1990年与2010年中国归因于室外空气污染的疾病负担分析

Burden of disease attributable to ambient particulate matter pollution in 1990 and 2010 in China

目的：分析比较1990年与2010年我国归因于室外空气污染的疾病负担。方法利用2010年全球疾病负担研究（GBD 2010）结果，计算人群归因分值（PAF），分析中国1990年和2010年归因于室外空气污染相关疾病死亡数、伤残调整寿命年（DALY）及其95%不确定性区间（95%UI），比较20年间我国归因于室外空气污染的疾病负担变化趋势。结果2010年，中国5岁以下儿童下呼吸道感染中有38.9%（95%UI：27.0%～49.4%）是由室外空气污染造成。25岁以上人群中，27.2%（95%UI：10.2%～37.5%）的肺癌、29.9%（95%UI：25.8%～34.2%）的冠心病、35.0%（95%UI：27.4%～41.1%）的脑卒中和21.0%（95%UI：10.7%～30.3%）的COPD归因于室外空气污染。2010年室外空气污染导致死亡123.5（95%UI：103.8～141.0）万例和DALY 2523.0（95%UI：2177.0～2860.0）万人年，分别较1990年增长33.4%（92.6万例）和4.0%（2426.0万人年）；增长最快的是肺癌，分别为154.5%（从5.5万例增长至14.0万例）和130.1%（从133.0万人年增长至306.0万人年）；其次是冠心病，分别为118.5%（从13.0万例增长至28.4万例）和86.6%（从328.0万人年增长至612.0万人年）；再次为脑卒中，分别为41.0%（从42.9万例增长至60.5万例）和33.8%（从897.0万人年增长至1200.0万人年）。1990年和2010年室外空气污染导致的死亡中，男女性均以60～79岁居多（男性分别为26.0万例和40.4万例，占53.7%和54.8%；女性分别为21.4万例和23.6万例，占48.5%和47.5%）；导致的DALY均为40～79岁居多（男性分别为845.8万人年和1346.0万人年，占62.9%和83.8%；女性分别为636.0万人年和715.2万人年，占58.9%和78.0%），男性增长快于女性。结论我国室外空气污染导致的疾病负担沉重，对死亡和残疾的影响均有加重趋势，减少室外空气污染及其健康危害势在必行。

Objective To assess the burden of disease attributable to ambient particulate matter pollution in 1990 and 2010 in China. Methods On the basis of the results of the Global Burden of Diseases Study 2010（GBD 2010） for China＆39;s estimates, we used population attributable fractions（PAF） to examine the burden of disease （mortality and disability-adjusted life years（DALY） ） attributable to ambient particulate matter pollution in 1990 and 2010 in China, with 95% uncertainty interval（95% UI） estimate, and increasing rate to explore the trends of attributed burden of disease across the study period of 20 years. Results In 2010, 38.9%（95%UI：27.0%-49.4%） of lower respiratory infections for 〈5 years children, 27.2%（95%UI：10.2%-37.5%） of lung cancer, 29.9%（95%UI：25.8%-34.2%） of ischemic heart disease, 35.0%（95%UI：27.4%-41.1%） of stroke, and 21.0%（95%UI：10.7%-30.3%） of chronic obstructive pulmonary disease（COPD） for ≥25 years adults were attributable to ambient particulate matter pollution, which accounted for 1.235（95%UI：1.038-1.410） million deaths and 25.230（95%UI：21.770-28.600） million person years DALY in total, and increased by 33.4% and 4.0%,respectively by comparison with that in 1990 （0.926 million and 24.260 million person years）. Lung cancer accounted for the largest increasing rate of 154.5%（from 0.055 million to 0.140 million） and 130.1%（from 1.330 million person years to 3.060 million person years）, followed by ischemic heart disease （118.5%, from 0.130 million to 0.284 million, and 86.6%, from 3.280 million person years to 6.120 million person years） and stroke （41.0%, from 0.429 million to 0.605 million, and 33.8%, from 8.970 million person years to 12.000 million person years）. The attributed mortality for both gender mostly occurred in age group of 60-79 years （male： 0.260 million and 0.404 million accounting for 53.7%and 54.8%;female：0.214 million and 0.236 million accounting for 48.5%and 47.5%） both in 1990 and 2010. The age group of 40-79 years accounted for the most portion of attributed DALY for both gender （male： 8.458 million person years and 13.460 million person years accounting for 62.9% and 83.8%; female： 6.360 million person years and 7.152 million person years accounting for 58.9% and 78.0%）. The increasing rates were higher for male than for female. Conclusion The burden of disease attributable to ambient particulate matter pollution was very high in China with significant increase in mortality and disability, which indicates the highly necessity for government to take actions to reduce ambient particulate matter pollution and its health hazards.