Trends and projections of chronic obstructive pulmonary disease burden in postmenopausal women: a comparative study of four Western Pacific countries, 1990–2050

BACKGROUND: Chronic obstructive pulmonary disease (COPD) burden in postmenopausal women (aged ≥55 years) across the Western Pacific remains understudied. METHODS: Using GBD 2023 data (1990-2023) for China, Japan, South Korea, and Mongolia, we analyzed incidence, prevalence, mortality, and DALYs via decomposition and Bayesian age-period-cohort models, projecting trends to 2050. RESULTS: Age-standardized rates declined in all four countries, but absolute prevalent cases rose due to population growth and aging. Ambient particulate matter replaced household air pollution as the leading risk factor for DALYs/mortality in China and Mongolia, while tobacco remained dominant in Japan and South Korea. Generational risk reductions contrasted with persistently high risk in the oldest groups. Age-standardized rates are projected to keep declining except for prevalence in Japan, which may reverse after 2024 due to super-aging. CONCLUSION: Despite improving epidemiological trends, the absolute COPD burden among postmenopausal women is growing, demanding tailored national policies aligned with healthy ageing goals.