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Epidemiological trends and risk factors of chronic obstructive pulmonary disease in young individuals based on the 2021 global burden of disease data (1990–2021)

BMC Pulmonary Medicine volume 25, Article number: 174 (2025) Cite this article

Abstract

Objective

Recent studies have shown that chronic obstructive pulmonary disease (COPD) in young individuals cannot be ignored. This study aims to investigate the burden of COPD and its associated risk factors in individuals aged 15 to 49 years, with a particular focus on health inequities across different levels of socioeconomic development.

Methods

By analyzing data from the Global Burden of Disease (GBD) 2021, we utilized statistical methods such as Joinpoint regression, frontier analysis, and health inequality analysis to evaluate the changes in the age-standardized disability-adjusted life year (DALY) rates (ASDR) and incidence rates (ASIR) of COPD among the global population aged 15–49 years from 1990 to 2021. We specifically examined the disparities in health across countries and regions with varying levels of socioeconomic development. Key risk factors, including particulate matter pollution, smoking, and occupational exposure, were analyzed.

Results

The number of COPD cases among young people globally has significantly increased.While the global ASDR and ASIR of COPD in the 15–49 age group showed an overall declining trend, the burden of COPD remained high in low Sociodemographic Index (SDI) regions and there were significant health inequalities between countries. Particulate matter pollution (41.79%), smoking (19.81%), and occupational exposure (11.73%) were identified as the primary contributors to the burden of COPD in younger individuals. In low SDI regions, particulate matter pollution had a particularly significant impact, accounting for 58.65% of attributable proportion of DALYs, and remained at a persistently high level. Smoking continued to contribute significantly to the burden of COPD in high-income regions, notably in North America, where smoking accounted for 34.26% of DALYs in 2021.

Conclusion

Although there is a global downward trend in the burden of COPD among young people, significant health inequities persist in low SDI regions. The findings emphasize the need for more effective public health activities targeting younger populations and low SDI countries and regions, particularly in improving air quality, reducing smoking, and mitigating occupational exposures.

Clinical trial number

Not applicable.

Peer Review reports

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and treatable chronic respiratory disease, carrying a significant burden of morbidity and mortality [1]. Traditionally, COPD has been considered a disease of the elderly. However, recent studies indicate that COPD can also occur in younger individuals, with an increasing burden observed among this population [2,3,4]. The concept of “young COPD” is gaining attention, and the 2022 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report first introduced the concept of “young COPD,” defining it as adult patients under the age of 50 (https://goldcopd.org/2022-gold-reports-2/). Compared to older patients, younger individuals with COPD may experience a longer disease course, potentially leading to higher healthcare needs and a greater economic burden [5, 6]. According to data from the China Pulmonary Health (CPH) study, the age-standardized prevalence of COPD among young people is 1.1%, with the prevalence in the 40–49 age group having risen to 5% [7]. In comparison, the prevalence in the same age group in South Korea is 4.2% [4], while the weighted prevalence of young COPD in American is 1.64%, with the prevalence increasing significantly with age [2]. Despite many young patients already experiencing moderate to severe airflow limitation and persistent lung parenchymal destruction (such as emphysema), nearly half of the cases remain undiagnosed [8]. Moreover, young COPD patients face a higher risk of disease exacerbation, along with a higher prevalence of comorbidities and risk of death [9]. The burden of COPD in younger populations is particularly concerning, as health issues in this group may have long-term social and economic implications. Therefore, studying the epidemiological characteristics of COPD in younger individuals and its associated risk factors, particularly environmental and behavioral factors, is crucial for developing effective intervention strategies.

