Highlights
- •The burden of chronic obstructive pulmonary disease (COPD) in China is substantial. In 2011, 31% of global COPD mortality was estimated to occur in China. Nevertheless, limited data are available on the predicted long-term health and economic burden of COPD in China.
- •Our simulation estimated that the number of patients with COPD in China would increase from 88.3 million to 103.3 million between 2020 and 2039; the number of severe cases of COPD is estimated to increase by 31%, and 3.9 million deaths because of COPD are predicted over this period. The discounted total direct and indirect costs incurred because of COPD over 20 years are estimated to be $3.1 trillion and $360.5 billion, respectively.
- •This analysis quantified the epidemiological burden and the significant toll that COPD is expected to take on the Chinese healthcare system over a 20-year period. Effective strategies to help diagnose and manage COPD are warranted and may help to reduce the projected burden of disease.
Abstract
Objectives
Methods
Results
Conclusions
Keywords
Introduction
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global initiative for chronic obstructive lung disease (2021 report). Global Initiative for Chronic Obstructive Lung Disease. https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf. Accessed February 23, 2021.
- Wang H.
- Naghavi M.
- Allen C.
- Soriano J.B.
- Abajobir A.A.
- Abate K.H.
- Wang H.
- Naghavi M.
- Allen C.
Methods
Model Overview and Structure
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global initiative for chronic obstructive lung disease (2021 report). Global Initiative for Chronic Obstructive Lung Disease. https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf. Accessed February 23, 2021.

- World population prospects - population division
- World urbanization prospects - population division
- World population prospects - population division
- World urbanization prospects - population division
Model parameter | Mean (SE) | Distribution |
---|---|---|
Population characteristics | ||
Annual population projections for population aged 40 years or older | Population projections based on age and sex for Mainland China from the UN Population Division 13
United Nations. https://population.un.org/wpp/Download/Probabilistic/Population/ Date accessed: January 7, 2020 | – |
Annual urbanization rate projections in China | Urbanization rate projections from the UN Population Division 14
United Nations. https://population.un.org/wup/ Date accessed: January 8, 2020 | – |
Prevalence of smoking | Projection of smoking prevalence in the Chinese population aged 15 years or older from the 2010 National Smoking Survey 15 and the China SimSmoke model16 | – |
Background mortality rates | Age-specific mortality rates from the China Life Tables, 19 provided in Appendix Table 4 in Supplemental Materials found at https://dx.doi.org/10.1016/j.vhri.2022.06.002GHO data repository. Life tables by country - China. World Health Organization. https://apps.who.int/gho/data/?theme=main%26vid=60340 Date accessed: July 8, 2020 | – |
COPD prevalence, 7 | 13.6% | Beta |
GOLD severity distributions at baseline, 7 ,8 | Mild: 56.4% Moderate: 36.3% Severe/very severe: 7.4% | – |
Mortality rate ratios for severe or very severe COPD 20 | 1.77 (95% CI 1.66-1.89) | Log-normal |
Transition probabilities between COPD severity stages 17 | ||
Mild to moderate COPD | Never smoker: 1.8% Current smoker: 2.5% Former smoker: 2.1% | - |
Moderate to severe/very severe COPD | Never smoker: 3.0% Current smoker: 3.7% Former smoker: 3.4% | - |
Transition probabilities between smoking states for COPD patients 17 | ||
Never smoker to current smoker | 0 | - |
Current smoker to former smoker | 4.7% | - |
