Burden of chronic obstructive pulmonary disease in adults aged 70 years and older, 1990–2021: Findings from the Global Burden of Disease Study 2021

Kaifang Meng; Xu Chen; Zhishang Chen; Jing Xu

doi:10.1371/journal.pone.0316135

Peer Review History

Original SubmissionOctober 23, 2024
28 Nov 2024 Decision Letter - Aida Fallahzadeh, Editor PONE-D-24-47807Burden of chronic obstructive pulmonary disease in adults aged 70 years and older, 1990-2021: findings from the Global Burden of Disease Study 2021PLOS ONE Dear Dr. Xu, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jan 12 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The following resources for replacing copyrighted map figures may be helpful: USGS National Map Viewer (public domain): http://viewer.nationalmap.gov/viewer/ The Gateway to Astronaut Photography of Earth (public domain): http://eol.jsc.nasa.gov/sseop/clickmap/ Maps at the CIA (public domain): https://www.cia.gov/library/publications/the-world-factbook/index.html and https://www.cia.gov/library/publications/cia-maps-publications/index.html NASA Earth Observatory (public domain): http://earthobservatory.nasa.gov/ Landsat: http://landsat.visibleearth.nasa.gov/ USGS EROS (Earth Resources Observatory and Science (EROS) Center) (public domain): http://eros.usgs.gov/# Natural Earth (public domain): http://www.naturalearthdata.com/ Additional Editor Comments: Dear Authors, After careful review of your manuscript, we have decided that it requires major revisions before it can be considered for publication in our journal. While your work presents valuable insights and contributes to the field, several key aspects of the study need further clarification and strengthening. These include (but are not limited to) the methodology, data analysis, and presentation of results. We believe that with substantial revision, your manuscript has the potential to make a significant impact, and we look forward to reviewing the updated version. Please ensure that you address all the reviewer comments thoroughly and provide a point-by-point response when resubmitting your revised manuscript. Best Regards, Aida Fallahzadeh, MD Reviewer 1: Thank you for inviting me to review this paper. I am not convinced about writing a paper for patients >70 when the more general paper about it is already published. Overall, I think that adding the incidence rates is required so the authors can discuss the significance of this health problem based on the data from death/DALY/prevalence. - Abstract: The method is too brief and more details are required. The authors can check previous GBD studies to get idea for improving this section. - Abstract: There is no mention of risk factors in the aim of the study. - The reason for increased prevalence can be attributed to higher life expectancies. Thus, we cannot use it to highlight the problem as the death rate is also decreasing. The authors should mention the trend for incidence rate as well. Also, it is important to discuss the results by its incidence throughout the manuscript. -line 93: abbreviations needs to be defined. - There was no mention of COVID-19 in this paper, which needs to be discussed in GBD2021 results, especially in respiratory diseases. - The authors have not discussed about the policymaking and interventions. The can suggest new ones and also discuss the previous ones that led to reducing the burden of disease. Reviewer 2: The manuscript is well-written and the overall quality of the introduction and discussion is acceptable. However, some minor modifications are suggested: - The Methods section is too brief. Please provide additional details regarding the models used in the GBD analysis. - In the GBD 2021 methodology, 500 iterations were used to obtain the 95% uncertainty intervals (UI). Please correct this in the Methods section. - Please mention that LOESS regression was used to assess the association between SDI and prevalence rates, as presented in Figure 3. - It is recommended to report the prevalence and DALY numbers for 2021 in the results of the abstract, in addition to the rates already provided. The manuscript is well-written and the overall quality of the introduction and discussion is acceptable. However, some minor modifications are suggested: - The Methods section is too brief. Please provide additional details regarding the models used in the GBD analysis. - In the GBD 2021 methodology, 500 iterations were used to obtain the 95% uncertainty intervals (UI). Please correct this in the Methods section. - Please mention that LOESS regression was used to assess the association between SDI and prevalence rates, as presented in Figure 3. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: No Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for inviting me to review this paper. I am not convinced about writing a paper for patients >70 when the more general paper about it is already published. Overall, I think that adding the incidence rates is required so the authors can discuss the significance of this health problem based on the data from death/DALY/prevalence. - Abstract: The method is too brief and more details are required. The authors can check previous GBD studies to get idea for improving this section. - Abstract: There is no mention of risk factors in the aim of the study. - The reason for increased prevalence can be attributed to higher life expectancies. Thus, we cannot use it to highlight the problem as the death rate is also decreasing. The authors should mention the trend for incidence rate as well. Also, it is important to