Divergent global trends in COPD burden attributable to ambient and household air pollution, 1990–2021, and projections to 2050

Particulate matter pollution (PMP) is a significant environmental risk factor for chronic obstructive pulmonary disease (COPD), contributing substantially to the global public health burden. Using data from the Global Burden of Disease Study 2021 (GBD 2021), we quantified COPD-related disability-adjusted life years (DALYs) attributable to ambient particulate matter pollution (APMP) and household air pollution (HAP) from 1990 to 2021. We applied an integrated analytical framework including Joinpoint regression, inequality assessment (SII and CI), decomposition analysis, frontier efficiency evaluation using LOESS regression, and Bayesian age–period–cohort modelling with INLA to assess historical patterns and project future trends. Globally, PMP-attributable COPD DALYs declined over the study period, with substantial heterogeneity across regions and socio-demographic index (SDI) levels. APMP-related burden exhibited a non-linear, inverted U-shaped association with SDI, peaking in middle-SDI regions, whereas the burdens attributable to HAP and total PMP declined consistently with increasing SDI. While COPD burden is generally higher in men, HAP-attributable burden remained disproportionately higher in women in East Asia. Frontier analysis identified countries with substantial excess burden relative to their development level, particularly Papua New Guinea. Projections to 2050 indicate a continued global decline, although regional disparities and uncertainties persist, especially for APMP. These findings highlight distinct epidemiological patterns between ambient and household pollution sources and underscore the need for region-specific and source-targeted interventions to reduce COPD burden and address persistent global health inequalities.