The 2021 Global Burden of Disease (GBD) study assesses the burden of diseases by examining the incidence, prevalence, mortality, and Disability-Adjusted Life Years (DALYs) across the globe, and systematically quantifies estimates of risk factor exposures and their associations with health outcomes [6, 10].It provides essential foundational data for exploring the epidemiological characteristics of diseases within specific age groups. Previous studies have utilized data from the GBD to explore the global epidemiology of COPD in various ways [11,12,13,14,15]. Although recent study has utilized GBD 2021 to explore the epidemiology of COPD in young, primarily focuses on analyzing the global overview [16]. In contrast, our study employs different statistical and analytical methods, such as Joinpoint regression, frontier analysis, and health inequality analysis, to comprehensively investigate trends and health inequalities of COPD across various levels of socioeconomic development globally. We also systematically assess the distribution of various risk factors for COPD among young. Our goal is to provide clinical practitioners, epidemiologists, and health policymakers with better insights and awareness regarding this population, thereby optimizing the allocation of medical resources and informing more targeted public health interventions.

Methodology

Data sources

The GBD 2021 study provides an in-depth assessment of health loss linked to 371 diseases, injuries, and conditions, alongside 88 risk factors across 204 countries and territories [17]. This analysis employs the latest epidemiological data and standardized methodologies. Specific data regarding COPD were gathered from systematic literature reviews, survey data, longitudinal studies, and other sources, all of which were integrated into the Disease-Model Bayesian Meta-Regression (DisMoD-MR) tool (version 2.1). This tool, which utilizes the Bayesian Priors Regularisation and Trimming (MR-BRT) model, amalgamates all available morbidity and mortality data with epidemiological and spatial linkages to produce accurate estimates of disease burden [18]. Since the study used publicly accessible, de-identified data from the GBD study, no ethical approval was necessary. The GBD study adheres strictly to ethical guidelines in data collection and analysis to safeguard human subjects [19]. The data utilized in this study were sourced from the GBD 2021 dataset, accessed via the Global Health Data Exchange query tool (https://vizhub.healthdata.org/gbd-results/). The data were categorized by region, gender, country/territory, and risk factors, with a particular focus on individuals aged 15 to 49, a key demographic for understanding the early onset and burden of COPD.

Sociodemographic index (SDI)

The SDI dataset was developed by GBD researchers as a comprehensive index closely related to health outcomes.The SDI serves as a composite measure to evaluate the social, economic, and demographic development levels of various countries and regions. It is based on three key metrics: the total fertility rate among women under 25, the average educational attainment of individuals aged 15 and older, and per capita income or GDP per capita. The SDI value ranges from 0 to 1, with higher values reflecting greater socioeconomic development. Based on SDI values, countries and regions are classified into five development levels (low, low-middle, middle, high-middle, and high) to assess their overall development and health status [18, 20].

Estimated annual percentage change (EAPC)

To analyze trends in disease burden, the EAPC for 1990–2021 was calculated using the age-standardized rate (ASR). The model used was ln(ASR) = α + β × (calendar year) + ε, where EAPC = 100 × [exp(β) − 1]. A positive EAPC indicates an increase in ASR, while a negative EAPC indicates a decrease. The significance was evaluated using the 95% confidence interval (CI); if the CI included zero, the trend was deemed not statistically significant. All tests were two-tailed with a significance level of P < 0.05 [21].

Joinpoint regression

Joinpoint regression was employed to assess trends in COPD burden by segmenting the timeline into intervals with distinct regression lines. This epidemiological method is vital for detecting shifts in disease patterns, which can inform policies and interventions [22]. The analysis of Annual Percent Change (APC) was analyzed using the U.S. National Cancer Institute’s Joinpoint software (version 4.6.0.0, https://surveillance.cancer.gov/joinpoint/).

Risk factors

Risk factors were selected based on strong evidence for risk-outcome associations established by the World Cancer Research Fund and the Comparative Risk Assessment framework. The GBD 2021 risk factor analysis utilized data from 54,561 sources to provide epidemiological estimates for 88 risk factors and their related health outcomes, spanning 631 risk-outcome pairs. These estimates were used to calculate population attributable fractions (PAFs), which, when combined with DALYs, provided measures of attributable burden. This metric represents the proportion of total disease burden attributable to specific risk factors or combinations of risk factors [23]. We estimated the impact of three levels of risk factors on DALYs, including seven key risk factors, is detailed in the results.

