The Analysis Of The Prevalence And Disease Burden Of Chronic Obstructive Pulmonary Disease In Jiangsu Province

PurposesTo analyze the prevalence of chronic obstructive pulmonary disease(COPD),trends of mortality rate,premature death rate and disability adjusted of life years(DALY)of COPD in Jiangsu Province from 2010 to 2019,and to predict the mortality rate of COPD in Jiangsu Province from 2020 to 2025.A quantitative evaluation of the burden of smoking-related diseases and the effects of PM2.5 pollution on COPD death in the population is also carried out to provide a scientific basis for the development of measures to prevent and treat COPD.Methods1.The epidemic of COPD data were obtained from the COPD surveillance programs in Jiangsu Province in 2015 and 2019.A multi-stage stratified cluster sampling method was used for the monitoring.A total of 3,600 residents aged 40 and over were selected for the six monitoring sites in Jiangsu province,with effective sample sizes of 3,365 and 3,587 in 2015 and 2019,respectively.The monitoring project asked the subjects the following information in the form of face-to-face interviews: gender,age,affiliation,smoking status,living environment,use of cooking and heating fuels,and occupational exposure and so on.At the same time,lung function tests were used to determine whether the subjects belonged to COPD patients and the severity grading of COPD.In this study,we used data from the death registration information of Jiangsu Province from 2010-2019 to collect data on underlying causes of death from COPD,and population data were obtained from annual household registration population data from the public security department.The mortality rate,agestandardized mortality rate and premature death rate of COPD among residents of Jiangsu Province from 2010-2019 were calculated by referring to the 2019 Global burden of diseases study(GBD)method.Referring to the life table method recommended by World health organization(WHO)to calculate the premature death rate of COPD among residents in Jiangsu Province from 2010 to 2019.The Joinpoint regression model was used to describe the average annual change trend.The average annual percentage change(AAPC)was used to estimate the change in mortality rate of COPD among residents of Jiangsu Province from 2020-2025.Indicators were standardized using the global standard population composition published by WHO in 2010.2.Using the GBD 2019 abbreviated estimation method to calculate DALY,including years of life lost(YLL)and years of life lived with disability(YLD).AAPC from Joinpoint regression was used to characterize the trend of disease burden in COPD.3.The COPD monitoring data of Jiangsu Province in 2015 and 2019 were used to obtain data on smoking in Jiangsu Province,and the comparative risk assessment method was used to evaluate and compare the health loss caused by smoking on COPD in Jiangsu Province.Daily PM2.5 data from 2016 and 2019 were obtained from all monitoring sites in Jiangsu Province through the Jiangsu Environmental Monitoring Center and a time series database was established.Based on Poisson distribution,a generalized summation model was used to analyze the effect of PM2.5 on COPD mortality among residents of Jiangsu Province,and subgroup analysis of the population was performed to identify at-risk populations.Results1.The crude prevalence of COPD among residents aged 40 years and above in Jiangsu Province was 12.72% in 2015,and the prevalence of COPD decreased to 11.32% in 2019.COPD patients were classified as mild,moderate,severe,and extremely severe by severity,and the proportion of mild and severe COPD patients in Jiangsu Province decreased in 2019 compared with 2015,but the proportion of moderate COPD patients increased.The proportion of mild COPD patients and the proportion of severe COPD patients was the highest and the lowest among COPD patients aged 40 years and above in Jiangsu Province in 2015 and 2019.AAPC in crude mortality of COPD in Jiangsu Province from 2010 to 2019 was 1.33%,and AAPC=-5.16% in age-standardized mortality.The annual number of COPD deaths,crude mortality and age-standardized mortality in Jiangsu Province were higher for males than for females during 2010-2019.In Jiangsu Province,the number of deaths from COPD and crude mortality rate increased from 2010 to 2019 for both males and females.However,the age-standardized mortality rate decreased,with AAPC of-4.78% and-6.07%, respectively.In Jiangsu Province,the crude mortality rate of COPD for urban and rural residents in 2019 was 50.17/100,000 and 68.85/100,000,respectively.During 2010-2019,the crude mortality rate from COPD increased in urban and rural residents in Jiangsu Province,but the age-standardized mortality rate both decreased,with AAPC of-6.73% and-3.94%,respectively.From 2010 to 2019,the crude and age-standardized