Objective To understand the incidence trends of chronic obstructive pulmonary disease (COPD) among elderly adults in China and to provide a reference for optimizing COPD prevention and control strategies in China.

Methods Data related to the incidence of COPD among Chinese residents aged ≥60 years from 1992 to 2021 were collected from the Global Burden of Disease Study 2021 (GBD 2021) database. Descriptive analyses were conducted using indicators such as the number of incident cases, incidence rate, and age-standardized incidence rate. Joinpoint regression models were used to analyze the trends in COPD incidence among elderly adults in China and to calculate the annual percentage change (APC) and average annual percentage change (AAPC). Age-period-cohort (APC) models were applied to fit and estimate the age, period, and cohort effects on the risk of COPD incidence among elderly adults in China.

Results The incidence rates of COPD among elderly adults in China overall, males, and females decreased from 1 374.91/1 000 001 359.40/100 000, and 1 389.29/100 000 in 1992 to 1 252.95/100 000, 1 207.43/100 000, and 1 179.24/100 000 in 2021, respectively. The age-standardized incidence rates decreased from 1 548.64/100 000, 1 590.77/100 000, and 1 515.03/100 000 in 1992 to 1 252.95/100 000, 1 331.37/100 000, and 1 190.16/100 000 in 2021, respectively. The AAPCs of the age-standardized incidence rates were –0.73%, –0.61%, and –0.83%, respectively (all P<0.05). The APC model analysis showed that the age effects on COPD incidence among elderly adults in China overall, males, and females all showed an increasing trend with age, with the age effect coefficients increasing from –0.817, –0.791, and –0.861 for ages 60-64 to 0.521, 0.611, and 0.504 for ages 90-94, respectively. The period effects on COPD incidence among elderly adults in China overall and females showed a trend of first decreasing and then increasing over time, with the period effect coefficients decreasing from 0.013 and 0.033 for the period 1992–1996 to –0.028 and –0.059 for the period 2007-2011, and then increasing to 0.013 and 0.024 for the period 2017–2021, respectively. The period effects on COPD incidence among elderly male adults showed an overall increasing trend over time, with the period effect coefficients increasing from –0.017 for the period 1992–1996 to 0.014 for the period 2017–2021. The birth cohort effects on COPD incidence among elderly adults in China overall, males, and females all showed a decreasing trend with birth year, decreasing from 0.255, 0.194, and 0.283 for the birth cohort 1902–1906 to –0.279, –0.307, and –0.258 for the birth cohort 1957–1961, respectively.

Conclusions The age-standardized incidence rate of COPD among elderly adults in China showed an overall decreasing trend from 1992 to 2021, but the disease burden of COPD among males and elderly adults at advanced ages continues to increase.