中国1990—2017年脑卒中及其危险因素疾病负担变化趋势分析

Change trend in disease burden of stroke and its risk factors in China,1990–2017

目的分析中国1990—2017年脑卒中及其危险因素疾病负担的变化趋势,为合理配置卫生资源和制定针对性的脑卒中防治策略提供依据。方法收集2017年全球疾病负担(GBD 2017)研究中1990、2000、2010和2017年中国脑卒中疾病负担相关数据,采用伤残损失健康寿命年(YLDs)、早死损失寿命年(YLLs)、伤残调整寿命年(DALYs)、人群归因分值(PAF)等指标对1990—2017年中国脑卒中及其危险因素疾病负担进行描述,并对比分析与全球脑卒中疾病负担的差异性。结果2017年中国脑卒中的YLD率、YLL率和DALY率均随年龄增大而升高,其中以≥70岁年龄组最高,分别为2617.2/10万、16789.4/10万、16773.4/10万;YLD率为男性(475.5/10万)低于女性(530.9/10万),YLL率和DALY率均为男性(3181.7/10万和3657.1/10万)高于女性(2060.9/10万和2591.8/10万)。1990—2017年中国脑卒中YLD率和DALY率逐渐上升,YLL率在2010年有暂时的下降,但整体仍呈上升的态势。2017年中国脑卒中的年龄标化YLD率、YLL率和DALY率分别为374.5/10万、1967.8/10万和2342.3/10万,均高于全球水平的235.0/10万、1422.2/10万和1657.2/10万。中国1990—2017年脑卒中的标化YLD率、YLL率和DALY率分别增长了30.9%、–38.8%和–33.1%,与全球脑卒中疾病负担整体变化趋势的5.9%、–34.5%、–30.7%一致。在与脑卒中有关的16种危险因素中,2017年DALYs、PAF和DALY率排名居于前5位的危险因素依次为高血压(2497.4万人年、56.4%和1768.1/10万)、钠摄入过多(1706.0万人年、38.5%和1207.8/10万)、水果摄入不足(1071.7万人年、24.2%和758.7/10万)、谷类摄入不足(1069.0万人年、24.1%和756.8/10万)、吸烟(1003.7万人年、22.7%和710.6/10万)。1990—2017年脑卒中危险因素PAF上升的有10种,下降的有6种,其中高体质指数的PAF上升幅度最大(90.0%),室内空气污染的PAF下降幅度最大(–71.3%)。结论脑卒中所致伤残负担逐渐增加,所致早死负担虽得到了有效控制,但仍是疾病负担的主要来源;应在危险因素层面制定有针对性的预防和控制策略,通过做好脑卒中的一级预防来减轻脑卒中的疾病负担。

Objective To analyze change trend in disease burden of stroke and its risk factors in China from 1990 through2017 and to provide evidences for rational allocation of health resources and the development of targeted stroke prevention and treatment strategies. Methods Data on disease burden of stroke during the period from 1990 through 2017 in China were extracted from the Global Burden of Disease(GBD) Study of 1990, 2000, 2010 and 2017. Years lived with disability(YLDs), years of life lost(YLLs), disability adjusted life years(DALYs) were used to evaluate the disease burden of stroke and population attributable fraction(PAF) was adopted to analyze risk factors of stroke-related disease burden. Disparities in disease burden of stroke between China and the world were compared. Results During the period of 1990 – 2017 in China,the YLLs rate and DALYs rate of stroke increased gradually;the YLLs rate also increased generally but with a temporary decline in 2010. In 2017 in China, the age-specific YLDs, YLLs, and DALYs rate of stroke increased with the increment of age and the highest rates were observed among the population aged ≥ 70 years(2 617.2/100 000 for YLDs, 16 789.4/100 000 for YLLs, and 16 773.4/100 000 for DALYs);the YLDs rate was lower for the males than that for the females(475.5/100 000 vs. 530.9/100 000) but the YLLs and DALYs rate were higher for the males than those for the females(3 181.7/100 000 vs. 2 060.9/100 000 and 3 657.1/100 000 vs. 2 591.8/100 000);the age-standardized YLDs, YLLs, and DALYs rate of stroke were higher than those in the world(374.5/100 000 vs. 235.0/100 000, 1 967.8/100 000 vs. 1 422.2/100 000, and 2 342.3/100 000 vs. 1 657.2/100 000). Compared to those in 1990 in China, the age-standardized YLDs rate of stroke increased by 30.9%;while, the age-standardized YLLs rate and DALYs rate decreased by 38.8% and 33.1%;the change trend of the three rates were consistent with the changes in global stroke burden(5.9% for YLDs, = – 34.5%for YLLs, and – 30.7% for DALYs). Among the 16 risk factors associated with DALYs(million person-years), PAF, and DALYs rate of stroke, the top five were hypertension(24.974, 56.4%, and 1 768.1/100 000), excessive sodium intake(17. 060, 38.5%, and 1 207.8/100 000), insufficient fruit intake(10.717, 24.2%, and 758.7/100 000), insufficient cereal intake(10.690, 24.1%, and 756.8/100 000), and smoking(10.037, 22.7%, and 710.6/100 000) for the population in China in 2017;from 1990 to 2017, PAF for the 10 of the 16 stroke risk factors increased and the other 6 decreased, with the highest increase(90.0%) for high body mass index and the greatest decrease( – 71.3%) for indoor air pollution. Conclusion In China, the disability caused by stroke is increasing gradually and although being effectively controlled, stroke-related premature death is still the main contribution of disease burden. Primary prevention strategies should be promoted to alleviate the disease burden of stroke.