中国居民1990 — 2019年心血管疾病和慢性呼吸系统疾病负担变化趋势及预测分析

盛百合; 张馨予; 杨洪喜; 王耀刚

doi:10.11847/zgggws1142436

中国居民1990 — 2019年心血管疾病和慢性呼吸系统疾病负担变化趋势及预测分析

Change trends and prediction of the burden of cardiovascular and chronic respiratory diseases in Chinese residents from 1990 to 2019

摘要

摘要:
目的分析中国居民1990 — 2019年心血管疾病（CVD）和慢性呼吸系统疾病（CRD）疾病负担变化趋势并对2020 — 2030年CVD及CRD的发病率、死亡率和伤残调整寿命年（DALY）率进行预测，为制定我国CVD和CRD的防治策略提供参考依据。
方法收集2019年全球疾病负担（GBD 2019）研究中1990 — 2019年中国居民CVD和CRD疾病负担的相关数据，采用发病数、发病率、标化发病率、死亡数、死亡率、标化死亡率、DALY、DALY率和标化DALY率等指标进行描述性分析，采用Joinpoint回归模型分析中国居民1990 — 2019年CVD和CRD疾病负担的变化趋势，并应用灰色预测模型预测中国居民2020 — 2030年CVD和CRD的发病率、死亡率和DALY率。
结果中国居民1990 — 2019年CVD发病数、发病率、标化发病率、死亡数、死亡率、DALY和DALY率分别从1990年的530.07万例、447.81/10万、646.20/10万、242.40万例、204.78/10万、6026.16万人年和5091.03/10万上升至2019年的1234.11万例、867.65/10万、652.21/10万、458.43万例、322.30/10万、9193.31万人年和6463.47/10万，总变化率分别为132.82%、93.75%、0.93%、89.12%、57.39%、52.56%和26.96%；CVD标化死亡率和标化DALY率分别从1990年的381.21/10万和7412.81/10万下降至2019年的276.94/10万和4938.38/10万，总变化率分别为 – 27.35%和 – 33.38%。中国居民1990 — 2019年CRD发病数和发病率分别从1990年的858.08万例和724.92/10万上升至2019年的1190.75万例和837.17/10万，总变化率分别为38.77%和15.48%；CRD标化发病率、死亡数、死亡率、标化死亡率、DALY、DALY率和标化DALY率分别从1990年的863.43/10万、130.10万例、109.93/10万、226.43/10万、2899.21万人年、2449.31/10万和3910.13/10万下降至2019年的767.50/10万、108.53万例、76.30/10万、67.98/10万、2252.05万人年、1583.33/10万和1269.95/10万，总变化率分别为 – 11.11%、 – 16.58%、 – 30.59%、 – 69.98%、 – 22.32%、 – 35.36%和 – 67.52%。Joinpoint回归模型分析结果显示，中国居民1990 — 2019年CVD标化发病率总体呈上升趋势（AAPC = 0.03%，P < 0.05），CVD标化死亡率、标化DALY率以及CRD标化发病率、标化死亡率、标化DALY率总体均呈下降趋势（均P < 0.05）。中国居民2020 — 2030年CVD预测发病率为886.94/10万～1151.61/10万，预测死亡率为329.00/10万～392.92/10万，预测DALY率为6525.22/10万～7260.53/10万，2020 — 2030年CVD预测发病率、预测死亡率和预测DALY率均持续上升（均P = 1.00）；中国居民2020 — 2030年CRD预测发病率为824.71/10万～971.00/10万，预测死亡率为55.68/10万～68.42/10万，预测DALY率为1145.20/10万～1420.31/10万，2020 — 2030年CRD预测发病率持续上升、预测死亡率和预测DALY率均持续下降（P = 0.85、1.00和1.00）。
结论中国居民1990 — 2019年CVD标化发病率总体呈上升趋势，而CVD标化死亡率、标化DALY率以及CRD标化发病率、标化死亡率、标化DALY率总体均呈下降趋势；2020 — 2030年CVD预测发病率、预测死亡率、预测DALY率和CRD预测发病率均持续上升，而CRD预测死亡率和预测DALY率均持续下降。