mortality rates of COPD were higher in rural residents than in urban residents in Jiangsu Province.The agestandardized mortality rate of COPD increased with age,which started to climb stepwise after age 30,peaking at the age 70 and older.The crude mortality rate of COPD in Jiangsu Province is predicted to decrease year by year from 2020 to 2025,and is expected to decrease to 46.61/100,000 for the whole population in 2025,with crude mortality rates of 4.97/100,000 and 444.81/100,000 for the population aged 0-69 years and 70 years and above,respectively.The premature death rate of COPD in the population of Jiangsu Province decreased from 0.61% in 2010 to 0.37% in 2019,with AAPC =-5.09%.The premature death rate of COPD in Jiangsu Province was 0.85% and 0.37% for males and females in 2010,respectively.They were decreased to 0.53% and 0.21% by 2019,respectively.In addition,premature death rate from COPD in Jiangsu province was higher for men than for women and the whole population in 2010-2019.The premature death rate in COPD in urban residents decreased from 0.40% in 2010 to 0.31% in 2019,with AAPC of-3.00%.The premature death rate in COPD for rural residents decreased from 0.72% in 2010 to 0.43% in 2019,with AAPC of-5.18%.From 2010 to 2019,the premature death rate of COPD in rural residents was higher than in urban residents of Jiangsu province.2.The age-standardized DALY rate of COPD among residents of Jiangsu Province decreased from 2,298.27/100,000 in 2010 to 1,492.22/100,000 in 2019,with AAPC of-4.45%.Similarly,the AAPC in the age-standardized YLL rate and the age-standardized YLD rate were-3.92% and-4.66%,respectively.The percentage of YLD was higher than YLL in all years of DALY composition,but the percentage of YLL increased over time,from 27.24% in 2010 to 30.35% in 2019.The age-standardized DALY rates for COPD in Jiangsu Province decreased from 2329.36/100,000 and 1108.82/100,000 in 2010 to 641.42/100,000 and 1533.82/100,000 in2019 for males and females,respectively.The AAPC was-4.07% and-5.23% for males and females,respectively.The age-standardized YLL rate of COPD decreased significantly in both males and females,with AAPC of-3.35% and-4.57%,respectively,and AAPC of the age-standardized YLD rate were-4.32% and-5.52%,respectively.The number and agestandardization rates of DALY,YLL and YLD of COPD were higher in males than in females in Jiangsu Province from 2010-2019.The YLL rate,YLD rate and DALY rate of COPD among residents of Jiangsu Province were relatively low in Jiangsu Province before age 30,and rose rapidly with age.The YLL rate,YLD rate and DALY rate of COPD among residents of Jiangsu Province peaked in the age group above 70 years in both 2010 and 2019.3.The smoking rate of residents aged 40 years and above in Jiangsu Province decreased from 39.14% in 2015 to 36.86% in 2019,a change of-5.83%.The population attributable fraction(PAF)decreased from 14.32% in 2015 to 13.15% in 2019,a change of-8.17%.The number of death and DALY due to COPD caused by smoking among residents aged 40 years and older in Jiangsu Province in 2019 were 20.07% and 15.74% lower than in 2015,respectively,and the disease burden attributable to smoking in COPD was higher in males than in females.The proportion of disease burden attributable to smoking in COPD among residents aged 40 years and above in Jiangsu Province in 2015 and 2019 was higher than that attributable to YLL than attributable to YLD,with attributable YLL/attributable YLD of 1.67 and 1.32,respectively.The smoking attributable DALY for COPD increased with age.For every 10 μg/m3 increase in the daily concentration of PM2.5,the relative risk(RR)of COPD death was 1.79(95%CI: 1.34-2.25).The RR of COPD death was 1.53(95%CI: 1.07-1.99)for each 10 μg/m3 increase in one-day lag concentration of PM2.5.The cumulative lag effect was strongest at the last 72 hours(lag02),RR of COPD death was 1.91(95%CI: 1.31-2.50)in the whole population,1.64(95%CI: 1.00-2.28)for males and 2.25(95%CI: 1.48-3.03)for females for each 10 μg/m3 increase in atmospheric PM2.5 concentration;the RR of COPD death in people aged 65 years and older was 2.25(95%CI: 1.48-3.03),and no statistically significant RR of COPD death in people under 65 years of age.ConclusionsAlthough the disease burden due to COPD among residents of Jiangsu Province from 2010 to 2019 showed a decreasing trend,it remained more serious,with the disease burden more prominent among males,the rural population,and the elderly population.We should focus on preventing and controlling the harm caused by smoking,exposure to polluting fuels and PM2.5 pollution,and take targeted measures to pay attention to the differences in the burden of disease among people of different regions,sexes,and age groups,to reduce the incidence of COPD mortality rate and disease burden among Jiangsu Province residents.