1990-2019年浙江省脑卒中疾病负担和危险因素变化趋势研究

Disease burden of stroke and related risk factors in Zhejiang,1990-2019

目的分析1990—2019年浙江省脑卒中疾病负担和危险因素变化趋势,为全省脑卒中防控工作提供基础依据。方法利用2019年全球疾病负担(GBD 2019)数据,采用伤残损失健康寿命年(YLDs)、早死损失寿命年(YLLs)和伤残调整寿命年(DALYs)等指标,描述和分析1990—2019年浙江省脑卒中疾病负担和主要危险因素变化趋势,同时与全国、世界不同社会人口学指数(SDI)地区进行比较。结果1990—2019年,浙江省脑卒中YLL率和DALY率总体呈现下降趋势,YLD率稳定上升,变化率分别为-17.4%、-9.6%和78.3%。2019年,浙江省脑卒中所致YLL率、YLD率和DALY率分别为1570.8/10万、301.7/10万、1872.5/10万,其中,≥70岁组最高,15~49岁组最低。2019年男性YLL率和DALY率明显高于女性,YLD率与女性持平。脑卒中发病类型以出血性脑卒中为主,逐步转变为缺血性脑卒中。脑卒中疾病负担的横向比较发现,浙江省脑卒中疾病负担处于相对较低水平(YLL标化率和DALY标化率仅高于高SDI地区标化疾病负担指标)。2019年脑卒中主要危险因素为高血压、室外空气污染、高盐饮食、吸烟和高血糖,相比1990年,行为危险因素和环境危险因素的影响程度有所提升。结论浙江省脑卒中疾病负担总体呈现下降趋势,且优于全球大多数地区,但也存在高年龄组、男性疾病负担较重等问题。应继续强化脑卒中防治策略,根据现阶段脑卒中疾病负担特点,制定差异化和精细化防治措施,进一步降低浙江省脑卒中疾病负担。

Objective To analyze the trend of stroke disease burden and its major risk factors in Zhejiang province from1990 to 2019 and provide evidence for the prevention and control of stroke.Methods By using 2019 Global Burden of Disease(GBD)data,the years lived with disability(YLDs),years of life lost(YLLs)and disability adjusted life years(DALYs)of stroke were calculated to describe the disease burden of stroke in Zhejiang from 1990 to 2019,and the changing trend of the disease burden and major risk factors of stroke were analyzed.Meanwhile,the findings were compared with other areas in China and other regions in the world with different Socio-Demographic Index(SDI).Results From 1990 to 2019,the YLL rate and DALY rate of stroke in Zhejiang showed decreasing trends and the rate of change was-17.4%and-9.6%.However,the YLD rate increased by 78.3%steadily.In 2019,the YLL rate,YLD rate and DALY rate of stroke in Zhejiang were 1570.8 per 100000,301.7 per 100000 and 1872.5 per 100000 respectively,which were highest in age group≥70 years and lowest in age group 15-49 years.In 2019,the YLL rate and DALY rate were significantly higher in men than in women,but men and women had same YLD rate.The type of stroke had gradually shifted from ischemic stroke to hemorrhagic stroke.Compared with other areas in China and other regions in the world with different SDI,the disease burden of stroke in Zhejiang was at a relatively low level[the age-standardized YLL rate and age-standardized DALY rate of stroke were only higher than those in areas(regions)with high SDI].In 2019,the main risk factors for stroke were hypertension,ambient particulate matter pollution,diet high in sodium,smoking and hyperglycemia.Compared with 1990,the influence of behavioral and environmental risk factors increased.Conclusion The disease burden of stroke in Zhejiang generally showed a downward trend,the situation was better than that in most regions of the world.The disease burden in age group 70 years and men were still serious.More efforts are needed for the prevention and control of stroke.Differentiated and precise methods need to be taken to further reduce the disease burden of stroke in Zhejiang.