1990―2019年中国脑卒中发病趋势及其年龄-时期-队列分析

Incidence trend and age-period-cohort analysis of stroke in China from 1990 to 2019

目的分析1990―2019年中国人群脑卒中发病率的变化趋势,并对其主要亚型进行年龄-时期-队列分析。方法从全球疾病负担数据库中提取中国1990―2019年全年龄段脑卒中及其亚型的发病数据,描述其粗发病率和标化发病率的变化趋势,应用年龄-时期-队列(age-period-cohort,APC)模型分析脑卒中主要亚型发病率的年龄、时期和队列效应。结果1990―2019年中国人群脑卒中标化发病率总体呈下降趋势,但缺血性脑卒中和出血性脑卒中的年龄标化发病率的长期变化趋势并不一致,且两者的年龄标化发病率明显高于蛛网膜下腔出血;出血性脑卒中发病效应系数随年龄的增大逐渐上升,0~<5岁年龄组最低(效应值-3.10),85~<90岁最高(效应值1.86),后者发病风险是前者的142.45倍。时期效应随着年份的增加呈先升后降的态势,队列效应则随着时间的推移呈下降趋势,值得注意的是近年来有小幅度回升;中国缺血性脑卒中发病效应系数随年龄的增大呈先下降后快速上升的变化趋势,20~<25岁年龄组效应最低(效应值-2.00),80~<85岁年龄组效应值最高(效应值1.86),80~<85岁年龄组的发病风险是20~<25岁的47.45倍。时期效应随着年份的增加而增加,队列效应随时间的推移呈下降趋势。结论1990―2019年中国人群脑卒中标化发病率总体呈下降趋势,其主要亚型缺血性脑卒中呈上升趋势,年龄越大发生脑卒中的可能性越大,仍需要加强对脑卒中(尤其是缺血性脑卒中)的防控工作。

Objective The study aims to analyze the changing trend of the incidence rate of stroke and its subtypes in Chinese population from 1990 to 2019,and to investigate the main subtypes by age-period-cohort(APC).Methods The data which including stroke incidence rate and its subtypes at all ages in China from 1990 to 2019 were extracted from the global burden of disease database.The changing trend of the crude and standardized incidence rates was briefly described.The APC model was further applied to analyze the age,period,and cohort effect of the incidence rate of the main stroke subtypes.Results From 1990 to 2019,the overall standardized incidence rate of stroke in Chinese population showed a downward trend.However,the long-term change trend of age-standardized incidence rate of ischemic stroke and hemorrhagic stroke was inconsistent.And the age-standardized incidence rate of ischemic stroke and hemorrhagic stroke was significantly higher than that of subarachnoid hemorrhage.The incidence effect coefficient of hemorrhagic stroke gradually increased with the increase of age,with the lowest in the 0-<5 age group(effect value-3.10)and the highest in the 85-<90 age group(effect value 1.86).The risk of the latter was 142.45 times than that of the former.The period effect increases first and then decreases with the these years.While the cohort effect decreases with the passage of time.It is worth noting that there has been a small recovery in recent years.The incidence effect coefficient of ischemic stroke in China showed a trend of first decreasing and then rapidly increasing with age.The effect coefficient of the 20-<25 age group was the lowest(effect value-2.00),and the 80-<85 age group had the highest effect value(effect value 1.86).The incidence risk of the 80-<85 age group was 47.45 times than that of the 20-<25 age group.The period effect increases with years,and the cohort effect showed a downward trend over time.Conclusions Although the overall standardized incidence rate of stroke in Chinese population from 1990 to 2019 showed a downward trend,its major subtypes of ischemic stroke showed an upward trend.The older people live get,the greater possibility of stroke they will have.It still needs to strengthen the prevention and control of stroke,especially ischemic stroke.