Analysis of health loss and attributable disease burden to smoking of chronic obstructive pulmonary disease among residents in Jing'an District of Shanghai in 2017

Background In recent years, the prevalence and burden of chronic obstructive pulmonary disease (COPD) have increased year by year, becoming one of the most important public health problems in the world.

Objective This study analyzes the health loss and disease burden to smoking of COPD of residents in Jing'an District, aiming to provide evidence for formulating related public health policies.

Methods The monitoring data of cause of death in Jing'an District of Shanghai in 2017 were collected to analyze the distribution of COPD in different genders, age groups, underlying causes of death, and associated diseases, and calculate crude mortalities and standardized mortalities of different genders and age groups. Combining with the surveillance data of chronic diseases and their risk factors in the district in 2017, Global Disease Burden 2017 and a comparative risk assessment method were adopted to calculate health loss indexes such as years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life year (DALY) as well as indirect economic burden of COPD and its attribution to smoking.

Results The majority of COPD deaths aged 80 years and above (80.07%), and were accompanied by hypertension (29.26%), coronary heart disease (28.90%), cerebrovascular disease (24.60%), and other diseases in the studied area. COPD deaths accounted for 6.21% of the total deaths (including 7.66% males and 4.57% females), and the mortality rate was 58.97/10⁵ (78.63/10⁵ for men and 39.97/10⁵ for women). The DALY due to COPD was 7 211 person-years (4 964 person-years for men and 2 247 person-years for women), and the DALY rate was 7.63‰ (10.69‰ for men and 4.68‰ for women). The attributable risk of smoking on COPD deaths was 50.12% (67.97% for men and 10.68% for women), the number of smoking attributable deaths was 254 (239 males and 15 women), and the smoking attributable mortality rate was 29.55/10⁵ (53.44/10⁵ for men and 4.27/10⁵ for women). The DALY attributable to smoking was 3 614 person-years (3 374 person-years for men and 240 person-years for women). The number of deaths, mortality rate, and DALY of COPD attributable to smoking were higher in males than those in females, and increased with age. The per capita indirect economic burden of COPD deaths and those attributable to smoking were 278200 yuan and 161400 yuan respectively, and both decreased with age.

Conclusion The burden of disease caused by COPD is huge, and smoking is the most important risk factor.