危险因素控制场景下2030年中国糖尿病疾病负担预测研究

Forecasting the burden of disease from diabetes under the scenarios of specific risk factors control in China in 2030

目的估算2030年我国糖尿病的死亡情况和过早死亡概率,评估控制相关危险因素对糖尿病未来死亡率、年龄标化死亡率和过早死亡概率的影响。方法根据WHO及我国政府规划文件筛选糖尿病相关危险因素控制目标,设置多种危险因素控制场景。基于比较风险评估理论,利用2015年全球疾病负担研究结果,采用比例变化模型预测不同危险因素控制场景下2030年糖尿病的死亡水平和过早死亡概率。结果如危险因素暴露水平按1990-2015年变化趋势发展,2030年我国糖尿病的死亡率、年龄标化死亡率和过早死亡概率将分别上升至32.57/10万、17.32/10万和0.84%。在此期间,男性糖尿病的死亡率、年龄标化死亡率和过早死亡概率始终高于女性。若这些危险因素暴露水平均达到控制目标,相比于自然趋势场景,2030年我国糖尿病死亡数将减少62.10%,过早死亡概率将降至0.29%。如果2030年仅控制单个危险因素暴露水平,高FPG控制对于糖尿病死亡的影响最大,将比自然趋势场景减少56.00%的死亡数。其次是高BMI(4.92%)、吸烟(0.65%)和身体活动不足(0.53%)。结论危险因素控制对降低糖尿病的死亡水平和过早死亡概率有重要作用。建议进一步针对重点人群和地区居民的相关危险因素开展综合性措施,以期达到降低糖尿病疾病负担的目标。

Objective To forecast mortality,age-standardized mortality,and probability of premature mortality from diabetes,and to simulate the impact of controlling risk factors by 2030 in China.Methods We simulated the burden of disease from diabetes in six scenarios according to the development goals of risk factors control by the WHO and Chinese government.Based on the theory of comparative risk assessment and the estimates of the burden of disease for China from the Global Burden of Disease Study 2015,we used the proportional change model to project the number of deaths,age-standardized mortality,and probability of premature mortality from diabetes under different scenarios of risk factors control in 2030.Results If the trends in exposures to risk factors from 1990 to 2015 continued.Mortality,age-standardized mortality,and probability of premature mortality from diabetes would increase to 32.57/100000,17.32/100000,and 0.84%by 2030,respectively.During that time,mortality,age-standardized mortality and probability of premature mortality for males would all be higher than for females.If the goals of controlling risk factors were all achieved,the number of deaths from diabetes in 2030 would decrease by 62.10%compared to the predicted numbers based on the historical trends in exposure to risk factors,and the probability of premature mortality would drop to 0.29%.If only the exposure to a single risk factor were achieved by 2030,high fasting plasma glucose control would have the greatest impact on diabetes,resulting in a 56.00%reduction in deaths compared to the predicted numbers based on the historical trends,followed by high BMI(4.92%),smoking(0.65%),and low physical activity(0.53%).Conclusions Risk factors control plays an important role in reducing the number of deaths,age-standardized mortality rate,and probability of premature mortality from diabetes.We suggest taking comprehensive measures to control relevant risk factors for certain populations and regions,to achieve the goal of reducing the burden of disease from diabetes as expected.