Sharp rise in lung disease deaths over past 27 years

Author: Adrian O'Dowd

Numbers of people dying or experiencing disability due to chronic respiratory diseases over the past three decades have risen sharply, according to an analysis* of data from 195 countries published today by The BMJ.

Chinese researchers also found that the poorest regions of the world had the greatest disease burden with ageing and risk factors including smoking, environmental pollution, and body weight playing a key role.

Chronic respiratory diseases are considered to be a significant public health problem with an estimated 3.9 million deaths in 2017 – accounting for 7% of all deaths worldwide.

Chronic obstructive pulmonary disease (COPD) and asthma are the most common conditions, but others such as pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis are also global public health concerns.

Previous analyses of death and loss of health due to chronic respiratory diseases were based on limited data or confined to local areas.

To explore this further, researchers in China used data from the Global Burden of Disease Study 2017 to describe trends in mortality and disability adjusted life years (DALYs) due to chronic respiratory diseases, by age and sex, across the world from 1990 to 2017.

During this period, the number of deaths due to chronic respiratory diseases increased by 18% from 3.32 million in 1990 to 3.91 million in 2017.

The number of deaths increased with age and rose sharply in those aged 70 and older – a burden that was likely to increase as the worldwide population ages, suggested the authors.

During the 27-year study period, rates of death and disability ranked according to age fell, particularly in men.

Overall, social deprivation was the most important factor affecting rates of death and disability, with the highest rates seen in the poorest regions of the world.

Lower mortality was seen in more affluent countries, which probably reflects better access to health services and improved treatments.

Smoking was the leading risk factor for deaths and disability due to COPD and asthma.

In 2017, smoking accounted for 1.4 million deaths and 33 million DALYs, particularly in poorer regions, indicating the need to improve tobacco control in developing countries, said the authors.

Pollution from airborne particulate matter was the next most important risk factor for COPD, with one million deaths and 25 million DALYs.

A high body mass index also accounted for the most deaths from asthma since 2013, particularly in women, and has contributed the most to DALYs since 2003.

The authors said: “As the prevalence of obesity continues to increase at a worrying rate worldwide, weight loss should be included in the management of obese patients with asthma.”

The researchers acknowledged some study limitations, such as differences in disease definitions and rates of misdiagnosis across countries.

Nevertheless, they said this study showed that the number of global deaths and DALYs from chronic respiratory diseases increased from 1990 to 2017, while the age standardised mortality rate and age standardised DALY rate fell, with a more profound decline in males.

They concluded: “Regions with a low socio-demographic index had the greatest burden of disease. The estimated contribution of risk factors (such as smoking, environmental pollution, and a high body mass index) to mortality and DALYs supports the need for urgent efforts to reduce exposure to them.”

*Li X, Cao X, Guo M, et al. Trends and risk factors of mortality and disability adjusted life years for chronic respiratory diseases from 1990 to 2017: systematic analysis for the Global Burden of Disease Study 2017. BMJ 2020;368:m237. DOI:10.1136/bmj.m237