discuss the results by its incidence throughout the manuscript. -line 93: abbreviations needs to be defined. - There was no mention of COVID-19 in this paper, which needs to be discussed in GBD2021 results, especially in respiratory diseases. - The authors have not discussed about the policymaking and interventions. The can suggest new ones and also discuss the previous ones that led to reducing the burden of disease. Reviewer #2: The manuscript is well-written and the overall quality of the introduction and discussion is acceptable. However, some minor modifications are suggested: - The Methods section is too brief. Please provide additional details regarding the models used in the GBD analysis. - In the GBD 2021 methodology, 500 iterations were used to obtain the 95% uncertainty intervals (UI). Please correct this in the Methods section. - Please mention that LOESS regression was used to assess the association between SDI and prevalence rates, as presented in Figure 3. - It is recommended to report the prevalence and DALY numbers for 2021 in the results of the abstract, in addition to the rates already provided. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Ali Golestani ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. 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Revision 1
3 Dec 2024 Author Response Dear editor and reviewers: Thank you very much for all the nice and insightful comments, which dramatically improved the manuscript quality. We have responded to all the comments point-by-point as shown below and have made revisions in the manuscript accordingly. The revisions in the lines of the revised manuscript have been provided. Responses to journal requirements: 1. When submitting your revision, we need you to address these additional requirements. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Reply: Thanks for your comments. Thanks for your comments. I will make sure the manuscript meets PLOS ONE's style requirements, including those for file naming. 2. Thank you for stating in your Funding Statement: This study was supported by the Scientific Research Project of Fuyang City, Anhui Province (FY2020xg01). Please provide an amended statement that declares all the funding or sources of support (whether external or internal to your organization) received during this study, Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf. Reply: Thanks for your comments. We have included the amended Funding Statement within our cover letter as follows： This study was supported by the Scientific Research Project of Fuyang City, Anhui Province (FY2020xg01). There was no additional external funding received for this study. 3. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Reply: Thanks for your comments. I appreciate the reminder regarding the ORCID iD requirement for the corresponding author. I will ensure that the ORCID iD is added to the submission in Editorial Manager as per PLOS guidelines. 4. We note that Figures 4 and 5 in your submission contain map images which may be copyrighted. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. For these reasons, we cannot publish previously copyrighted maps or satellite images created using proprietary data, such as Google software (Google Maps, Street View, and Earth). Reply: Thanks for your thoughtful comments. Thank you for your questions regarding the map images in Fig 4 and 5. Please find our responses below: a) Source of Map Images: The map images in Fig 4 and 5 were created using the rnaturalearth R package, which provides access to Natural Earth map data. This data is open-source and available at https://github.com/ropensci/rnaturalearth. b) Copyright Status: To our knowledge, the map data from Natural Earth provided through the rnaturalearth package is in the public domain and therefore not subject to copyright restrictions. Natural Earth map data is widely used for world mapping and is explicitly designed for open, unrestricted use. We believe no additional copyright permission is required. Please let us know if any further clarification is required, or if additional details or documentation are needed to satisfy PLOS ONE’s requirements. Responses to Reviewer 1: 1.Abstract: The method is too brief and more details are required. The authors can check previous GBD studies to get idea for improving this section. Reply: Thanks for the reviewer's comments. We agree with the reviewer's opinion and have expanded description of our methodology in the revised manuscript (lines 34-35). 2. Abstract: There is no mention of risk factors in the aim of the study. Reply: Thanks for your thoughtful consideration. We agree with the reviewer's opinion and have added the description of risk factors to the aim of the study (lines 29-30). 3. The reason for increased prevalence can be attributed to higher life expectancies. Thus, we cannot use it to highlight the problem as the death rate is also decreasing. The authors should mention the trend for incidence rate as well. Also, it is important to discuss the results by its incidence throughout the manuscript. Reply: Thanks a lot for your professional advice. We agree with your opinion, the incidence of COPD among older adults has also increased over the past 3 decades. We have added the description of incidence (S1 and S5 Tables in File 1; and the corresponding part in Fig1-2, Fig4-5; S2, S4-5, S13 Figs) and discussed the results involving incidence throughout the revised manuscript. 4. -line 93: abbreviations needs to be defined Reply: Thanks a lot for your thoughtful consideration. We have added the abbreviations of FEV1, FVC in the revised manuscript (lines 469-470). 