Gender Divergence in COPD Phenotypes and Narrowing Urban-Rural Diagnostic Gaps: A Surveillance Study in Chongqing, China, 2020-2024.

PURPOSE: To analyze epidemiological trends of COPD, chronic bronchitis, and emphysema in Chongqing, China (2020-2024), and assess spirometry-confirmed diagnosis rates.

PATIENTS AND

METHODS

Data were obtained from the Chongqing Chronic Disease Surveillance System (CCDSS), including 975,421 incident cases and 1,244,978 prevalent cases among residents aged ≥15 years, and 239,086 deaths from all age groups. Age‑standardized rates were calculated using the 2000 Chinese census population. Type 1 (spirometry‑confirmed) COPD diagnosis rate was analyzed by urban-rural residence.

RESULTS

Age-standardized prevalence per 100,000 increased for COPD (732.06 to 1,424.54), emphysema (182.51 to 536.71), and chronic bronchitis (309.48 to 1,021.75). COPD and emphysema were male-predominant; chronic bronchitis became female-predominant after 2023. Rural burden was consistently higher. Type 1 diagnosis rate rose sharply from 6.96% (2022) to 26.04% (2024), with urban-rural gap narrowing to 0.77 percentage points.

CONCLUSION

The rising prevalence mainly reflects improved case ascertainment. Female‑predominant chronic bronchitis highlights the need for sex‑specific public health strategies. The rapid increase in spirometry‑confirmed diagnosis and near‑elimination of urban-rural disparity demonstrate a successful model for diagnostic standardization in primary care.