Cross-country inequality analysis

Health inequalities were assessed using an evidence-driven evaluation system, primarily employing two standard metrics of absolute and relative gradient inequality: the Slope Index of Inequality and the Concentration Index. These indices quantify the distributional inequalities of COPD burden among young people across countries [24]. Countries were ranked by SDI values from most disadvantaged (0) to most advantaged (1), with weighted scores accounting for population distribution. The weighted rank for each country represented the midpoint of its cumulative population proportion, ensuring socioeconomic disparities were measured proportionally. The Slope Index of Inequality was calculated by regressing national DALY rates against a scale linked to sociodemographic development. The Concentration Index was determined by integrating the area under the Lorenz concentration curve, which was generated using the cumulative fraction of DALYs and the cumulative relative distribution of the population ordered by SDI [25].

Frontier analysis

To further explore the relationship between COPD burden and sociodemographic development, frontier analysis was conducted. This approach generates a non-linear frontier representing the minimum achievable COPD burden at a given level of development. The “effective difference” is defined as the gap between the actual disease burden observed in a country or territory and the theoretically achievable burden given its SDI. This disparity signifies the potential for reduction or elimination of the burden through optimal utilization of the region’s sociodemographic resources [26, 27].

Statistical analysis

All disease estimates in the GBD incorporate 95% uncertainty intervals (UIs), calculated using the 25th and 75th percentile values derived from 1,000 bootstrap samples drawn from the posterior distribution [23]. Age-standardized rates and their corresponding 95% CI were computed using standardization based on the world standard population reported in the GBD 2021 study [28] Overall trends and directions of incidence and DALY rates for COPD patients aged 15–49 years from 1990 to 2021 were evaluated using EAPC and corresponding 95% CI. Joinpoint regression was used to calculate segmented APCs with specific time points. Pearson correlation analysis was employed to assess linear or non-linear relationships between SDI and ASR across 21 regions. Additionally, we analyzed the percentage contribution of seven key risk factors to COPD DALYs among young people in different age groups and regions. All statistical analyses and figures were generated using R version 4.3.3.

Results

Evolution of COPD burden across global SDI regions

In 2021, the global number of COPD cases among individuals aged 15 to 49 reached 2,503,318 (95% CI: 2,087,722–2,955,787), marking a 50.55% increase since 1990. The ASDR for COPD was 142.94 per 100,000 (95% CI: 126.82–158.90) in 2021, reflecting a decline from 1990, when the rate was 225.54 per 100,000 population (95% CI: 194.82–251.18). The EAPC for ASDR during this period was -1.72 (95% CI: -1.80 to -1.65) (Table 1).Additionally, the ASIR exhibited a modest decline from 68.87 per 100,000 in 1990 (95% CI: 49.95–87.71) to 61.46 per 100,000 in 2021 (95% CI: 44.59–79.05), with an EAPC of -0.85 (95% CI: -0.93 to -0.77).

Table 1 Trends in age-standardized rate of DALYs and incidence of young COPD by SDI Level, 1990–2021
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Across all SDI levels, the global ASDR of COPD among the 15–49 age group showed a gradual downward trend from 1990 to 2021, particularly in middle SDI regions (EAPC: -2.61, 95% CI: -2.70 to -2.52) and high-middle SDI regions (EAPC: -2.56, 95% CI: -2.72 to -2.40). Lower SDI quintiles were associated with higher ASDRs for COPD, with low SDI regions reporting 198.31 per 100,000 (95% CI: 165.53–231.86), compared to 64.98 per 100,000 (95% CI: 57.12–73.53) in high SDI regions (Table 1).The ASIR also displayed a downward trend, with varying degrees across different SDI regions. Notably, a more pronounced decline in incidence was observed in middle SDI regions (EAPC: -1.05, 95% CI: -1.16 to -0.94) and high-middle SDI regions (EAPC: -1.41, 95% CI: -1.52 to -1.30). In 2021, the highest ASIR was recorded in low-middle SDI regions (71.5 per 100,000; 95% CI: 52.88–89.25), while the lowest was observed in high-middle SDI regions (55.87 per 100,000; 95% CI: 39.93–73.17) (Table 1).