Abstract:
Objective To analyze the change in the disease burden of cardiovascular disease (CVD) and chronic respiratory disease (CRD) among Chinese residents from 1990 to 2019, and to predict the incidence rate, mortality rate, and disability-adjusted life year (DALY) rate of CVD and CRD from 2020 to 2030, so as to provide a reference for formulating the prevention and control strategies of CVD and CRD in China.
Methods From the Global Burden of Disease 2019 (GBD 2019) study, we collected relevant data on the burden of CVD and CRD among Chinese residents from 1990 to 2019. Descriptive analysis was performed using the following indicators: incident cases (in million), incidence rate (1/100 000), standardized incidence rate (1/100 000), number of deaths (in million), mortality rate (1/100 000), standardized mortality rate (1/100 000), DALY (person-years), DALY rate (1/100 000), and standardized DALY rate (1/100 000). The Joinpoint regression model was used to analyze the changes in the disease burden of CVD and CRD among Chinese residents during the period, and the gray prediction model was used to predict the incidence rate, mortality rate, and DALY rate of CVD and CRD among Chinese residents from 2020 to 2030.
Results Comparison between 1990 and 2019 showed an increase in the number of CVD incident cases (5.3007 vs. 12.3411), incidence rate (447.81 vs. 867.65), standardized incidence rate (646.20 vs. 652.21), number of deaths (2.4240 vs. 4.5843), mortality rate (204. 78 vs. 322.30), DALYs (6026.16 × 10⁴ vs. 9193.31 × 10⁴), and DALY rate (5 091.03 vs. 6463.47) among Chinese residents, with overall percentage changes of 132.82%, 93.75%, 0.93%, 89.12%, 57.39%, 52.56%, and 26.96%, respectively, but the decreases in CVD standardized mortality rate (381.21 vs. 276.94) and standardized DALY rate (7 412.81 vs. 4 938.38), with overall percentage changes of – 27.35% and – 33.38%, respectively. The number of CRD incident cases and the incidence rate increased from 8.5808 and 724.92 in 1990 to 11.9075 and 837.17 in 2019, with the overall percentage changes of 38.77% and 15.48%; while there were decreases in standardized incidence rate (863.43 vs. 767.50), number of deaths (1.3010 vs. 1.0853), mortality rate (109.93 vs. 76.30), standardized mortality rate (226.43 vs. 67.98), DALYs (2 899.21 × 10⁴ vs. 2 252.05 × 10⁴), DALY rate (2 449.31 vs. 1 583.33), and standardized DALY rate (3 910.13 vs. 1 269.95) of CRD during the period, with the total percentage changes of – 11.11%, – 16.58%, – 30.59%, – 69.98%, – 22.32%, – 35.36%, and – 67.52%, respectively. The Joinpoint regression model showed an increasing trend in the overall standardized incidence rate of CVD among Chinese residents from 1990 to 2019 (average annual percentage change AAPC = 0.03%, P < 0.05), while the standardized mortality rate and standardized DALY rate of CVD and the standardized incidence rate, standardized mortality rate, and standardized DALY rate of CRD all showed a decreasing trend (all P < 0.05). The predicted CVD incidence rate of Chinese residents in 2020 – 2030 is 886.94 – 1 151.61, the predicted mortality rate is 329.00 – 392.92, and the predicted DALY rate is 6 525.22 – 7 260.53. The predicted CVD incidence rate, mortality rate, and DALY rate in 2020 – 2030 continue to increase (all P = 1.00); the predicted CRD incidence rate of Chinese residents in 2020 – 2030 will be 824.71 – 971.00, the predicted mortality rate will be 55.68 – 68.42, and the predicted DALY rate will be 1 145.20 – 1 420.31. The predicted CRD incidence rate will continue to increase, the predicted mortality rate and the predicted DALY rate will continue to decrease (P = 0.85, 1.00 and 1.00).
Conclusion From 1990 to 2019, the standardized CVD incidence rate of Chinese residents showed an overall increasing trend, while the standardized CVD mortality rate, standardized DALY rate, and CRD standardized incidence rate, standardized mortality rate, and standardized DALY rate showed an overall decreasing trend; from 2020 to 2030, the predicted CVD incidence rate, mortality rate, DALY rate, and predicted CRD incidence rate all continued to increase, while the predicted CRD mortality rate and DALY rate both continued to decrease.

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