1990-2019年中国结核病发病趋势的年龄-时期-队列模型分析

Trend of tuberculosis incidence in China from 1990 to 2019 based on the age-period-cohort model

目的 分析1990―2019年中国结核病发病趋势并探讨年龄、时期、队列对结核病发病风险的影响。方法 收集全球健康数据交换数据库中0~<95岁中国居民结核病发病数据,采用Joinpoint回归模型分析1990―2019年中国居民结核病发病率的变化趋势,采用年龄-时期-队列模型来分析影响中国结核病发病风险的年龄效应、时期效应和队列效应。结果 1990―2019年,全国、男性、女性的结核病标化发病率均呈下降趋势,男性、女性年龄标化发病率分别从1990年的120.56/10万和99.75/10万下降至2019年的56.08/10万和30.60/10万,年平均下降速度分别为2.60%和3.98%。年龄-时期-队列模型分析结果显示,1990―2019年中国结核病发病率的年龄效应总体上随年龄的增加而增加,在90~<95岁发病风险达到最大,男性和女性的RR值分别为2.50(95%CI:2.33~2.69)和1.93(95%CI:1.76~2.12);时期效应随着时间的推移发病风险逐渐下降,发病风险RR值从1990年的[男性:1.13(95%CI:1.08~1.17);女性:1.58(95%CI:1.51~1.65)]降至2019年的[男性:0.80(95%CI:0.76~0.83);女性:0.61(95%CI:0.57~0.65)];队列效应显示,出生越晚的人发病风险越小。结论 1990―2019年中国居民结核病发病率呈现下降趋势,结核病发病风险总体上随着年龄的增加而增加,越早出生的人发病风险越高。建议重点对婴幼儿、大学生、男性、老年等群体进行结核病筛查,全国各大高校多开展结核病健康知识讲座,相关政府部门应该利用多种途径给群众宣传结核病健康知识。

Objective To analyze the trend of tuberculosis incidence in China in 1990-2019 and to explore the impact of age,period and cohort on tuberculosis risk.Methods The global health data exchange database was used to collect tuberculosis incidence data from Chinese residents aged 0-<95 years old.Joinpoint regression was used to analyze the changing trend of tuberculosis incidence in China from 1990 to 2019.The age-period-cohort model was used to analyze the age effect,period effect and cohort effect on the risk of tuberculosis in China.Results From 1990 to 2019,the standardized incidence of tuberculosis showed a downward trend in the whole population and in the subgroups of males and females.The age-standardized incidence rate decreased from 120.56/100 000 and 99.75/100 000 in 1990 to 56.08/100 000 and 30.60/100 000 in 2019,with an average annual decline rate of 2.60% and 3.98%,respectively.The results of the age-period-cohort model analysis showed that the age effect of tuberculosis incidence in China increased with age from 1990 to 2019,and reached the highest risk at the age of 90-<95 years old.The RR of males and females were 2.50(95% CI:2.33-2.69) and 1.93(95% CI:1.76-2.12),respectively.The period effect gradually decreased with the passage of time,and the RR value of incidence risk decreased from [male:1.13(95% CI:1.08-1.17);female:1.58(95% CI:1.51-1.65)] in 1990 to [male:0.80(95% CI:0.76-0.83);female:0.61(95% CI:0.57-0.65)] in 2019.The cohort effect showed that people who were born later have a lower risk of developing the disease.Conclusions The incidence of tuberculosis in China showed a downward trend from 1990 to 2019.On the whole,the risk of tuberculosis increased with the increase in age.The farther away from the contemporary period,the higher the risk of people being born earlier.It is suggested that TB screening should be focused on infants,college students,men,the elderly,and other groups.Colleges and universities across the country should carry out more lectures on TB health knowledge,and relevant government departments should use a variety of ways to publicize TB health knowledge to the public.