Difference in Long-Term Trends in COPD Mortality between China and the U.S., 1992⁻2017: An Age⁻Period⁻Cohort Analysis

Complications due to chronic obstructive pulmonary disease (COPD) is a leading cause of death in China and the United States (U.S.). This study aimed to investigate the long-term trends in COPD mortality in China and the U.S. using data from the Global Burden of Disease Study 2017 (GBD 2017) and explore the age, period, and cohort effects independently by sex under the age-period-cohort (APC) framework. Taking the age group 40-44 years old, the period 1992-1996, and the birth cohort 1913-1917 as reference groups, we found that the age relative risks (RRs) of COPD mortality increased exponentially in both China and the U.S., the period RRs increased in the U.S. but decreased in China; and the cohort RRs showed an overall downward trend in both China and the U.S. with the year of birth. From 1992 to 2017, the increased RRs of COPD mortality in the U.S. was mainly attributable to the increased prevalence of smoking before 1965, while the decreased RRs of COPD mortality in China was mainly attributable to reduced air pollution as well as improvements in medical technology and more accessible health services. Reducing tobacco consumption may be the most effective and feasible way to prevent COPD in China. However, we also need to pay more attention to COPD in nonsmokers in the future.