COPD Burden Across 48 Asian Locations, 2009–2023: Demographic Drivers and Socioeconomic Inequality

Background: Chronic obstructive pulmonary disease (COPD) can show declining age-standardized rates while the number of affected people grows. We quantified this divergence and its demographic and socioeconomic pattern across Asia. Methods: Using Global Burden of Disease 2023 estimates for 48 Asian locations (2009– 2023), primary analyses examined incidence, prevalence, deaths, disability-adjusted life-years (DALYs), age-sex patterns, estimated annual percentage changes, demographic decomposition, and Socio-demographic Index (SDI)-related inequality. Exploratory analyses assessed pre-2020 trend deviations and subregional ARIMA forecasts to 2030. Results: From 2009 to 2023, incident cases increased from 7.74 million to 10.75 million (38.9%), prevalent cases from 91.88 million to 129.76 million (41.2%), deaths from 2.11 million to 2.63 million (24.8%), and DALYs from 46.43 million to 55.97 million (20.5%). Age-standardized incidence and prevalence rates declined in 34 of 48 locations, death rates in 37, and DALY rates in 43. Of 522,061 additional deaths, population growth contributed 345,084 and population aging 933,776, partly offset by epidemiological change (− 756,799). The death-rate SII changed from − 69.90 in 2009 to − 87.22 in 2023, and the concentration index from − 0.140 to − 0.220, indicating increasing concentration in lower-SDI populations. Summed subregional point deviations for 2020– 2023 were small relative to expected burden: deaths were 0.57% and DALYs 0.26% above expected, whereas incidence was 0.35% and prevalence 0.51% below expected. Conditional 2030 point forecasts were 13.28 million incident cases, 156.74 million prevalent cases, 2.81 million deaths, and 62.63 million DALYs. Conclusion: Declining age-standardized rates have not reduced COPD service need across Asia. Population aging and lower-SDI disadvantage support prevention and care strategies tailored to demographic and socioeconomic context. Keywords: chronic obstructive pulmonary disease, global burden of disease, Asia, population aging, health inequality, disease burden