Former smoker to current smoker | 2.6% | - |
COPD exacerbation rates, 18 | ||
Mild COPD | Total exacerbation: 0.82 (0.26) Severe exacerbation: 0.11 (0.14) | Gamma |
Moderate COPD | Total exacerbation: 1.17 (0.15) Severe exacerbation: 0.16 (0.07) | Gamma |
Severe/very severe COPD | Total exacerbation: 1.66 (0.14) Severe exacerbation: 0.23 (0.04) | Gamma |
Health-related quality of life for patients with COPD 21 | ||
Utility of mild COPD | 0.786 (0.085) | Beta |
Utility of moderate COPD | 0.734 (0.158) | Beta |
Utility of severe/very severe COPD | 0.682 (0.122) | Beta |
Average health-state utility of adults in China 22 | 0.956 | |
COPD-attributable direct medical costs for urban residential areas (2020 USD per person-year) 11 | ||
Mild COPD | $995 ($100) | Gamma |
Moderate COPD | $1990 ($199) | Gamma |
Severe/very severe COPD | $3540 ($354) | Gamma |
COPD-attributable direct nonmedical costs for urban residential areas (2020 USD per person-year) 11 | ||
Mild COPD | $114 ($11) | Gamma |
Moderate COPD | $101 ($10) | Gamma |
Severe/very severe COPD | $384 ($38) | Gamma |
COPD-attributable indirect costs for urban residential areas (2020 USD per person-year) 11 | ||
Mild COPD | $214 ($21) | Gamma |
Moderate COPD | $509 ($51) | Gamma |
Severe/very severe COPD | $4048 ($405) | Gamma |
COPD-attributable direct medical costs for rural residential areas (2020 USD per person-year) 23 | $1740 ($174) | Gamma |
COPD-attributable direct nonmedical costs for rural residential areas (2020 USD per person-year) 23 | $109 ($11) | Gamma |
COPD-attributable indirect costs for rural residential areas (2020 USD per person-year) 23 | $22 ($2) | Gamma |
China consumer price index (urban household) 24 (from 2011 to 2020)National data. NBS. http://data.stats.gov.cn/english/adv.htm?cn=A01 Date accessed: May 1, 2020 | +25.5% | - |
China consumer price index (rural household) 24 (from 2011 to 2020)National data. NBS. http://data.stats.gov.cn/english/adv.htm?cn=A01 Date accessed: May 1, 2020 | +25.0% | - |
Modeling Population Growth and Smoking Prevalence
- World population prospects - population division
- World urbanization prospects - population division
Prevalence and Severity Distributions
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global initiative for chronic obstructive lung disease (2021 report). Global Initiative for Chronic Obstructive Lung Disease. https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf. Accessed February 23, 2021.
Transition Probabilities and Dynamic Cohort Structure
Outcomes
Number of COPD patients, exacerbations, and mortality
Losses of QALYs and costs
Analysis Methods
Dedicated Scenario Analysis for Modeling Future Declines in Smoking Prevalence in China
Results
Number of COPD Patients
COPD Exacerbations and Excess Mortality due to COPD
COPD-Attributable Losses of QALYs
Outcome | Undiscounted 20-year total (95% CrI) | Discounted 20-year total (95% CrI) |
---|---|---|
Losses of QALYs (million) | 393.78 (141.39-710.34) | 253.65 (91.09-457.12) |
Total direct costs (a + b + c) (billion USD) | $4858.01 ($4226.15-$5546.99) | $3113.47 ($2710.61-$3551.89) |
Direct medical costs (a + b) (billion USD) | $4635.79 ($4007.33-$5313.21) | $2969.68 ($2569.60-$3399.87) |
Hospitalization costs (a) (billion USD) | $3526.43 ($2988.33-$4112.89) | $2267.25 ($1922.86-$2641.47) |
Outpatient costs (b) (billion USD) | $1109.36 ($887.94-$1364.14) | $702.43 ($562.55-$862.79) |
Direct nonmedical costs (c) (billion USD) | $222.22 ($188.97-$259.35) | $143.79 ($122.39-$167.69) |
Indirect costs (billion USD) | $570.24 ($460.72-$699.50) | $360.47 ($291.35-$442.07) |

Direct and Indirect Costs of COPD
Subgroup Analyses
Male | Female | ||||
---|---|---|---|---|---|
