Global and National Burden of Chronic Obstructive Pulmonary Disease and Tracheal, Bronchus, and Lung Cancer From 1990 to 2021: Comorbidity Burden Analysis Based on the Global Burden of Disease Study 2021.

IntroductionQuantifying disease burden plays a critical role in informing prevention strategies and optimizing health resource allocation. While existing studies have separately described the global epidemiological landscapes of chronic obstructive pulmonary disease (COPD) and tracheal, bronchus, and lung cancer (LC), there is a notable absence of comprehensive analysis on the combined burden of LC-COPD. Addressing this gap is essential for improving disease management and policy development.MethodsData on age-standardized incidence, death, prevalence, and disability-adjusted life year (DALY) rates (ASIR, ASDR, ASPR, and ASDALYR per 100 000) from 1990 to 2021, in global, regional, and national/territorial hierarchy, were retrieved from the 2021 Global Burden of Disease Study (GBD 2021). COPD to LC ratios of ASRs (C/L-ASRs) were calculated to describe the relative burden of LC-COPD. With Joinpoint regression, the average annual percentage changes were generated to study epidemiological trends. ASDALYR attributable to four shared risks, were systematically studied.ResultsIn 2021, global ASRs for both COPD and LC declined, yet their combined disease burden remained substantial. Notably, five regions exhibited synchronous increases. Low SDI regions showed severe imbalance-described by a C/L-ASIR of 3.53 in 2021. Age stratification further revealed COPD-dominated mortality in aged ≥ 75 years, particularly among females. Despite a 60.1% global decline since 1990, smoking was still the leading contributor. Household air pollution from solid fuels posed a greater burden than smoking in South Asia and Sub-Saharan Africa. Ambient particulate matter pollution increased LC-related ASDALYRs in almost all regions.ConclusionAlthough the overall burden of LC-COPD is declining, the comorbid population remains large and continues to face healthcare access barriers. This study calls for shifting focus to the shared comorbidity burden, prioritizing the prevention of common risk factors, early identification of comorbidities, and implementing integrated care to optimize resource utilization under constrained conditions.