1990与2013年中国15岁以上人群归因于高BMI的死亡分析

Mortality attributable to high body mass index in Chinese people aged 15 or over, in 1990 and 2013

目的分析比较1990与2013年中国15岁以上人群归因于高BMI的死亡情况。方法利用2013年全球疾病负担研究中国研究结果，根据相关人群归因分值，分析中国15岁以上人群各省份（不包括中国台湾）的1990和2013年归因于高BMI的死亡情况，以2000- 2025年世界平均人口结构为标准，对死亡率进行标化，比较1990和2013年中国高BMI导致死亡的变化情况。结果 2013年，中国归因于高BMI的死亡例数为640294例，相对于1990年（301 231例），增长了114.27%；与1990年相比，2013年男性归因于高BMI的死亡例数和标化死亡率分别增长142.81％和30.74%，均高于女性（分别为84.69％和2.88%）；随着年龄的递增，高BMI所致死亡例数的增长率在递增，相比于1990年，2013年15-49、50-69和≥70岁人群高BMI所致死亡例数的增长率分别为63.37%、89.11％和183.64%。1990和2013年，高BMI导致死亡例数均较多的前3种疾病依次是脑卒中（分别为128 657和247042例）、缺血性心脏病（分别为57 173和156 614例）和高血压心脏病（分别为34 960和58 435例）；与1990年相比，2013年标化死亡率增长速度较快的主要疾病是慢性肾病（129.44%）、胰腺癌（101.76%）、结直肠癌（85.45%）和乳腺癌（63.86%）。1990年归因于高BMI死亡例数较多的前3个省份依次是河南（31376例）、山东（27969例）和河北（24 164例），而2013年依次是山东（61 897例）、河北（58 383例）和河南（57 501例）。与1990年相比，2013年高BMI导致的标化死亡率在26个省份出现增长，增长速度较快的是青海（56.96％）、贵州（45.30%）和云南（39.39%），在7个省份出现下降，下降速度较快的是天津（20.68%）、澳门（14.08%）和吉林（6.86%）。结论 过去20多年间，中国高BMI所致死亡的上升速度较快，男性快于女性，相关疾病中归因于慢性肾病、胰腺癌、结直肠癌和乳腺癌的死亡大幅增长，且高BMI所致标化死亡率较高的省份集中在东北和华北，而高BMI所致标化死亡率增长速度较快的省份集中在西南和西北。

Objective To analyze and compare deaths（mortality）attributable to high body mass index（BMI）in Chinese population aged ≥15 years between 1990 and 2013.Methods We used the results of the 2013 Global Burden of Disease Study for China, based on population attributable fractions（PAF）to analyze deaths attributable to high BMI in all provinces（not including Taiwan, China）in 1990 and 2013. The average world population from 2000 to 2025 was used as a reference to calculate age-standardized mortality rates, and to compare the change of attributable deaths in 1990 and 2013.Results In 2013, the number of deaths attributable to high BMI was 640 294, compared with 301 231 in 1990, an increase of 114.27%. Compared with 1990, in 2013, the number of deaths and age-standardized mortality rate attributable to high BMI showed a higher growth rate in men（142.81% and 30.74%, respectively）than women（84.69% and 2.88% , respectively）. The growth rate of attributable deaths increased with age. Compared with 1990, in 2013, the growth rates of attributable deaths among 15-49, 50-69 and ≥70 years age groups were 63.37%, 89.11% and 183.64%, respectively. In both 1990 and 2013, the top three diseases in terms of deaths attributable to high BMI were stroke（128 657 and 247 042, respectively）, ischemic heart disease（57 173 and 156 614, respectively）, and hypertensive heart disease（34 960 and 58 435, respectively）. Compared with 1990, in 2013, the standardized mortality rates of chronic kidney disease（129.44%）, pancreatic cancer（101.76%）, colorectal cancer（85.45%）and breast cancer（63.86%）showed more substantial increases. In 1990, the top three provinces with most deaths attributable to high BMI were Henan（31 376）, Shandong（27 969）and Hebei（24 164）, while in 2013 they were Shandong（61 897）, Hebei（58 383）and Henan（57 501）. Compared with 1990, in 2013, the age-standardized mortality rate attributable to high BMI increased in 26 of 33 provinces, with a faster increase in Qinghai（56.96%）, Guizhou（45.30%）and Yunnan（39.39%）. The rate declined in the other seven provinces, declining faster in Tianjin（20.68%）, Macao（14.08%）and Jilin（6.86%）.Conclusion Deaths and age-standardized mortality rates attributable to high BMI increased rapidly between 1990 and 2013, with higher increases in men than in women. Age-standardized mortality rates of chronic kidney disease, pancreatic cancer, colorectal cancer and breast cancer attributable to high BMI showed much higher growth rates than other attributed diseases. The highest BMI-attributed age-standardized mortality rates were found in northeast and northern provinces, and the fastest growth rates of BMI-attributed age-standardized mortality rates were observed in southwest and northwest provinces.