EAPC分别为2.32%、2.48%，t值分别为64.23、39.67，P<0.001）；而男性标化死亡率从97.13/10万升高至101.05/10万，但在趋势上无统计学意义（EAPC=0.05%，t=0.62，P=0.54）。2021年中国女性慢阻肺标化发病率为320.70/10万，标化患病率为3 829.79/10万；与1990年相比，女性慢阻肺标化发病率、患病率呈上升趋势（EAPC分别为2.19%、2.59%，t值分别为25.29、33.19，P<0.001）；女性标化死亡率呈下降趋势（EAPC=-0.77%，t=-3.36，P<0.01），从1990年的91.43/10万下降至74.18/10万。2021年中国女性慢阻肺的标化发病率、患病率分别是男性的1.04倍和1.14倍；男性慢阻肺的标化死亡率是女性的1.36倍。年龄分层分析中，25~29岁年龄组的标化发病率呈微弱的增长趋势（EAPC=0.05%，P<0.01），30~44岁人群的标化发病率波动变化（P>0.05）。50岁以上人群的标化发病率呈现增长趋势，且随年龄增长增幅进一步扩大，其中≥80岁年龄组上升幅度最大（EAPC=4.46%，t=89.92，P<0.001）。慢阻肺患病率的年龄分层趋势呈现显著分化：25~34岁人群患病率下降（25~29岁：EAPC=-1.52%，P<0.001；30~34岁：EAPC=-0.57%，P=0.045），35~39岁人群患病率的变化无统计学意义（EAPC=-0.4%，P=0.187），而40~44岁人群出现转折性上升（EAPC=0.60%，P=0.047），50岁以上人群则表现为快速上升趋势（EAPC>2.00%，P<0.001）。慢阻肺的死亡率表现为：≥80岁年龄组慢阻肺死亡率呈现上升趋势（EAPC=0.95%，P<0.001）；80岁以下年龄组的慢阻肺死亡率持续下降（EAPC均<-0.50%，P<0.001）。ARIMA模型预测结果显示，2022—2032年中国慢阻肺发病率、患病率呈现上升趋势，总体死亡率下降，但男性死亡率表现为上升趋势，女性死亡率存在波动，但总体呈下降态势。2032年慢阻肺发病率预计可达409.39/10万，患病率预计可达4 675.48/10万。2032年，全人群死亡率预计达到71.39/10万，男性人群死亡率预计达到112.10/10万，女性人群死亡率预计达到77.32/10万。

1990—2021年中国全人群、男性人群、女性人群慢阻肺的标化发病率和患病率总体呈上升趋势。在老年群体中，慢阻肺标化发病率及患病率呈增长趋势，80岁以上人群死亡率呈上升趋势，而80岁以下人群的慢阻肺死亡率表现为下降趋势。2022—2032年中国慢阻肺发病率、患病率呈现上升趋势，总体死亡率下降，但男性死亡率表现为上升趋势，女性死亡率存在波动。