Joinpoint Analysis provided a more intuitive illustration of the temporal trends in global and regional ASDR and ASIR. From 1990 to 2021, the global ASDR showed a consistent decline, with a more rapid decrease observed between 1990 and 2014 (APC = -1.78, P < 0.05). Throughout the study period, the ASDR in high SDI regions remained significantly lower than in other regions, with no notable decline. The global ASIR experienced a slow overall decrease, with a relatively sharper decline between 2005 and 2017 (APC = -0.75, P < 0.05). Interestingly, a temporary increase in ASIR was observed in high SDI regions from 1996 to 2005 (APC = 0.64, P < 0.05) (Fig. 1).

Fig. 1
figure 1

Trend analysis of age-standardized DALY rates (A) and age-standardized incidence rates (B) of COPD among individuals aged 15–49 globally and across various SDI regions from 1990 to 2021. This analysis was conducted using joinpoint regression, with trendlines segmented to calculate the average annual percentage change (APC) for each inflection point. *Indicates statistically significant differences.DALY, Disability-Adjusted Life Year

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Global trends by SDI

Globally, the ASDR and ASIR of COPD show distinct correlation patterns with SDI. Figure 2A illustrates a negative correlation between COPD ASDR and SDI (r = -0.42, P < 0.001), indicating that regions with lower SDI experience a higher COPD burden. This trend is particularly pronounced in regions with SDI values greater than 0.4, whereas in regions with SDI values below 0.4, ASDR actually increases as SDI rises. High-burden areas are concentrated in impoverished regions such as South Asia, East Asia, and Oceania.Similarly, Fig. 2B shows a slight negative correlation between ASIR and SDI (r = -0.39, P < 0.001), with this trend being more noticeable in regions where SDI exceeds 0.4. Compared to other regions, High-income North America, South Asia, and Oceania exhibit relatively higher ASIR.

Fig. 2
figure 2

Age-standardized DALY rate (A) and age-standardized incidence rate (B) of COPD per 100,000 population across the 21 Global Burden of Disease regions, stratified by Sociodemographic Index (SDI), from 1990 to 2021. Expected values based on SDI and disease rates across all locations are shown as a black line. DALY, Disability-Adjusted Life Year

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Health inequality

Significant absolute and relative inequalities related to SDI were observed in the DALY burden among COPD patients aged 15–49, with lower SDI countries bearing a disproportionately heavy burden. The Slope Index of Inequality (SII) indicated that the disparity in DALY rates between the highest and lowest SDI countries decreased from -118 (95% CI: -145 to -91) in 1990 to -102 (95% CI: -121 to -83) in 2021,showing only a slight decline (Fig. 3A). Additionally, the Concentration Index demonstrated a slight reduction in DALY burden among younger COPD patients, decreasing from -0.14 (95% CI: -0.18 to -0.11) in 1990 to -0.12 (95% CI: -0.14 to -0.09) in 2021. Despite these improvements, significant disparities persist (Fig. 3B).

Fig. 3
figure 3

ASR-DALY health inequality index for young people with COPD in 1990 and 2021, based on the SDI of 204 countries and regions globally. (A) Slope Index (numbers in parentheses represent the slope); (B) Concentration Index. Each country or region is represented by a solid dot, with larger dots indicating higher population sizes. For comparison, China is highlighted. SDI, Sociodemographic Index; ASR, Age-Standardized Rate; DALY, Disability-Adjusted Life Year

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Frontier analysis

To better understand potential improvements in COPD DALY rates relative to a country’s development level, a frontier analysis was conducted using data from 1990 to 2021 based on DALY rates and SDI (Fig. 4). The frontier line identifies countries and territories achieving the lowest DALY rates, which are considered optimal given their SDI. The “effective difference” refers to the gap between observed DALY rates and the potential optimal rates, indicating the extent to which a country or territory’s sociodemographic resources could be leveraged to improve health outcomes (Supplementary Material 1).

