COPD burden trends in China and G20 countries from GBD 2023 and Mendelian randomization.

Chronic obstructive pulmonary disease (COPD) remains a major contributor to morbidity and mortality, making comparative evidence on long-term burden and risk factors important for prevention. Using the Global Burden of Disease (GBD) 2023 data, we assessed COPD prevalence, incidence, deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs), and age-standardized rates (ASRs) in China and the Group of Twenty (G20) countries from 1990-2023. Joinpoint regression characterized temporal changes, autoregressive integrated moving average (ARIMA) models projected burden to 2028, and two-sample Mendelian randomization evaluated genetically proxied risk factors in human populations. In 2023, China had substantial COPD burden, with 52.5 million prevalent cases and nearly 1.0 million deaths. Absolute burden increased since 1990, whereas ASRs generally declined across China and G20 countries. Fifteen exposures showed Bonferroni-corrected associations with COPD risk. These findings highlight persistent disparities in COPD burden and support targeted prevention while recognizing that genetic evidence requires further validation.