Abstract
BACKGROUND: China is one of the countries with the heaviest burden of chronic obstructive pulmonary disease (COPD). In high-altitude areas of China (≥1,500 m), factors such as low oxygen levels, burning of biomass, and an aging population make the prevention and treatment of COPD more challenging. However, there is currently a lack of systematic epidemiological studies. This study aimed to assess the prevalence of COPD in high-altitude areas of China. METHODS: The search was conducted in PubMed, Embase, Web of Science, Ovid, ProQuest, Scopus, The Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, Weipu, and China Biology Medicine disc (CBM) from their inception to May 17, 2025. Studies were evaluated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and registered in International Prospective Register of Systematic Reviews (PROSPERO) (Identifier: CRD420251063646). RESULTS: A total of 6 cross-sectional studies from high-altitude areas of China (including 15,621 participants) were included. The COPD prevalence rate in high-altitude areas (≥1,500 m) of China was 10% [95% confidence interval (CI): 7-14%; P<0.001]. Subgroup analysis showed that the prevalence rate in people aged ≥50 years was significantly higher than that in those aged 40-49 years (17% vs. 6%, P=0.004), and the prevalence rate in those with smoking history of ≥20 pack-years was significantly higher than that in non-smokers (19% vs. 3%, P=0.01). The sensitivity analysis was stable, and there was no statistical significance for publication bias (Begg's test P=0.13; Egger's test P=0.16). CONCLUSIONS: The prevalence of COPD in high-altitude areas of China is 10%, which is closely related to aging and smoking. It is necessary to promote clean energy and strengthen health education for targeted intervention. In the future, priority should be given to conducting age-standardized estimates and multi-center studies to verify the results and provide a basis for COPD prevention and control strategies.