What question did this study set out to answer?

This study aims to assess the multidimensional burden of COPD in comparison to other prevalent non-communicable diseases in China.

March 4, 2026Open Access

The Multidimensional Burden of COPD in China: A Propensity Score-Matched Comparison with Other Prevalent Non-Communicable Diseases

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Adults in urban China aged 6 years with self-reported COPD confirmed by symptoms (COPD-SQ score 16), compared with matched cohorts having hypertension, diabetes, hypercholesterolemia, or osteoporosis (n=589). Intervention: COPD (chronic obstructive pulmonary disease) management vs. Hypertension, diabetes, hypercholesterolemia, or osteoporosis patient cohorts. Primary outcome: Multidimensional disease burden including health-related quality of life (HRQoL measured by SF-12v2 MCS, PCS and EQ-5D-5L utility), work productivity and activity impairment (WPAI), and healthcare resource utilization (outpatient visits, emergency department visits, hospitalizations).

Key Result

COPD patients in urban China showed significantly greater multidimensional disease burden with lower HRQoL scores, higher work productivity loss, and increased healthcare utilization compared to patients with hypertension, diabetes, or hypercholesterolemia, with burden worsening by GOLD stage.

Key Points

This study aims to assess the multidimensional burden of COPD in comparison to other prevalent non-communicable diseases in China.
Conducted a cross-sectional analysis using 2020 National Health and Wellness Survey data.
Included 589 COPD patients and cohorts from other non-communicable diseases.
Utilized propensity score matching to balance demographic and clinical characteristics.
Evaluated health-related quality of life, work productivity, activity impairment, and healthcare utilization.
COPD patients showed a greater overall disease burden than those with hypertension, diabetes, or hypercholesterolemia.
Burden severity varied, with GOLD stages B and D presenting the most significant impairments.
Patients with severe COPD had lower health-related quality of life and higher activity impairment.
Severe COPD exhibited greater work productivity loss and hospitalization rates compared to diabetes.
The advantage of mild COPD diminished in advanced stages when compared to osteoporosis.

Study Design

Type

Cross-Sectional (n=589)

Multicenter

Yes

Structured PICO

Population

20,051 adults aged ≥18 years from urban areas in China from the 2020 National Health and Wellness Survey, including 589 with self-reported COPD and comparator cohorts with hypertension (n=1,635), diabetes (n=262), hypercholesterolemia (n=371), and osteoporosis (n=602).

Comparator

Propensity score-matched cohorts of patients with hypertension, diabetes, hypercholesterolemia, or osteoporosis.

Outcome

Health-related quality of life (SF-12v2 Physical and Mental Component Summary scores, EQ-5D-5L utility index), work productivity and activity impairment (WPAI), and healthcare resource utilization (outpatient visits, emergency department visits, and hospitalizations over the preceding 6 months).patient reported

COPD imposes a substantial multidimensional burden in China that often exceeds other common non-communicable diseases like hypertension and diabetes, highlighting the need for severity-based management.

Limitations

Cross-sectional design limits causal inference and temporal assessment of disease burden.
COPD diagnosis based on self-report and symptom questionnaire without spirometry confirmation, risking misclassification.
Relatively small matched sample sizes for some comparator groups limit statistical power and generalizability.
Residual confounding possible from unmeasured factors such as disease duration and health-seeking behavior.
Economic burden assessment did not capture full societal costs including informal care and indirect productivity losses.

Abstract

Purpose: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality in China, yet its multifaceted burden relative to other major non-communicable diseases (NCDs) is not well-characterized. This study comprehensively assessed the multidimensional burden of COPD compared to hypertension, diabetes, hypercholesterolemia, and osteoporosis in China. Patients and Methods: A cross-sectional analysis was performed using data from the 2020 China National Health and Wellness Survey (NHWS). The study included 589 self-reported COPD patients and comparison cohorts with other NCDs. Propensity score matching (1:1) was used to balance demographic and clinical characteristics. Outcomes included health-related quality of life (HRQoL), work productivity and activity impairment (WPAI), and healthcare resource utilization (HCRU). Results: After matching, COPD patients exhibited a significantly greater overall disease burden compared to those with hypertension, diabetes, or hypercholesterolemia. The burden was severity-dependent, with patients in GOLD stages B and D experiencing the most severe impairments. COPD was associated with significantly lower HRQoL and higher activity impairment than hypertension and hypercholesterolemia. Compared to diabetes, severe COPD (Stage D) showed greater work productivity loss and higher hospitalization rates. The burden relative to osteoporosis was more variable, with the advantage of mild COPD (Stage A) diminishing in advanced stages. Conclusion: COPD imposes a substantial and distinct multidimensional burden in China, often exceeding that of other common NCDs and escalating with severity. These findings underscore the need for severity-based management and integrated care to mitigate the significant health and socioeconomic impact of COPD. Keywords: chronic obstructive pulmonary disease, disease burden, propensity score matching, urban China, comparative study

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Cite This Study

Sun et al. (Sun,) conducted a cross-sectional in Adults in urban China aged 6 years with self-reported COPD confirmed by symptoms (COPD-SQ score 16), compared with matched cohorts having hypertension, diabetes, hypercholesterolemia, or osteoporosis (n=589). COPD (chronic obstructive pulmonary disease) management vs. Hypertension, diabetes, hypercholesterolemia, or osteoporosis patient cohorts was evaluated on Multidimensional disease burden including health-related quality of life (HRQoL measured by SF-12v2 MCS, PCS and EQ-5D-5L utility), work productivity and activity impairment (WPAI), and healthcare resource utilization (outpatient visits, emergency department visits, hospitalizations). COPD patients in urban China showed significantly greater multidimensional disease burden with lower HRQoL scores, higher work productivity loss, and increased healthcare utilization compared to patients with hypertension, diabetes, or hypercholesterolemia, with burden worsening by GOLD stage.

synapsesocial.com/papers/69a7cc8ed48f933b5eed82c1 https://doi.org/https://doi.org/10.2147/copd.s576684

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