Fig. 4
figure 4

Frontier analysis of the Sociodemographic Index (SDI) and COPD Disability-Adjusted Life Year (DALY) rates from 1990 to 2021. The figure illustrates frontier values for all 204 countries across the time span, with a color gradient representing the years (dark blue for 1990, light blue for 2021). Frontier boundaries are delineated in solid black. (B) shows frontier values for 204 countries or regions in 2021. Red dots indicate an increase in rates from 1990 to 2021, while green dots indicate a decrease. Points labeled in black represent the 15 countries with the largest discrepancies between frontier and actual values. Red-labeled points denote the five countries with the greatest discrepancies above the high-SDI threshold, while blue-labeled points indicate the five countries with the smallest discrepancies below the low-SDI threshold

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The effective difference from the frontier was assessed for each country and territory using 2021 DALY and SDI data (Fig. 4A and Supplementary Material 1). The top 10 countries with the largest effective differences, ranging between 251.09 and 423.26, were identified as Kiribati, Palau, Vanuatu, Marshall Islands, Nauru, Papua New Guinea, Micronesia (Federated States of), Samoa, Tuvalu, and American Samoa. These countries exhibit disproportionately higher COPD DALY rates compared to other nations with similar sociodemographic characteristics (Fig. 4B).

Major risk factors globally and by region

Figure 5 shows the proportion of COPD-related DALYs attributable to specific risk factors, such as smoking, particulate matter pollution, occupational exposure to particulate matter, gases, and fumes, secondhand smoke, ambient ozone pollution, and temperature extremes in 2021. The data are presented globally as well as across different SDI levels (high, high-middle, middle, low-middle, and low). In global, the particulate matter pollution, smoking, and occupational exposures were particularly significant, contributing 41.79%, 19.81%, and 11.73% to the total burden, respectively. Particulate matter pollution had a notably higher impact in low and low-middle SDI regions, contributing 58.65% and 53.33%, respectively. Conversely, smoking predominantly affected high and high-middle SDI regions, accounting for 31.39% and 30.46%, respectively.

Fig. 5
figure 5

Proportion of COPD-related Disability-Adjusted Life Years (DALYs) attributable to major risk factors among individuals aged 15–49 globally and across different Sociodemographic Index(SDI) levels in 2021

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Globally, the proportion of DALYs attributable to particulate matter pollution has gradually decreased from 1990 to 2021. However, it remains the leading risk factor. The proportion attributable to smoking has also declined slightly over this period.At the regional level, the impact of particulate matter pollution and smoking has gradually declined in high SDI and high-middle SDI regions. However, in low SDI and low-middle SDI regions, the levels of particulate matter pollution remain persistently high, with little change over time(Fig. 6).

Fig. 6
figure 6

Temporal trends in the proportion of COPD burden attributable to major risk factors across different Sociodemographic Index(SDI) levels from 1990 to 2021, expressed as percentages

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Figure 7 presents the distribution of COPD-related DALYs attributable to various risk factors across 21 global regions in 2021. Particulate matter pollution was a prominent risk factor in regions such as South Asia (55.7%), Oceania (53.85%), Western Sub-Saharan Africa (52.82%), Eastern Sub-Saharan Africa (56.99%), and Central Sub-Saharan Africa (54.92%). In contrast, smoking had a higher contribution in High-income Asia Pacific (31.07%), High-income North America (34.26%), Western Europe (33.27%), Central Europe (41.25%), and Eastern Europe (40.86%). Occupational exposures significantly impacted East Asia (16.06%), while ambient ozone pollution was notably influential in South Asia (11.75%). High and low temperatures had relatively minor impacts globally, though low temperatures affected regions like Southern Latin America and Central Asia to some extent.

