1990—2019年中国缺血性脑卒中疾病负担变化分析

Changes in the disease burden of ischemic stroke in China from 1990 to 2019

目的系统评价中国人群缺血性脑卒中流行趋势及其疾病负担,为制定合理的防治措施和进行卫生资源配置提供依据。方法利用全球疾病负担(GBD)数据,对1990—2019年中国缺血性脑卒中的发病率、死亡率、伤残调整寿命年(DALY)及其标化率进行分析,并按不同性别和年龄组对中国缺血性脑卒中疾病负担的变化进行评估。同时构建Joinpoint回归模型用于分析研究期间各阶段的时间变化趋势特征。结果相对于1990年,2019年中国缺血性脑卒中的发病率、死亡率和DALY率分别上升171.68%、125.60%和98.60%,其中男性发病率、死亡率和DALY率分别上升184.29%、148.96%和115.16%;女性发病率、死亡率和DALY率分别上升160.9%、101.32%和81.44%。年龄标准化发病率上升34.70%,而年龄标准化死亡率和年龄标准化DALY率分别下降3.33%和4.02%,其中男性年龄标准化发病率、年龄标准化死亡率和年龄标准化DALY率分别上升39.52%、8.03%和3.68%;女性年龄标准化发病率上升31.40%,而年龄标准化死亡率和年龄标准化DALY率分别下降14.02%和11.53%。2019年因缺血性脑卒中所致死亡率和DALY率均随年龄增长而上升,其中85岁以上人群最高,在60岁以上人群中男性明显高于女性;2019年因缺血性脑卒中所致发病率随着年龄的增长而增加,在55~84岁人群中,女性的发病率高于男性,而在≥85岁人群中,女性发病率低于男性。1990—2019年因缺血性脑卒中所致的年龄标准化发病率、年龄标准化死亡率和年龄标准化DALY率的平均年度变化百分比(AAPC)分别为1.06%[95%CI(1.00%,1.11%)]、0.01%[95%CI(-0.45%,0.48%)]和-0.16%[95%CI(-0.53%,0.22%)],男性各项指标的AAPC均高于女性。结论当前我国缺血性脑卒中的年龄标准化死亡率和DALY率相对于1990年有小幅度减少,但粗死亡率、发病率和疾病负担仍然显著增加。男性各项指标的AAPC均高于女性。应结合不同性别和年龄组人群制定有效的防治措施及合理配置卫生资源,以降低中国人群缺血性脑卒中的疾病负担。

Objective To systematically review the epidemic trend and disease burden of ischemic stroke in the Chinese population and to provide references for formulating reasonable prevention and treatment measures and allocating health resources.Methods Based on Global Burden of Disease(GBD)data,we analyzed the morbidity,mortality,disability-adjusted life year(DALY)and normalized rates for ischemic stroke in China from 1990 to 2019 and evaluated the changes in the disease burden by sex and age group.Meanwhile,joinpoint regression model was constructed to analyze the time trend change in each stage during the study period.Results Compared with 1990,the incidence,mortality and DALY rate of ischemic stroke in China increased by 171.68%,125.60% and 98.60% in 2019,among which the incidence,mortality and DALY rate of males increased by 184.29%,148.96% and 115.16%,respectively;the morbidity,mortality and DALY rates of females increased by 160.9%,101.32% and 81.44%,respectively.The age-standardized incidence increased by 34.70%,while the age-standardized mortality and age-standardized DALY rate decreased by 3.33% and 4.02%,respectively;the age-standardized incidence,mortality and DALY rates of males increased by 39.52%,8.03% and 3.68%,respectively;the age-standardized incidence rate of females increased by 31.40%,while the age-standardized mortality rate and age-standardized DALY rate decreased by 14.02% and 11.53%,respectively.In 2019,both the mortality rate and DALY rate due to ischemic stroke increased with age,and the highest rate was found in the population over 85years old.Males over 60 years old were significantly than females.In the 55-84 age group,the incidence of ischemic stroke in females was higher than that in males,while in the 85 and above age group,the incidence of ischemic stroke in females was lower than that in males.The AAPC of age-standardized incidence,age-standardized mortality,and age-standardized DALY rates due to ischemic stroke from 1990 to 2019 were 1.06%(95%CI 1.00%to 1.11%),0.01%(95%CI-0.45%to0.48%)and-0.16%(95%CI-0.53%to 0.22%),respectively.All indicators of the AAPC for males were higher than those for females.Conclusion The curvent age-standardized mortality and DALY rate of ischemic stroke in China have decreased slightly compared with 1990.The crude mortality,morbidity and disease burden have significantly increased.All indicators of the AAPC for males were higher than those for females.To reduce the epidemic trend and disease burden of ischemic stroke,reasonable prevention and treatment measures and rational allocation of health resources should be made according to sex and age.