Abstract: Objective To investigate the temporal trends in the disease burden of chronic obstructive pulmonary disease (COPD) attributable to tobacco exposure in China from 1990 to 2021, thereby providing an evidence base for public health authorities to formulate targeted prevention and control strategies and tobacco control policies. Methods Data on COPD attributable to tobacco in China, Asia, various Socio-Demographic Index (SDI) regions, and globally from 1990 to 2021 were extracted from the Global Burden of Disease Study 2021 (GBD 2021). A descriptive analysis was conducted using metrics such as age-standardized mortality rates and age-standardized Disability-Adjusted Life Year (DALY) rates. The Estimated Annual Percentage Change (EAPC) was calculated to quantify trends in the disease burden metrics. An Age-Period-Cohort (APC) model was employed to analyze the respective effects of age, period, and cohort. Furthermore, a Bayesian Age-Period-Cohort (BAPC) model was utilized to forecast the age-standardized mortality and DALY rates for tobacco-attributable COPD in the Chinese population from 2022 to 2035. Results In China, the age-standardized mortality rate and age-standardized DALY rate for tobacco-attributable COPD decreased from 111.74 and 1 884.73 per 100 000 in 1990 to 35.46 and 589.75 per 100 000 in 2021, respectively. Compared to global, Asian, and other SDI regional counterparts, China demonstrated the most substantial decline in both the age-standardized mortality rate (EAPC=-4.20%, 95% CI: -4.40% to -4.00%) and the age-standardized DALY rate (EAPC=-4.20%, 95% CI: -4.37% to -4.04%). Between 1990 and 2021, the age-standardized mortality and DALY rates for tobacco-attributable COPD in China increased with advancing age, peaking in the ≥80 years age group. The age-standardized mortality rate (and DALY rate) for males decreased from 193.55 (3 117.39) per 100 000 in 1990 to 70.91 (1 079.53) per 100 000 in 2021, while for females, the corresponding rates declined from 59.65 (967.21) per 100 000 to 12.50 (225.11) per 100 000. Over the study period, the age-standardized mortality rate exhibited a positive correlation with age, whereas both period and cohort effects demonstrated a declining trend. Projections from the BAPC model indicate a continued, gradual downward trend in age-standardized mortality and DALY rates from 2022 to 2035, with the rates anticipated to reach 29.43 and 455.00 per 100 000, respectively, by 2035. Conclusion Although the burden of COPD attributable to tobacco in China has decreased significantly from 1990 to 2021, it remains severe in comparison to other nations and regions, with a particularly pronounced burden among the male population. It is therefore imperative to intensify tobacco control interventions, especially targeting males, promote healthy lifestyles, and elevate public awareness regarding COPD prevention and management.

Key words: Tobacco, Chronic obstructive pulmonary disease, Disease burden