基于Joinpoint和年龄-时期-队列模型的1990-2019年中国伤寒副伤寒发病和死亡趋势分析

Trend analysis on the incidence of and mortality from typhoid and paratyphoid fever in China from 1990 to 2019 based on Joinpoint and age-period-cohort model

目的 分析中国伤寒/副伤寒发病率、死亡率随年龄、时期和出生队列的变化趋势,为制定伤寒副伤寒防控政策提供理论依据。方法 从全球疾病负担(Global Burden of Disease,GBD) 2019数据库中获取我国1990-2019年全年龄段发病率和死亡率数据。应用连接点回归(join point regression,JPR)模型进行分段时间趋势分析;应用年龄-时期-队列(age-period-cohort,APC)模型分别探讨年龄、时期及队列对伤寒副伤寒发病率、死亡率的影响。结果 JPR结果显示,1990-2019年中国伤寒副伤寒发病率、死亡率整体均呈下降趋势,年平均下降率为4.20%和4.50%。APC模型结果显示,1990-2019年中国伤寒副伤寒发病和死亡风险随年龄增长先增高后降低,并在10~<15岁年龄段达到最大值,25岁趋于平稳;时期效应表明,伤寒副伤寒发病和死亡风险随着年份推移持续降低,30年间发病风险值由1.65降至0.65,死亡风险值由1.66降至0.61;队列效应表明,发病、死亡风险随年代推移而增加,发病、死亡风险值在1990-1994年队列至2015-2019年队列分别由0.60和0.53增长至1.90和1.99。结论 中国伤寒副伤寒发病和死亡率总体呈下降趋势,发病和死亡风险随年龄增长先升高后降低,随时期推移而降低,随出生队列推移而升高。应对易感人群做好健康教育,降低我国伤寒副伤寒疾病负担。

Objective To analyze the trends of incidence and mortality of typhoid and paratyphoid fever by age,period and birth cohort in China,so as to provide evidence for the development of prevention and control policies for typhoid and paratyphoid fever.Methods The incidence and mortality data of all age groups in China from 1990 to 2019 were extracted from the Global Burden of Disease(GBD)2019 database.The joinpoint regression(JPR)model was used to analyze the segmental time trend.Age-period-cohort model(APC)was used to analyze the effects of age,period and cohort separately on the incidence and mortality of typhoid fever and paratyphoid fever.Results JPR analysis showed an overall downward trend of the incidence and mortality rates of typhoid and paratyphoid fever in China from 1990 to 2019,with an average annual reduction of 4.20%and 4.50%,respectively.APC model analysis showed that the disease/death risk of typhoid and paratyphoid fever increased first and then decreased with age in China from 1990 to 2019,reaching the maximum in the age group of 10-<15 years and leveling off after 25 years old.For period effects,the risk of typhoid and paratyphoid fever morbidity/mortality continuously decreased over the calendar years,with the risk of incident disease dropping from 1.65 to 0.65 and the risk of death from 1.66 to 0.61.For cohort effect,the risk of disease/death increased with time,with the risk of disease/death rising from 0.60 and 0.53,respectively,in the 1990-1994 birth cohort to 1.90 and 1.99,respectively,in the 2015-2019 birth cohort.Conclusions The incidence and mortality rates of typhoid fever and paratyphoid fever in China were generally decreasing.The risk of disease/death increases first and then decreases with age,decreases with calendar time,and increases with birth cohort.Health education should be conducted for susceptible population to reduce the disease burden of typhoid and paratyphoid fever in China.