1990-2019年中国人类免疫缺陷病毒/获得性免疫缺陷综合征流行趋势及疾病负担

Trend and disease burden of human immunodeficiency virus/acquired immunodeficiency syndrome in China from 1990 to 2019

目的 分析1990-2019年中国人类免疫缺陷病毒/获得性免疫缺陷综合征(HIV/AIDS)疾病流行现状、负担及危险因素变化趋势,预测2020—2030年HIV/AIDS发病和死亡情况。方法 探讨1990—2019年中国HIV/AIDS疾病的流行现状,通过Joinpoint回归拟合其发病率和疾病负担变化趋势。采用集成嵌套拉普拉斯近似(INLA)的贝叶斯年龄-时期-队列分析(BAPC)方法预测2020-2030年HIV/AIDS发病和死亡趋势。结果 1990-2019年中国男性HIV/AIDS标化发病率、标化死亡率高于女性,15~19岁、20~24岁标化发病率总体呈增长趋势,75~79岁标化发病率变化幅度最大。1990—2019年中国HIV/AIDS标化发病率、标化伤残调整寿命年(DALYs)率均呈上升趋势,差异具有统计学意义(P均<0.001);归因于危险性行为的标化DALYs率最高。BAPC预测结果显示,2020-2030年中国男性HIV/AIDS标化死亡率呈上升趋势。结论 中国青少年HIV/AIDS发病风险持续增加,老年群体死亡风险也不容忽视;HIV/AIDS疾病负担呈上升趋势,危险性行为是首要危险因素。未来应针对重点人群采取预防和控制措施。

Objective To analyze the situation,disease burden and risk factors of human immunodeficiency virus/ac-quired immunodeficiency syndrome(HIV/AIDS)in China from 1990 to 2019 and to forecast the incidence and mortality from 2020 to 2030.Methods The situation of HIV/AIDS in China from 1990 to 2019 was explored and its temporal trend of incidence and disease burden were analyzed with Joinpoint regression.The trend of incidence and mortality from 2020 to 2030 were predicted with Bayesian age-period-cohort(BAPC)model integrated with nested Laplace approxima-tions.Results The age-standardized incidence and mortality rate of HIV/AIDS in China in males were higher than those in females.The age-standardized incidence showed an increasing trend in people aged 15 to 19 years and 20 to 24 years,and showed the largest variation in people aged 75 to 79 years.The age-standardized incidence and disability-adjusted life years(DALYs)rate of HIV/AIDS in China increased from 1990 to 2019 and there were statistically significant differ-ences(P<0.001);the age-standardized DALYs rate of HIV/AIDS attributable to unsafe sex was the highest.The BAPC predicted that the age-standardized mortality rate of HIV/AIDS in China in males would increase from 2020 to 2030.Conclusion The risk of HIV/AIDS incidence in adolescents continues to increase in China and the risk of mortality in elderly should not be ignored.The disease burden of HIV/AIDS shows an increasing trend and unsafe sex is the primary risk factor.In the future,prevention and control measures should be taken for the key population.