ObjectiveTo quantify the global burden of chronic obstructive pulmonary disease (COPD) attributable to high temperature, low temperature, and non-optimal temperature from 1990 to 2021 using the Global Burden of Disease (GBD) 2021 data. MethodsBased on the GBD 2021 data, we analyzed global, regional, and national COPD mortality and disability-adjusted life years (DALYs) from COPD attributable to high, low, and non-optimal temperatures. Joinpoint regression, age-period-cohort modeling, and Bayesian prediction models were employed. ResultsGlobally, age-standardized mortality rates (ASMR) and age-standardized DALYs rates (ASDR) for COPD attributable to low temperature and non-optimal temperature declined. However, the burden from high temperature increased. Low temperature consistently exerted a greater burden than high temperature across all metrics. Significant geographical disparities emerged: high-temperature mortality was highest in South Asia; low-temperature burden was most severe in East Asia; and high-income North America exhibited accelerated high-temperature mortality growth. The highest low-temperature burden occurred in middle-SDI region, while high-temperature impacts predominated in low-middle-SDI region. Age patterns showed rising high-temperature burden in the 15-39 age group and increasing low-temperature burden among adults ≥80 years old. Bayesian projections revealed divergent gender trajectories: a continuing decline in low-temperature burden for males versus a decelerated decline for females (2020-2030). ConclusionLow temperature exposure remains the primary risk factor for COPD within non-optimal temperatures globally, although high-temperature impacts are increasing. Significant regional variations necessitate targeted interventions for three key populations: older adults vulnerable to cold, working-age adults with occupational heat exposure, and older women requiring rehabilitative support.
