1990—2019年中国乙型肝炎疾病负担分析及趋势预测

An analysis of disease burden and trend forecast of hepatitis B in China from 1990 to 2019

目的了解2019年中国乙型肝炎的疾病负担情况并对2020—2030年乙型肝炎的疾病负担发展趋势进行预测。方法在2019全球疾病负担研究数据库(Global Burden of Disease 2019,GBD 2019)中下载中国乙型肝炎数据。利用患病率、发病率、死亡率、伤残调整寿命年(disability-adjusted life year,DALY)、早死损失寿命年(years of life lost,YLL)、伤残损失寿命年(years lived with disability,YLD)及年龄标化率等指标描述2019年中国乙型肝炎的疾病负担情况,利用估计年百分比变化(estimated annual percentage change,EAPC)描述中国乙型肝炎疾病负担1990—2019年的变化趋势。采用R4.2.1构建贝叶斯年龄-时期-队列模型对2020—2030年中国乙型肝炎总体发病、死亡、DALY和YLD情况进行预测。结果1990—2019年中国乙型肝炎的总体疾病负担呈下降趋势,中国乙型肝炎的总体标化患病率为6566.1/10万、标化发病率为1397.3/10万、标化死亡率为8.1/10万、标化DALY率为247.7/10万、标化YLL率为241.5/10万、标化YLD率为6.2/10万,与1990年相比分别下降2.34%、2.35%、4.92%、5.15%、5.20%、2.71%。女性居民的疾病负担指标均低于同时期的男性居民。乙型肝炎的患病率在20~24岁最高,发病率在25~29岁最高,死亡率随着年龄增长而升高。根据贝叶斯模型预测,2020—2030年中国乙型肝炎发病人数约为1486.56万人,死亡人数约为11.18万人,DALY约为634.9万人年,YLD约为12.1万人年。结论尽管在1990—2019年之间中国乙型肝炎疾病负担呈下降趋势,但在2030年消除乙型肝炎病毒这一公共威胁的目标仍然面临挑战。因此,有必要扩大诊断覆盖范围、减轻患者经济负担,进一步推进健康中国建设。

Objective To understand the current state of the disease burden of hepatitis B in China 2019 and predict the trend of hepatitis B disease burden in 2020—2030.Methods The hepatitis B data of China were collected from the 2019 Global Burden of Disease Study(GBD 2019).The prevalence,incidence,deaths,disability-adjusted life years(DALY),years of life lost(YLL),years lived with disability(YLD)and age-standardized rates(ASR)were used to describe the current disease burden of hepatitis B in China 2019.The estimated annual percentage change(EAPC)was used to describe the trend of hepatitis B disease burden in China from 1990 to 2019.A Bayesian age–period–cohort(BAPC)model was constructed using R 4.2.1 to predict overall hepatitis B incidence,death,DALY and YLL in China from 2020 to 2030.Results The overall disease burden of hepatitis B in China has shown a decreasing trend from 1990 to 2019,the overall standardized prevalence of hepatitis B in China was 6566.1 per 100,000,the standardized incidence rate was 1397.3 per 100,000,the standardized death rate was 8.1 per 100,000,the standardized DALY rate was 247.7 per 100,000,the standardized YLL rate was 241.5 per 100,000 and the standardized YLD rate was 6.2 per 10,000.Those indicators have decreased by 2.34%,2.35%,4.92%,5.15%,5.20%and 2.71%respectively compared to 1990.All disease burden indicators for the female population were lower than those for the male population in the same period.The prevalence of hepatitis B is highest in the 20~24 age group,the incidence is highest in the 25~29 age group,and the death rate increases with age.The BAPC model predicts that from 2020 to 2030 the number of hepatitis B cases in China will be about 14,865,600 and the number of deaths will be about 111,800,the DALY will be about 6,349,000 person-years and the YLD will be about 121,000 person-years.Conclusion Despite a decreasing trend in the burden of hepatitis B disease in China from 1990 to 2019,there are still challenges to the goal of eliminating hepatitis B virus as a public threat by 2030.Therefore,it is necessary to extend diagnostic coverage,reduce the financial burden on patients and further promote the construction of healthy China.