Fig. 7
figure 7

Distribution of risk factors contributing to COPD-related Disability-Adjusted Life Years (DALYs) among individuals aged 15–49 globally and across 21 regions in 2021, expressed as percentages. The bar charts represent the contributions of smoking, secondhand smoke, particulate matter pollution, occupational exposure to particulate matter, gases, and fumes, low temperature, high temperature, and ambient ozone pollution

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Age-specific risk factors

Figure 8 illustrates the distribution of COPD-related DALYs by risk factors across different 5-year age groups within the 15–49 age range for the year 2021. Particulate matter pollution and secondhand smoke consistently influenced individuals aged 25 to 49 and were among the most significant risk factors across these age groups.

Fig. 8
figure 8

Proportion of COPD-related Disability-Adjusted Life Years(DALYs) attributable to risk factors among individuals aged 15–49 in 2021, broken down by 5-year age intervals

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Smoking emerged as the primary risk factor across all age groups, with its contribution to DALYs increasing progressively with age and peaking in the 40–49 age group. This trend underscores the escalating impact of smoking on older segments within the young adult population.

Occupational exposures and ambient ozone pollution showed varying impacts across different age groups, with a more pronounced effect observed among individuals aged 30 to 49. This suggests cumulative health damage due to prolonged exposure over time in these age cohorts.

High and low temperatures had relatively minor impacts across all age groups. However, low temperatures exhibited a slightly greater effect on older age groups (40–49 years), while the influence of high temperatures remained relatively consistent across all age ranges.

Discussion

Main findings

This study focuses on the young population, offering a unique perspective on the incidence and status of COPD in this group. It provides an in-depth analysis of the global burden of COPD and its associated risk factors in the 15–49 age group, with a special emphasis on health inequalities in regions with different levels of socio-economic development. Although the global ASDR and ASIR of COPD in the 15–49 age group generally showed a declining trend between 1990 and 2021, the burden of COPD remains high in regions with a low SDI. In 2021, the ASDR in low SDI regions was 198.31 per 100,000 people (95% CI: 165.53-231.86), significantly higher than the ASDR of 64.98 per 100,000 people (95% CI: 57.12–73.53) in high SDI regions. Furthermore, the study provides more detailed data to support the evidence of health inequity. Particulate matter pollution, smoking, and occupational exposure were identified as the main risk factors contributing to the burden of COPD in young individuals, with the impact of particulate matter pollution remaining particularly high in low SDI regions. These results are consistent with existing evidence on the link between air pollution and respiratory diseases [29,30,31]. Meanwhile, smoking remains a significant contributor to the COPD burden in high-income regions, especially in North America, where 34.26% of COPD-related DALYs are attributable to smoking.

Interpretation of results

The findings suggest that COPD is not only a major health burden among older populations but also presents a significant burden in the 15–49 age group, aligning with recent studies that increasingly recognize the phenomenon of “young COPD.” For instance, it has been noted in previous studies that due to the widespread presence of risk factors like pollution and smoking, the age of COPD onset is decreasing, making younger populations a critical group of concern [3, 6, 32]. Although the incidence of COPD among younger individuals is relatively low, the disease burden may be more pronounced due to the potential for disease progression over several decades, which can have profound impacts on quality of life, labor capacity, and economic burden. However, traditional COPD research has mostly focused on older populations, particularly in high-income countries. Compared to existing GBD 2021 studies [16, 33,34,35], this research focuses on the burden of COPD among young populations across varying socioeconomic levels and introduces novel analyses of health inequality and Frontier Analysis to assess disparities and achievable improvements in disease burden.We find that the burden of disease in these areas is decreasing at a much slower rate than in middle-high SDI regions, and in some areas, it remains significantly high.

