Burden of COPD in Nepal

Tara Ballav Adhikari,1 Dinesh Neupane,1,2 Per Kallestrup3 1Nepal Development Society, Chitwan, Nepal; 2Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China; 3Center for Global Health (GloHAU), Department of Public Health, Aarhus University, Aarhus, Denmark Background: COPD is a globally significant public health problem and is the second leading cause of mortality. This study presents the health burden of COPD in Nepal using the Global Burden of Disease (GBD) study 2016 dataset. Methods: This study used the data from the GBD repository presenting morbidity and mortality attributed to COPD, by sex and age. In GBD 2016, due to a lack of the primary source of data in Nepal, estimations on morbidity and mortality of COPD were based on its predictive covariates. Years of life lost (YLLs) were calculated based on the cause of death estimations, applying GBD’s Cause of Death Ensemble modeling. Likewise, years lived with disability (YLDs) were calculated by multiplying the prevalence of each sequela by the disability weight. Disability-adjusted life years (DALYs) were derived as the sum of YLLs and YLDs. Results: Between 1990 and 2016, the estimated age-standardized mortality rate due to COPD was decreasing for both genders, but the decline was much higher among males. Unlike the high rate of incidence among males, the age-standardized DALYs were found to be high among females (2,274.9 [95% UI: 1,702.0–2,881.5] per 100,000). YLLs contributed around 80% of DALYs due to COPD in 2016. Age-standardized YLLs rate was higher among females, with a value of 1,860 (95% uncertainty interval (UI): 1,282.8–2,472.8) vs 1,547.6 (95% UI: 992.1–2,018.5) among the males per 100,000 population. Conclusion: The prevalence and incidence of COPD remained almost stationary over the years, but still very high. Though the incidence and prevalence of disease were high among males, the death rate and DALYs were more significant among females throughout the years. If the current situation prevails, the burden of COPD will continue to increase in the country. Hence, comprehensive social, environmental, and behavioral approaches to curtail the risk factors along with early identification, treatment, and management of COPD is of utmost importance. Keywords: DALYs, disability, mortality, burden of illness, GBD