5. There was no mention of COVID-19 in this paper, which needs to be discussed in GBD2021 results, especially in respiratory diseases. Reply: Thanks a lot for your professional comment. The COVID-19 pandemic had a substantial impact on COPD globally, which caused a huge disruption to healthcare services, lockdowns, and reduced access to diagnostic and treatment facilities. This may lead to delays in COPD diagnoses and treatments, which in turn resulted in an increase in COPD cases during and after the pandemic. In addition, COVID-19 itself contributed to COPD-related complications, exacerbations, and mortality, either directly or indirectly, which might lead to a temporary rise in the observed burden of elderly COPD. We have added the part of COVID-19 in the discussion in the revised manuscript (lines 348-353; lines 388-391). 6. The authors have not discussed about the policymaking and interventions. The can suggest new ones and also discuss the previous ones that led to reducing the burden of disease. Reply: Thanks a lot for your professional comment. We agree with your opinion and added the policymaking and interventions in the part of the discussion. (a). In high SDI regions, where the aging population contributes to increased COPD prevalence, policies should focus on geriatric care, chronic disease management, and preventive healthcare. In low SDI regions, policies must focus on strengthening primary healthcare systems and increasing the availability of basic diagnostic tools for COPD, such as spirometers. These regional inequalities highlight the need for a multifaceted approach to COPD management in older adults (lines 373-377). (b). We acknowledged the impact of widespread tobacco control measures, environmental pollution management, enhanced access to disease-modifying treatments, and management of comorbidities in the general population. And on this basis, we emphasized that ambient ozone pollution remains a challenge for this population, especially in low and low-middle SDI regions (lines 394-398; lines 416-418). Responses to Reviewer 2: The manuscript is well-written and the overall quality of the introduction and discussion is acceptable. However, some minor modifications are suggested: 1. - The Methods section is too brief. Please provide additional details regarding the models used in the GBD analysis. Reply: Thanks a lot for your professional advice. We agree with your opinion, and we have added the description of DisMod-MR 2.1 (Prevalence and incidence estimates) and CODEm (Cause of death estimates) in the part of ‘Overview and data sources’ (lines 93-98). 2. - In the GBD 2021 methodology, 500 iterations were used to obtain the 95% uncertainty intervals (UI). Please correct this in the Methods section. Reply: Thanks a lot for your professional comment, and we have corrected it in the part of ‘Statistical analysis’ (line 137). 3. - Please mention that LOESS regression was used to assess the association between SDI and prevalence rates, as presented in Figure 3. Reply: Thanks a lot for your professional comment, and we have added the LOESS regression in the part of ‘Statistical analysis’ (lines 143-144). 4. - It is recommended to report the prevalence and DALY numbers for 2021 in the results of the abstract, in addition to the rates already provided. Reply: Thanks a lot for your professional comment, and we have added the numbers of COPD in 2021 in the abstract. We appreciate your warm work earnestly and hope that the revisions will meet the requirements. Once again, we are really grateful for the help from the editorial team and the reviewers. Hope everything is going well. Yours sincerely， Jing Xu. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0316135.r002
6 Dec 2024 Decision Letter - Aida Fallahzadeh, Editor Burden of chronic obstructive pulmonary disease in adults aged 70 years and older, 1990-2021: findings from the Global Burden of Disease Study 2021 PONE-D-24-47807R1 Dear Dr. Xu, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Aida Fallahzadeh Guest Editor PLOS ONE Additional Editor Comments (optional): Dear Dr. Xu, I hope this message finds you well. I am pleased to inform you that your manuscript titled "Burden of chronic obstructive pulmonary disease in adults aged 70 years and older, 1990-2021: findings from the Global Burden of Disease Study 2021" has been reviewed following your recent revisions. After carefully assessing your responses to the reviewers' comments and the changes made to the manuscript, I am happy to report that the reviewers are satisfied with the revisions you have provided. As a result, I will be recommending the manuscript for acceptance for publication. I would like to thank you for your hard work in addressing the reviewers' feedback, and I appreciate your prompt and thoughtful revisions. We will proceed with the final steps of the publication process and keep you updated on the next stages. Please feel free to reach out if you have any questions or need further assistance. Congratulations on reaching this stage, and I look forward to seeing your work published. Best regards, Aida Fallahzadeh Reviewers' comments: https://doi.org/10.1371/journal.pone.0316135.r003
Formally Accepted
11 Dec 2024 Acceptance Letter - Aida Fallahzadeh, Editor PONE-D-24-47807R1 PLOS ONE Dear Dr. Xu, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Aida Fallahzadeh Guest Editor PLOS ONE https://doi.org/10.1371/journal.pone.0316135.r004

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