Moreover, the analysis of health inequality reveals both absolute and relative inequities across socio-economic development levels. Although there has been slight improvement, the disparities remain stark. The high COPD burden in low SDI regions may result from the combined effects of multiple factors, including poor air quality, high smoking rates, and limited access to healthcare. These regions often lack effective environmental management, leading to long-term uncontrolled air pollution [36,37,38,39,40]. The situation is further complicated by a lack of financial and medical resources, competing health priorities such as communicable diseases, maternal and neonatal health, and nutritional deficiencies, as well as the adverse health impacts associated with rapid global economic growth driven by industrial relocation [41, 42]. In relatively underdeveloped regions, there is a need for more targeted public health interventions. On one hand, policies aimed at improving the accessibility of medical services, particularly in underserved areas, are especially necessary. This does not only involve treatment, but also early diagnosis and management of COPD. Enhancing primary healthcare infrastructure to ensure timely interventions can help slow down disease progression and mitigate long-term economic impacts. On the other hand, implementing measures to improve air quality, including restricting industrial pollutant emissions and promoting the use of clean energy, is also essential.

Risk factors

This study identifies particulate matter pollution (41.79%), smoking (19.81%), and occupational exposure (11.73%) as the leading risk factors for COPD in the young population. Interestingly, these findings differ from Professor Kolahi’s recent report on global risk factors for COPD across all age groups, which lists smoking (46.0%), ambient particulate matter pollution (20.7%), and occupational exposure (15.6%) as the major factors (30). This suggests that, for young individuals, the impact of particulate matter pollution outweighs that of smoking. In low-income regions, such as Oceania, sub-Saharan Africa (West, East, and Central), air pollution caused by solid fuel is the primary risk factor for COPD, rather than smoking [36]. This aligns with our findings that the PAF value for particulate matter pollution in low and low-middle SDI regions remains consistently high over time. These results indicate that implementing stringent health measures to address particulate matter pollution is an effective strategy to reduce the burden of COPD in young populations in low-income regions. For example, such measures could include promoting the use of clean fuels, improving kitchen ventilation, and providing better stoves [43, 44]. Additionally, the government need taking action to improve air quality by supporting the development of clean energy vehicles and regulating emissions from polluting industries.

Smoking remains a key driver of COPD incidence and is the most important modifiable behavioral risk factor. Compared with studies including all COPD populations [11, 37], the global PAF for smoking-attributable age-standardized DALYs in this study was only 19.81%. This suggests significant heterogeneity in the PAF for smoking-induced DALYs between younger and older individuals, reflecting the chronic cumulative effects of smoking [45, 46], whose impact exceeds that of other risk factors. This finding is consistent with our observation that smoking-related DALYs increase with age, peaking in the 40–49 age group. Despite a global decrease in smoking rates by 27.5% over the past 30 years, smoking remains the most common risk factor for chronic respiratory diseases, particularly COPD [47]. Our study found that the PAF of smoking-related DALYs exceeds 30% in high and upper-middle SDI regions in 2021, although it has decreased since 1990. Despite the relatively low ASDR for young people with COPD in high-income regions, it cannot be ignored. The WHO estimates that more than 70% of COPD cases are attributable to smoking (https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)). Early smokers have poorer lung function and a higher risk of death [46]. Mitigation of ambient particulate matter pollution is primarily driven by global health policy initiatives. Conversely, smoking, as a preventable risk factor, can be addressed through individual behavioral modifications such as cessation. Public health campaigns should focus on raising awareness about the dangers of smoking and secondhand smoke. Implementing or enhancing smoking cessation support services, including counseling and nicotine replacement therapies, can help reduce smoking rates [48]. Preventing tobacco smoke exposure remains the most effective long-term strategy for alleviating the COPD burden in young people in high-income regions, including economic, cultural, media, and family function measures [49,50,51].

