Burden of chronic obstructive pulmonary disease, related heart failure and risk factors among middle-aged and elderly patients, 1990-2050.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition that disproportionately affects middle-aged and elderly populations, often leading to heart failure (HF) and imposing a significant global health burden. This study aimed to quantify the global, regional, and national burden of COPD and COPD-related HF among middle-aged and elderly populations, analyze temporal trends from 1990 to 2021, project prevalence through 2050, and evaluate the population attributable fractions of major risk factors. Methods: Data were extracted from the Global Burden of Disease (GBD) Study 2021. Prevalence was calculated using standardized techniques, trends were analyzed using estimated annual percentage change (EAPC), and future projections were made using the Bayesian Age-Period-Cohort (BAPC) model. Risk factors were evaluated using population attributable fractions. Results: In 2021, the global prevalent cases of COPD among middle-aged and elderly patients were estimated at 166.94 million, with 3.39 million of COPD-related HF. The prevalence rates for COPD and COPD-HF were 11,234.28 and 228.24 per 100,000, respectively. The prevalence rates for COPD and COPD-HF peaked in the 95+ years age group for males and the 90-94 years age group for females, with consistently higher rates in males than females. The significant variations were observed across 204 countries and territories, with prevalence rate for COPD increasing with socio-demographic index (SDI) levels and prevalence rate for COPD-HF showing an initial decline followed by an increase. Between 1990 and 2021, the prevalence rate for COPD and COPD-HF exhibited consistent increases globally (EAPC 0.18 for COPD; EAPC 0.06 for COPD-HF). The prevalence rate for COPD and COPD-HF showed parallel trends with SDI levels across 21 regions, initially increasing and then peaking before declining and rising again. Projections indicate that the number of COPD cases will increase from 172.62 million in 2022 to 336.92 million by 2050, while COPD-HF cases will rise from 3.53 million to 12.29 million. Smoking and particulate matter pollution were identified as the primary risk factors for COPD, contributing significantly to disability-adjusted life years (DALYs), with varying impacts across regions and SDI levels. Conclusions: The growing burden of COPD and COPD-HF among middle-aged and elderly patients emphasizes the urgent need for interventions targeting smoking and air pollution, with tailored strategies required to address sex and geographical disparities and mitigate future impacts.