Declining Prevalence and Disability Burden of Chronic Obstructive Pulmonary Disease Associated With Heart Failure

Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are two major chronic conditions that frequently coexist, compounding clinical complications and disability. However, the global burden of COPD attributable to HF remains insufficiently characterized.

A comprehensive global analysis was conducted to evaluate trends in COPD prevalence and years lived with disability (YLDs) attributable to HF across 204 countries and territories. Standardized epidemiological estimates were derived through harmonized data sources and modeling frameworks. The results were stratified by sex, age group, region, and sociodemographic index (SDI). Temporal trends were quantified using the estimated annual percentage change (EAPC), and the association between national prevalence and SDI was examined using Spearman's rank correlation analysis.

Globally, COPD cases attributable to HF rose from 1 504 707 to 3 613 136, and the prevalence rate increased from 28.21 to 45.79 per 100 000 population (EAPC: +1.33). YLDs grew from 134 013 to 321 753, with the rate increasing from 2.51 to 4.08 per 100 000. Males experienced slightly greater increases than females, suggesting a somewhat heavier burden. Although the EAPCs across all age groups remained relatively stable, adults aged 75 years and older exhibited the highest prevalence and YLDs. In 2021, the highest prevalence rates were observed in East Asia (104.9 per 100 000), Australasia (90.69 per 100 000), and North America (78.56 per 100 000). At the national level, Canada (115.9 per 100 000), Denmark (112.08 per 100 000), and France (98.16 per 100 000) reported the highest rates, reflecting substantial burden in high-SDI countries. A moderate positive correlation was identified between COPD prevalence and national SDI (ρ = 0.383, p < 0.001).

The global burden of COPD attributable to HF is increasing and exhibits marked geographic disparities, with rising trends in both low-income regions and aging, industrialized countries. These findings emphasize the need for integrated comorbidity management and region-specific health strategies.