I had the privilege of reviewing the manuscript titled “Disease burden of COPD in the Chinese population: a systematic review” by Jianxin Xu, et al.

Comments

1) Please add in the first sentence that can be associated with an exposure.

2) In the discussion, this statement “The cost of drugs increased as a result of patients attending higher-ranked hospitals having better financial situations and being more willing to use better medications” is not clear. Please expand on the findings of Zhao and colleagues. The cost of COPD specific medications were higher between institutions? Are these outpatient medications (i.e. inhalers)?

3) In the discussion, “Career is a side effect of the patient's socioeconomic status,” is not clear. It requires rewording. The concept of “side effect” has to be revised.

4) With regards to this statement “According to research by Yu et al, the farmers group in Lanzhou had lower hospitalization costs than patients from other occupations with COPD. This may be because of their financial circumstances, as they only have one small source of income in comparison to patients from other occupations and cannot afford the high medical expenses” Can the authors comment if the expense/cost of medical care is different in the rural vs urban regions and possible this explains the differences observed by Yu and colleagues?

5) Under limitations, please mention that the diagnosis of some of the studies was not confirmed by spirometry.

6) Consider deleting the 3 limitation. The sources are already described. The evidence would not come from grey literature.

The authors have successfully addressed all my comments.