Trends in the Burden of COPD Attributable to Ambient PM_2.5 Exposure in China 1990−2019: An Age-Period-Cohort Analysis

Figures & data

Table 1 The DALYs and Deaths of COPD in China Attributable to Ambient PM_2.5 Exposure in 1990 and 2019, and Its Estimated Annual Percentage Change from 1990 to 2019

Characteristics		1990		2019		1990–2019
	Sex	Numbers No.×103 (95% UI)	ASR per 100,000 No.(95% UI)	Numbers No.×103 (95% UI)	ASR per 100,000 No.(95% UI)	EAPC
DALYs	Both	3969.5 (1995.5–6615.1)	554.8 (280.7–926.1)	5055.9 (3969.8–6386.1)	278.6 (218.7–353.6)	−2.02 (−7.85–4.19)
	Female	1712.1 (843.5–2961.3)	450.1 (224.3–772.1)	2216.5 (1678–3047.8)	224.7 (169.9–308.4)	−2.23 (−8.05–3.97)
	Male	2257.4 (1099.6–3770.5)	698 (349–1164.1)	2839.4 (2151.5–3631.8)	356 (271.2–454.3)	−2.49 (−8.3–3.69)
Deaths	Both	192.4 (96–318.9)	33.8 (17–55.7)	263.6 (203.3–347.3)	16.6 (12.8–21.8)	−2.82 (−8.61–3.34)
	Female	86.3 (41.5–149.1)	27.3 (13.3–47.2)	110 (78.7–159.1)	12.1 (8.7–17.4)	−3 (−8.79–3.15)
	Male	106.2 (51.7–176.7)	44.8 (22.6–73.9)	153.7 (114.3–197.2)	24.2 (18.4–30.8)	−3.06 (−8.85–3.09)

Abbreviations: COPD, chronic obstructive pulmonary disease; EAPC, estimated annual percentage change; ASR, age standardized rate; UI, uncertainty interval; DALYs, disability adjusted of life years.

Figure 1 The trends in the age-standardized mortality rate (ASMR) of chronic obstructive pulmonary disease attributable to ambient PM2.5 exposure from 1990 to 2019 in China.

Figure 2 The trends in the age-standardized DALYs rate (ASDR) of chronic obstructive pulmonary disease attributable to ambient PM_2.5 exposure from 1990 to 2019 in China.

Table 2 Age–Period–Cohort (APC) Model Analysis Results of COPD Mortality Attributable to Ambient PM_2.5 Exposure in China Female, P < 0.05

Group	Coef	95% CI	P	RR
Age
25–29	−2.99	(−3.02,−2.96)	0.000	0.05
30–34	−2.57	(−2.6,−2.55)	0.000	0.08
35–39	−2.42	(−2.44,−2.4)	0.000	0.09
40–44	−2	(−2.01,−1.98)	0.000	0.14
45–49	−1.54	(−1.56,−1.53)	0.000	0.21
50–54	−0.99	(−1,−0.98)	0.000	0.37
55–59	−0.55	(−0.56,−0.54)	0.000	0.58
60–64	0.12	(0.11,0.13)	0.000	1.13
65–69	0.68	(0.68,0.69)	0.000	1.98
70–74	1.44	(1.44,1.45)	0.000	4.23
75–79	1.96	(1.95,1.97)	0.000	7.1
80–84	2.55	(2.55,2.56)	0.000	12.87
85–89	2.98	(2.97,2.99)	0.000	19.74
90–94	3.32	(3.31,3.33)	0.000	27.52
Period
1990–1994	0.01	(0,0.01)	0.051	1.01
1995–1999	0.07	(0.06,0.07)	0.000	1.07
2000–2004	0.1	(0.1,0.1)	0.000	1.11
2005–2009	0.02	(0.02,0.02)	0.000	1.02
2010–2014	−0.05	(−0.05,−0.04)	0.000	0.95
2015–2019	−0.14	(−0.15,−0.14)	0.000	0.87
Cohort
1900–1904	1.35	(1.33,1.37)	0.000	3.85
1905–1909	1.33	(1.32,1.34)	0.000	3.78
1910–1914	1.28	(1.27,1.29)	0.000	3.59
1915–1919	1.19	(1.18,1.2)	0.000	3.29
1920–1924	1.1	(1.09,1.11)	0.000	3
1925–1929	0.98	(0.97,0.99)	0.000	2.67
1930–1934	0.83	(0.82,0.84)	0.000	2.3
1935–1939	0.66	(0.65,0.67)	0.000	1.94
1940–1944	0.46	(0.45,0.47)	0.000	1.59
1945–1949	0.26	(0.24,0.27)	0.000	1.29
1950–1954	0.05	(0.03,0.06)	0.000	1.05
1955–1959	−0.23	(−0.25,−0.21)	0.000	0.8
1960–1964	−0.56	(−0.58,−0.54)	0.000	0.57
1965–1969	−0.74	(−0.77,−0.72)	0.000	0.47
1970–1974	−0.95	(−0.98,−0.93)	0.000	0.39
1975–1979	−1.27	(−1.3,−1.23)	0.000	0.28
1980–1984	−1.62	(−1.68,−1.57)	0.000	0.2
1985–1989	−1.92	(−2,−1.85)	0.000	0.15
1990–1994	−2.19	(−2.33,−2.04)	0.000	0.11
AIC	24.12
BIC	1462.74

