ABSTRACT:
This study aims to characterize the divergent drivers of COPD burden across Southeast Asia over the last decade, specifically comparing the impact of tobacco smoking versus household air pollution among female populations. We conducted a secondary epidemiological analysis using the Global Burden of Disease study database. We extracted data on COPD-related Disability-Adjusted Life Years (DALYs) and mortality rates for 11 Southeast Asian countries from 2013 to 2023. The attributable burden was stratified by gender and risk factors, specifically comparing "Smoking" and "Household air pollution from solid fuels." We calculated the percentage change in age-standardized DALY rates to evaluate the effectiveness of current health interventions. The analysis reveals a stark gender disparity in COPD etiology across the region. While tobacco smoking remains the primary driver of COPD DALYs in the male population, household air pollution accounts for a disproportionately high percentage of the disease burden in women, particularly in lower-middle-income nations such as Indonesia, Myanmar, and Laos. Data indicates that while tobacco-attributable DALYs have shown variable trends, the burden attributable to HAP in women has declined at a significantly slower rate than global targets. In rural demographics, HAP remains the leading risk factor for COPD in non-smoking women, surpassing tobacco exposure. Real-world evidence from the GBD study highlights a persistent "unmet need" in respiratory health policy for Southeast Asian women. The dominant focus on tobacco control, while essential, may inadvertently overshadow the critical impact of indoor biomass exposure. These findings advocate for a paradigm shift in regional respiratory guidelines to integrate clean energy interventions as a core component of COPD management and prevention strategies in Southeast Asia.