Abstract
OBJECTIVE: To analyze trends in the disease burden of chronic respiratory diseases (CRD) attributable to smoking in China from 1990 to 2021 and to project its development from 2022 to 2035, providing scientific evidence for optimizing tobacco control strategies and public health decision-making. METHODS: Using Global Burden of Disease (GBD) 2021 data, epidemiological data on smoking-attributable CRD were collected for China, Japan, the European Union, the United States, and the global population from 1990 to 2021. Indicators included years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs), covering individuals aged 30 years and older. Joinpoint regression models estimated average annual percentage changes (AAPCs), while Bayesian age-period-cohort (BAPC) models projected future trends. RESULTS: In 2021, smoking-attributable CRD DALYs in China reached 10320279 (95% uncertainty interval [UI]: 7806610-12875089) person-years, with an age-standardized disability-adjusted life years rate (ASDR) of 522.34 (95% UI: 394.50-653.32) per 100000 person-years. The number of deaths was 566446 (95% UI: 416802-720431), with an age-standardized mortality rate (ASMR) of 31.34 (95% UI: 23.10-39.69) per 100000 population. YLLs and YLDs were 8983486 (95% UI: 6547449-11421727) person-years and 1336793 (95% UI: 981768-1699656) person-years, corresponding to age-standardized rates (ASR) of 458.96 (95% UI: 337.53-582.19) per 100000 person-years and 63.38 (95% UI: 46.17-80.72) per 100000 person-years, respectively. The disease burden showed significant differences by gender and age, with higher risks among males and middle-aged and elderly populations. From 1990 to 2021, all burden indicators in China showed a declining trend, with ASMR and ASDR projected to continue decreasing over the next decade. CONCLUSION: China has made positive progress in CRD prevention and tobacco control, but challenges such as population aging require continued attention. Targeted prevention interventions, particularly for high-risk populations, should be strengthened to reduce disease burden. The experience and challenges documented in China could offer valuable lessons and policy insights for other countries undergoing similar epidemiological transitions.