COPD in Africa in the Post-COVID Era: A GBD 2023 Analysis of Trends, Demographic Drivers and Health-System Performance.

Background: Chronic obstructive pulmonary disease (COPD) is an emerging non-communicable priority in Africa, yet how the COVID-19 era has shaped COPD burden and its drivers across the continent remains unclear. Methods: Using Global Burden of Disease (GBD) 2023 estimates, we quantified COPD incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for 52 African countries from 2019 to 2023. Age-standardised rates (ASRs) per 100,000 population were calculated using the GBD standard population. Trends were summarised using estimated annual percentage change (EAPC). Das Gupta decomposition partitioned changes in total DALYs into contributions from population growth, population ageing, and epidemiologic change (changes in age-specific DALY rates). Frontier analysis benchmarked 2023 age-standardised DALY rates against Socio-demographic Index (SDI)-expected values to identify over- and under-performing countries. Socioeconomic gradients were assessed using the Slope Index of Inequality (SII). Results: From 2019 to 2023, incident COPD cases increased from 751,091 to 871,054 (+16.0%), prevalent cases from 10.99 to 12.70 million (+15.6%), DALYs from 3.56 to 3.86 million (+8.5%), and deaths from 119,371 to 125,680 (+5.3%). Median age-standardised DALY and mortality rates declined from 579.6 to 540.6 and from 23.2 to 21.2 per 100,000, respectively, whereas incidence and prevalence ASRs rose modestly in most countries. Men had higher age-specific incidence and prevalence than women, with substantially larger excesses in DALYs (~50-60%) and mortality (~70-80%) across adult age groups. Decomposition showed that the net increase of ~303,100 DALYs was driven mainly by population growth and ageing, while epidemiologic improvements offset ~60% of demographic pressure. Frontier analysis showed marked heterogeneity: about one-third of countries had DALY rates ≥20% above SDI-expected values, whereas another third achieved burdens at or below the frontier. Conclusion: In the immediate post-pandemic period, Africa has rising absolute COPD burden but improving age-standardised disability and mortality in most countries. Large sex disparities and wide performance gaps at similar SDI levels highlight opportunities for targeted tobacco control, clean-energy transitions, and strengthened chronic respiratory care.