Additionally, occupational particulate matter, gases, and fumes were responsible for a PAF of 11.73% for young COPD-related DALYs, which is a non-negligible risk factor. The PAF increases with age, suggesting that COPD may take years, or even decades, to develop following exposure after exposure to pollutants [52]. Furthermore, we found no significant variation in the PAF of occupational exposure across SDI regions or the 21 GBD regions, reflecting the complex nature of occupational exposure, which is not directly related to national or regional development levels [53]. Additionally, COPD is an underdiagnosed disease, and occupational COPD is even less frequently identified than predicted [54]. Therefore, it is necessary to strengthen occupational safety regulations, implement stricter occupational health standards in high-risk industries, raise public awareness about the harms of occupational exposure to particulate matter, gases, and fumes, and provide support for individuals affected by COPD due to occupational exposure.

Strengths and limitations

One strength of this study is its focus on the disease burden of COPD and its risk factors in the 15–49 age group, which contributes to a deeper understanding of COPD in the young population and provides important evidence for early prevention and intervention. However, a limitation of this study is that it relies on data from GBD 2021, which, despite being widely sourced and authoritative, may present inconsistencies in data quality and availability across regions [37]. Particularly in low-income and low-SDI regions, data accuracy and completeness may be poor, leading to biased estimates of the disease burden [15]. Moreover, health data in some countries may be insufficient, or there may be underreporting of early-stage COPD [4], which could affect the generalizability of the findings. Additionally, some risk factors, such as genetic susceptibility, although rare, were not accounted for in our estimates.

Conclusion and policy implications

This study reveals a significant burden of COPD in the young population (aged 15–49), with the potential for long-term disease progression, which could have profound impacts on quality of life, labor capacity, and socio-economic factors. Although global public health measures have made some progress in reducing the COPD burden among young individuals, their effects have been relatively limited in low-SDI regions. Particulate matter pollution and smoking are the main risk factors contributing to this burden, with occupational exposure also significantly influencing disease development. COPD in the young population should be a priority for future research and public health interventions, particularly in low-SDI regions.

Data availability

Data are available in a public, open access repository as follows: https://vizhub.healthdata.org/gbd-results/.

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Acknowledgements

We would like to express our gratitude to Xiao Ming (Xiaoming_room@hotmail.com) and JD_GBDR reseach group for thier outstanding work.

Funding

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Author notes

  1. Yaolin Li and Fangtao Yan contributed equally to this work.

Authors and Affiliations

  1. The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China

    Yaolin Li, Fangtao Yan & Wang Zhen

  2. The 3rd Affiliated Hospital of Chengdu Medical College, Pidu District People’s Hospital, Chengdu, China

    Lixiang Jiang

  3. Chengdu Second’s People Hospital, Chengdu, China

    Xiayahu Li

  4. Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China

    Huiqin Wang

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  1. Yaolin Li
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Contributions

Yaolin Li(Co-first author 1):Conceptualization, Methodology, Formal analysis, Writing - original draft, Writing - review and editing, Project administration.Fangtao Yan(Co-first author 2):Conceptualization, Investigation, Data curation, Writing - original draft, Writing - review and editing, Supervision.Lixiang Jiang：Conceptualization, Formal analysis, Investigation.Xiayahu Li: Conceptualization, Supervision, Project administration.Huiqin Wang: Conceptualization, Supervision, Project administration.All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Xiayahu Li or Huiqin Wang.

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Ethics approval and consent to participate

Our research involves a secondary assessment of publicly accessible GBD research datasets, with no primary data collection involved. And we followed the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) recommendations.Therefore, ethical approval is not required.

Competing interests

The authors declare no competing interests.

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Li, Y., Yan, F., Jiang, L. et al. Epidemiological trends and risk factors of chronic obstructive pulmonary disease in young individuals based on the 2021 global burden of disease data (1990–2021). BMC Pulm Med 25, 174 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12890-025-03630-z

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Keywords

BMC Pulmonary Medicine

ISSN: 1471-2466

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