Burden and risk factors of chronic obstructive pulmonary disease in Sub-Saharan African countries, 1990-2019: a systematic analysis for the Global Burden of disease study 2019

Mulubirhan Assefa Alemayohu; Maria Elisabetta Zanolin; Lucia Cazzoletti; Peter Nyasulu; Vanessa Garcia-Larsen; GBD 2019 Sub-Saharan COPD Collaborators

doi:10.1016/j.eclinm.2023.102215

Burden and risk factors of chronic obstructive pulmonary disease in Sub-Saharan African countries, 1990-2019: a systematic analysis for the Global Burden of disease study 2019

EClinicalMedicine. 2023 Oct 2:64:102215. doi: 10.1016/j.eclinm.2023.102215. eCollection 2023 Oct.

Authors

Mulubirhan Assefa Alemayohu^{1

2

3}, Maria Elisabetta Zanolin¹, Lucia Cazzoletti¹, Peter Nyasulu⁴, Vanessa Garcia-Larsen⁵; GBD 2019 Sub-Saharan COPD Collaborators

Collaborators

GBD 2019 Sub-Saharan COPD Collaborators:
Mulubirhan Assefa Alemayohu, Maria Eisabetta Zanolin, Lucia Cazzoletti, Peter S Nyasulu, Vanessa Garcia-Larsen, Yonas Derso Abtew, Denberu Eshetie Adane, Miracle Ayomikun Adesina, Amadou Barrow, Alemshet Yirga Berhie, Belay Boda Abule Bodicha, Gashaw Sisay Chanie, Feleke Mekonnen Demeke, Diriba Dereje, Lankamo Ena Digesa, Michael Ekholuenetale, Daniel Berhanie Enyew, Hawi Leul Esayas, Adeniyi Francis Fagbamigbe, Getahun Fetensa, Kahsu Gebrekirstos Gebrekidan, Yibeltal Yismaw Gela, Habtamu Alganeh Guadie, Segun Emmanuel Ibitoye, Olayinka Stephen Ilesanmi, Tesfaye K Kanko, Patrick Dmc Katoto, Samson Mideksa Legesse, Shafiu Mohammed, Jobert Richie Nansseu, Ogochukwu Janet Nzoputam, Chimezie Igwegbe Nzoputam, Oluwakemi Ololade Odukoya, Osaretin Christabel Okonji, Mayowa O Owolabi, Bereket Beyene Shashamo, Yonatan Solomon, Worku Animaw Temesgen, Gedif Ashebir Wubetie, Yazachew Yismaw, Getachew Assefa Zenebe

Affiliations

¹ Unit of Epidemiology and Medical Statistics, University of Verona, Italy.
² School Public Health, Mekelle University, Ethiopia.
³ Biostatistics and Clinical Epidemiology Unit, Department of Public Health, Experimental and Forensic Medicin, University of Pavia, 27100, Pavia, Italy.
⁴ Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁵ Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.

Abstract

Background: Sub-Saharan Africa (SSA) has experienced a surge of non-communicable diseases (NCDs) including chronic obstructive pulmonary disease (COPD) over the past two decades. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), in this study we have estimated the burden and attributable risk factors of COPD across SSA countries between 1990 and 2019.

Methods: COPD burden and its attributable risk factors were estimated using data from the 2019 GBD. Percentage change was estimated to show the trend of COPD estimates from 1990 to 2019. COPD estimates attributable by risk factors were also reported to ascertain the risk factor that brings the greatest burden by sex and locations (at country and regions level).

Findings: In 2019, all-age prevalent cases of COPD in SSA were estimated to be 10.3 million (95% Uncertainty Intervals (UI) 9.7 million to 10.9 million) showing an increase of 117% compared with the number of all-age COPD cases in 1990. From 1990 to 2019, SSA underwent an increased percentage change in all-age YLDs due to COPD ranging from 41% in Lesotho to 203% in Equatorial Guinea. The largest premature mortality due to COPD was reported from Central SSA accounting for 729 subjects (95% UI, 509-1078). The highest rate of DALYs attributable to COPD was observed in Lesotho. Household air pollution from solid fuel was the primary contributor of the age standardized YLDs, death rate, and DALYs rate per 100,000 population.

Interpretation: The prevalence of COPD in SSA has had a steady increase over the past three decades and has progressively become a major public health burden across the region. Household air pollution from solid fuel is the primary contributor to COPD related burden, and its percentage contribution showed a similar trend to the reduction of COPD attributed age-standardized DALY rate. The methodological limitations of surveys and datapoints included in the GBD need to be considered when interpreting these associations.

Funding: There are no specific fundings received for this study. The Global Burden of Disease study was supported by funding from the Bill & Melinda Gates Foundation.

Keywords: Burden; COPD; Chronic respiratory diseases; DALYs; Global burden of disease; Risk factors.