1990—2019年我国主要人体寄生虫病疾病负担变化趋势研究

Temporal trends in disease burden of major human parasitic diseases in China from 1990 to 2019

目的掌握1990—2019年我国主要人体寄生虫病疾病负担时间变化趋势,为完善寄生虫病防治策略提供参考。方法在2019全球疾病负担研究(global burden of disease study 2019,GBD 2019)数据中,提取1990—2019年我国疟疾、肠道线虫感染、血吸虫病、食源性吸虫病、囊尾蚴病和棘球蚴病等寄生虫病伤残调整寿命年(disability-adjusted life years,DALYs),对其DALYs从大到小进行排序,并描述年龄和性别分布。使用Joinpoint回归模型分析各病种DALYs平均年度变化百分比(average annual percent change,AAPC)。结果2019年我国主要人体寄生虫病DALYs由大到小依次为:食源性吸虫病(643836.42人·年)、囊尾蚴病(156853.03人·年)、血吸虫病(79764.62人·年)、肠道线虫感染(70989.73人·年)、棘球蚴病(4258.61人·年)和疟疾(264.86人·年),男性DALYs(546441.93人·年)高于女性(409525.33人·年),青壮年(14~65岁,684780.84人年)高于儿童(≤14岁,35437.38人·年)和老年(≥65岁,235749.04人·年)。1990—2019年,我国食源性吸虫病DALYs在6种寄生虫病中一直居首位,囊尾蚴病由1990年的第4位上升至2019年的第2位,肠道线虫感染则由1990年的第2位下降至2019年的第4位。1990—2019年,我国主要人体寄生虫病DALYs总体呈下降趋势,疟疾DALYs下降速度最快(AAPC=-19.6%,P=0.003),其次是肠道线虫感染(AAPC=-8.2%,P<0.001)和血吸虫病(AAPC=-3.1%,P<0.001),食源性吸虫病DALYs下降趋势较缓(AAPC=-1.0%,P<0.001),棘球蚴病DALYs下降不明显(AAPC=-0.5%,P=0.264),囊尾蚴病DALYs呈增长趋势(AAPC=0.7%,P<0.001)。结论1990—2019年,我国血吸虫病、肠道线虫感染与疟疾等重点寄生虫病疾病负担显著降低,食源性寄生虫病疾病负担较高,棘球蚴病疾病负担下降不明显,囊尾蚴病疾病负担有上升趋势。建议我国以棘球蚴病防控为重点,在继续巩固其他重点寄生虫病防治成果的同时,加强食源性寄生虫病的监测和预防。

Objective To analysize the temporal trends in the disease burden of major human parasitic diseases in China from 1990 to 2019,so as to provide the evidence for improving the parasitic disease control strategy in China.Methods The disability-adjusted life years(DALYs)of malaria,intestinal nematode infections,schistosomiasis,food-borne trematodiases,cysticercosis and echinococcosis in China from 1990 to 2019 were captured from the Global Burden of Disease Study 2019(GBD2019),and age-and gender-specific DALYs of parasitic diseases were estimated.The temporal trends in DALYs of malaria,intestinal nematode infections,schistosomiasis,food-borne trematodiases,cysticercosis and echinococcosis were evaluated in China from 1990 to 2019 using average annual percent change(AAPC)with Joinpoint regression analysis.Results The DALYs were643836.42 person-years due to food-borne trematodiases,156853.03 person-years due to cysticercosis,79764.62 person-years due to schistosomiasis,70989.73 person-years due to intestinal nematode infections,4258.61 person-years due to echinococcosis and 264.86 person-years due to malaria in China in 2019,respectively.The overall DALYs of six parasitic diseases were higher among men(546441.93 person-years)than among women(409525.33 person-years),and were greater among adults at ages of14 to 65 years(684780.84 person-years)than among children at 14 years and lower(35437.38 person-years)and the elderly at ages of 65 years and older(235749.04 person-years).During the period from 1990 to 2019,food-borne trematodiases were the leading cause of DALYs among the six parasitic diseases,and cysticercosis shifted from the fourth leading cause in 1990 to the second leading cause of DALYs in China in 2019,while intestinal nematode infections shifted from the second leading cause in1990 to the fourth leading cause of DALYs in 2019.The DALYs of major human parasitic diseases appeared an overall tendency towards a decline in China from 1990 to 2019,with the fastest drop seen in DALYs due to malaria(AAPC=-19.6%,P=0.003),followed by due to intestinal nematode infections(AAPC=-8.2%,P<0.001)and schistosomiasis(AAPC=-3.1%,P<0.001),and a slow decline was seen in the DALYs of food-borne trematodiases(AAPC=-1.0%,P<0.001),while there were no significant decrease in the DALYs of echinococcosis(AAPC=-0.5%,P=0.264)and the DALYs of cysticercosis appeared a tendency towards a rise(AAPC=0.7%,P<0.001).Conclusions The disease burden of major human parasitic diseases appeared an overall tendency towards a decline in China from 1990 to 2019,with a high disease burden seen due to food-borne parasitic diseases,no remarkable reduction seen in echinococcosis,and a tendency towards a rise seen in cysticercosis.It is recommended to focus on echinococcosis control,and continue to consolidate the control achievements of other major human parasitic diseases in China;meanwhile,the surveillance and prevention of food-borne parasitic diseases should be reinforced.