Global, Regional, and National Burden of Chronic Obstructive Pulmonary Disease–Associated Heart Failure: A Systematic Analysis of the Global Burden of Disease Study from 1990 to 2021 with Projections up to 2050

Can Liu,1,* Haitian Zhang,2,* Zhengyan Wang,3,* Hongjin Shi,4 Lingdan Chang,1 Zhifang Ruan,1 Yan Li,1 Ming Qiu,4 Ping chu Li,4 Jinsong Zhang,4 Bing Hai11Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China; 2Faculty of Medicine, MAHSA University, Bandar Saujana Putra, Selangor, Malaysia; 3Department of Urology, Honghe Hospital Affiliated to Kunming Medical University/South Yunnan Central Hospital of Yunnan Province, Honghe, Yunnan, People’s Republic of China; 4Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jinsong Zhang; Bing Hai, Email 945933392zjs@sina.com; binghai999@163.comBackground: Chronic obstructive pulmonary disease (COPD) is strongly linked to heart failure (HF), but comprehensive global evaluations of COPD-associated HF remain limited.Methods: Using Global Burden of Disease Study 2021 data, we assessed prevalence and years lived with disability (YLDs) of COPD-associated HF. We applied decomposition analysis, Joinpoint regression, and Bayesian age-period-cohort modeling to evaluate trends by sex, age, sociodemographic index (SDI), and region, and to project burden to 2050.Results: In 2021, global COPD-associated HF cases exceeded 3.61 million, a 1.4-fold increase since 1990. Age-standardized prevalence rates (ASPR) and YLD rates (ASYR) increased overall. Absolute cases and YLDs rose in both sexes, but age-standardized rates declined in males and rose in females. Burden peaked at ages 70– 74 and grew fastest among those aged ≥ 95. The Middle SDI region had the highest counts; East Asia had the highest regional burden, and China the highest national absolute burden. Only High-SDI regions showed rising ASPR and ASYR; most other regions declined, notably Eastern Europe. Projections indicate global increases in ASPR and ASYR from 2022 to 2050, with slightly higher rises in females than males.Conclusion: The global burden of COPD-associated HF continues to rise with substantial heterogeneity and is projected to increase further. Coordinated international efforts and targeted prevention and management are urgently needed.Keywords: chronic obstructive pulmonary disease, heart failure, global burden of disease, disease trends, predictive analysis, forecasting, sex, age, sociodemographic index, geographic regions