Abbreviations: COPD, chronic obstructive pulmonary disease; RR, relative risk; RR, exp (coef.).

Table 3 Age–Period–Cohort (APC) Model Analysis Results of COPD Mortality Attributable to Ambient PM_2.5 Exposure in China Male, P < 0.05

Group	Coef	CI	P	RR
Age
25–29	−3.38	−3.41,−3.35	0.000	0.03
30–34	−2.89	−2.91,−2.87	0.000	0.06
35–39	−2.48	−2.5,−2.46	0.000	0.08
40–44	−1.9	−1.92,−1.89	0.000	0.15
45–49	−1.5	−1.51,−1.49	0.000	0.22
50–54	−0.86	−0.87,−0.85	0.000	0.42
55–59	−0.34	−0.35,−0.33	0.000	0.71
60–64	0.26	0.25,0.27	0.000	1.3
65–69	0.77	0.76,0.77	0.000	2.16
70–74	1.45	1.45,1.46	0.000	4.27
75–79	1.92	1.91,1.92	0.000	6.81
80–84	2.46	2.46,2.47	0.000	11.72
85–89	3.09	3.08,3.09	0.000	21.91
90–94	3.4	3.4,3.41	0.000	30.09
Period
1990–1994	−0.13	−0.14,−0.13	0.000	0.88
1995–1999	−0.02	−0.02,−0.02	0.000	0.98
2000–2004	0.05	0.04,0.05	0.000	1.05
2005–2009	0.02	0.01,0.02	0.000	1.02
2010–2014	0.06	0.06,0.06	0.000	1.06
2015–2019	0.03	0.03,0.04	0.000	1.03
Cohort
1900–1904	1.43	1.41,1.45	0.000	4.16
1905–1909	1.36	1.35,1.37	0.000	3.89
1910–1914	1.33	1.32,1.33	0.000	3.76
1915–1919	1.26	1.25,1.27	0.000	3.52
1920–1924	1.17	1.17,1.18	0.000	3.23
1925–1929	1.05	1.04,1.05	0.000	2.84
1930–1934	0.86	0.86,0.87	0.000	2.37
1935–1939	0.66	0.65,0.67	0.000	1.94
1940–1944	0.43	0.43,0.44	0.000	1.54
1945–1949	0.2	0.19,0.21	0.000	1.22
1950–1954	−0.07	−0.08,−0.06	0.000	0.93
1955–1959	−0.35	−0.37,−0.34	0.000	0.7
1960–1964	−0.65	−0.67,−0.64	0.000	0.52
1965–1969	−0.83	−0.85,−0.82	0.000	0.44
1970–1974	−1.07	−1.09,−1.05	0.000	0.34
1975–1979	−1.37	−1.4,−1.34	0.000	0.25
1980–1984	−1.61	−1.66,−1.57	0.000	0.2
1985–1989	−1.78	−1.84,−1.73	0.000	0.17
1990–1994	−2	−2.11,−1.89	0.000	0.14
AIC	38.55
BIC	1983.51

Abbreviations: COPD, chronic obstructive pulmonary disease; RR, relative risk; RR, exp (coef.).

Figure 3 Chronic obstructive pulmonary disease mortality in China attributable to ambient PM_2.5 exposure relative risks due to (A) Age; (B) Period; and (C) Cohort.