中国儿童青少年缺铁性贫血疾病负担及健康公平性分析

Analysis on disease burden and health equity of iron-deficiency anemia among children and adolescents in China

目的分析2015年我国儿童青少年缺铁性贫血疾病负担状况及变化情况,并基于我国各省儿童青少年缺铁性贫血疾病负担指标进行健康公平性分析。方法基于"2015年全球疾病负担研究数据"集中1990年和2015年我国31个省、自治区、直辖市的儿童青少年缺铁性贫血疾病负担的相关数据资料,应用描述流行病学方法分析1990年和2015年我国31个省儿童青少年缺铁性贫血的患病率、伤残生命损失年率(YLD率)和伤残调整生命年率(DALY率)的人群、时间和地区分布情况。基于主要疾病负担指标,应用集中指数法对儿童青少年健康公平性进行分析,评价我国儿童青少年的健康公平程度。结果 2015年我国22个省的儿童青少年缺铁性贫血标化患病率高于20.00%,同时,16个省的儿童青少年缺铁性贫血标化DALY率超过800人年/10万。31个省中,疾病负担最高的省份为新疆。与1990年相比,2015年16个省的儿童青少年缺铁性贫血标化DALY率下降幅度超过10%,其中,西藏下降幅度最大,为29.94%;5个省的儿童青少年缺铁性贫血疾病负担有所增加。与5岁以下儿童相比,2015年各省5~9岁儿童和10~19岁青少年缺铁性贫血标化DALY率相对较高。2015年,我国儿童青少年缺铁性贫血患病主要集中在经济水平相对富裕的省份(集中指数为0.01880),疾病负担也集中在相对富裕的省份(集中指数为0.01830和0.01710),与1990年相比,2015年基于儿童青少年缺铁性贫血疾病负担的集中指数绝对值有所增大。针对不同地区的分析结果显示,与1990年相比,2015年东部地区和西部地区儿童青少年健康不公平程度有所增大,中部地区健康公平程度有所改善。结论 2015年我国31个省儿童青少年缺铁性贫血疾病负担分布存在差异,儿童青少年健康公平程度未得到明显改善。应持续关注儿童青少年缺铁性贫血疾病负担的发展趋势,考虑将相关指标应用到儿童青少年健康公平程度评价体系,从而改善儿童青少年健康状况。

Objective To analyze the status and changes of the burden of iron-deficiency anemia in children and adolescents in China in 2015 and conduct health equity analysis based on the burden of iron-deficiency anemia(IDA) in children and adolescents in various provinces in China.Methods Data of China on children and adolescents in 31 provinces were collected from Global Burden of Disease Study 2015(GBD 2015).Based on the method of descriptive epidemiology, we analyzed the prevalence, years lost due to disability(YLD) rate and disability-adjusted life year(DALY) rate of IDA among children and adolescents by population, time and region in China in 1990 and 2015.The concentration indexes method based on the main indicators of disease burden was used to analyze the health equity of children and adolescents and evaluate the degree of health equity of children and adolescents in China.Results In 2015,the standardized prevalence of IDA among children and adolescents in 22 provinces was higher than 20.00%.Meanwhile, the standardized DALY rate of IDA in children and adolescents in 16 provinces exceeded 800 person-year per 100,000.Among the 31 provinces, the province with the highest disease burden of IDA among children and adolescents was Xinjiang.Compared with 1990,the standardized DALY rate of IDA among children and adolescents in 16 provinces dropped by more than 10% in 2015.The standardized DALY rate of IDA among children and adolescents in Xizang dropped the most in a percentage of 29.94% among 31 provinces.However, there were 5 provinces with an increased burden of IDA among children and adolescents in 2015.Compared with children under 5 years old, the burden of IDA among children aged 5 to 9 and adolescents aged 10 to 19 was relatively higher.In 2015,the prevalence of IDA in children and adolescents in China was mainly concentrated in relatively wealthy provinces(the concentration index was 0.01880),and the disease burden was also concentrated in relatively wealthy provinces(the concentration index was 0.01830 and 0.01710).Compared to 2009,the absolute value of the concentration index based on the burden of IDA in children and adolescents has increased in 2015.The analysis results for different regions showed that compared with 1990,the gaps of inequities increased in Eastern and Western China based on health level of children and adolescents in 2015,while the health disparity among children and adolescents in Central China was reduced.Conclusion There were disparities in the distribution of the disease burden across 31 provinces of China in 2015.The health equity of children and adolescents had not been significantly improved.We should continue to pay attention to the development trend of the burden of IDA in children and adolescents and consider applying relevant indicators to the evaluation system of children and adolescents′ health equity, to improve the health of children and adolescents.