Age | Urban | Rural | Age | Urban | Rural |
20-year total COPD-attributable losses of QALYs in million (95% CrI) | |||||
40-49 | 31.77 (10.48-59.38) | 16.97 (6.04-30.71) | 40-49 | 13.77 (4.31-26.22) | 6.38 (1.93-11.98) |
50-59 | 32.88 (11.66-58.98) | 19.02 (7.30-33.62) | 50-59 | 14.34 (4.79-26.69) | 7.17 (2.33-13.27) |
60-69 | 27.35 (9.43-50.12) | 15.85 (5.75-28.28) | 60-69 | 12.67 (4.04-23.84) | 6.36 (2.04-11.89) |
70-79 | 15.22 (5.60-27.16) | 9.04 (3.50-15.74) | 70-79 | 7.89 (2.82-14.52) | 4.06 (1.40-7.42) |
≥80 | 5.00 (1.84-8.92) | 2.81 (1.09-4.90) | ≥ 80 | 3.42 (1.22-6.30) | 1.67 (0.57-3.05) |
20-year total number of COPD exacerbations (severe and nonsevere) in million (95% CrI) | |||||
40-49 | 253.38 (184.78-347.4) | 126.98 (90.25-174.29) | 40-49 | 107.77 (72.48-150.58) | 46.69 (30.40-66.64) |
50-59 | 260.28(194.68-351.58) | 141.03 (101.71-189.63) | 50-59 | 110.55 (74.96-154.40) | 51.62 (33.95-73.35) |
60-69 | 227.34 (169.21-306.27) | 123.16 (89.65-166.17) | 60-69 | 103.30 (70.83-142.44) | 48.28 (32.00-68.05) |
70-79 | 132.70 (103.12-172.00) | 73.96 (56.40-96.30) | 70-79 | 66.73 (46.81-90.85) | 32.11 (22.03-44.28) |
≥80 | 45.04 (35.00-58.38) | 23.70 (18.08-30.86) | ≥ 80 | 29.88 (20.96-40.69) | 13.58 (9.31-18.73) |
20-year total number of excess deaths due to COPD in thousand (95% CrI) | |||||
40-49 | 23.02 (18.62-27.78) | 11.77 (9.53-14.21) | 40-49 | 2.80 (2.16-3.59) | 1.19 (0.92-1.51) |
50-59 | 114.5 (92.64-138.29) | 63.36 (51.38-76.49) | 50-59 | 14.29 (11.05-18.17) | 6.57 (5.05-8.28) |
60-69 | 286.59 (232.54-345.85) | 157.98 (128.59-190.61) | 60-69 | 40.48 (31.41-51.33) | 18.58 (14.27-23.45) |
70-79 | 909.62 (739.91-1097.33) | 514.50 (419.60-621.45) | 70-79 | 166.18 (129.33-210.17) | 78.72 (61.10-98.47) |
≥80 | 777.50 (632.44-937.95) | 414.94 (338.40-501.19) | ≥80 | 232.2 (180.67-293.53) | 103.85 (80.62-129.93) |
Male | Female | ||||
---|---|---|---|---|---|
Age | Urban | Rural | Age | Urban | Rural |
20-year total direct costs of COPD in billion (2020 USD) (95% CrI) | |||||
40-49 | $434.85 ($361.54-$526.06) | $160.11 ($130.44-$194.10) | 40-49 | $183.25 ($142.34-$232.13) | $57.69 ($44.45-$73.58) |
50-59 | $455.83 ($378.56-$552.12) | $183.48 ($149.08-$222.16) | 50-59 | $190.88 ($148.30-$241.35) | $65.10 ($50.08-$82.95) |
60-69 | $380.40 ($316.19-$459.37) | $152.94 ($124.94-$184.88) | 60-69 | $170.78 ($133.39-$215.54) | $58.47 ($44.87-$74.58) |
70-79 | $218.30 ($181.57-$264.1) | $91.35 ($74.77-$111.01) | 70-79 | $108.54 ($85.45-$136.28) | $38.47 ($29.74-$48.95) |
≥80 | $71.73 ($59.66-$86.78) | $28.41 ($23.25-$34.53) | ≥80 | $47.08 ($37.06-$59.11) | $15.81 ($12.22-$20.12) |
20-year total indirect costs of COPD in billion (2020 USD) (95% CrI) | |||||
40-49 | $68.02 ($53.56-$84.80) | $2.33 ($1.80-$2.88) | 40-49 | $29.09 ($21.59-$37.48) | $0.86 ($0.65-$1.14) |
50-59 | $69.01 ($54.48-$86.12) | $2.56 ($1.99-$3.17) | 50-59 | $29.80 ($22.35-$38.43) | $0.95 ($0.72-$1.25) |
60-69 | $58.68 ($46.65-$73.09) | $2.18 ($1.70-$2.70) | 60-69 | $26.97 ($20.25-$34.60) | $0.86 ($0.65-$1.13) |
70-79 | $32.20 ($25.50-$40.11) | $1.23 ($0.96-$1.52) | 70-79 | $16.72 ($12.50-$21.37) | $0.55 ($0.42-$0.72) |
≥80 | $10.58 ($8.38-$13.18) | $0.38 ($0.30-$0.47) | ≥80 | $7.25 ($5.42-$9.27) | $0.23 ($0.17-$0.30) |
Sensitivity Analyses
Scenario Analysis
Discussion
Conclusion
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global initiative for chronic obstructive lung disease (2021 report). Global Initiative for Chronic Obstructive Lung Disease. https://goldcopd.org/wp-content/uploads/2020/11/GOLD-REPORT-2021-v1.1-25Nov20_WMV.pdf. Accessed February 23, 2021.
Article and Author Information
Acknowledgment
Supplemental Materials
- Supplementary Material
References
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