基于年龄-时期-队列模型的中国人群慢性肾脏病发病与死亡趋势分析

Trend analysis of chronic kidney disease incidence and mortality in Chinese population based on age-period-cohort model

目的探讨中国人群慢性肾脏病(chronic kidney disease,CKD)发病与死亡随年龄、时期、出生队列三因素的变化趋势及其流行病学特征。方法基于GHDx数据库中1990—2019年间20~<80岁中国人群CKD发病与死亡数据,运用Joinpoint软件分析发病率和死亡率的时间变化趋势。构建年龄-时期-队列模型,分析年龄、时期和出生队列对CKD发病与死亡趋势变化影响。结果Joinpoint回归分析显示,1990—2019中国CKD标化发病率(标化发病率)由1990年的146.37/10万上升至2019年的161.52/10万;人群标化死亡率(标化死亡率)由1990年的12.98/10万波动下降至2019年的11.23/10万。APC模型分析显示中国人群CKD发病死亡风险均随着年龄的增长而增加,发病风险随时期的增加而增加,死亡风险随时期的增加变化不明显,较晚出生的队列,其CKD发病与死亡风险均低于之前出生的队列。结论现阶段中国CKD发病与死亡风险的年龄效应与时期效应占据主导地位,应采取有效措施进行及时的干预,特别是加强对较早出生的年龄较大的高危人群的防护。

Objective To investigate the changing trend and epidemiological characteristics of the incidence and mortality of chronic kidney disease(CKD)with age,period and birth cohort in Chinese population.Methods Based on the data of incidence and mortality of CKD in Chinese population aged 20-80 years from 1990 to 2019 in GHDx database,joinpoint regression model was used to analyze the incidence and mortality trend of CKD.An age-period-cohort model was constructed to analyze the effects of age,period,and birth cohort on the trend of CKD incidence and mortality.Results Joinpoint regression analysis showed that the standardized incidence rate of chronic kidney disease in Chinese population increased from 146.37/100000 in 1990 to 161.52/100000 in 2019,while the standardized mortality rate decreased from 12.98/100000 in 1990 to 11.23/100000 in 2019.The APC model analysis showed that the risk of CKD incidence and death in the Chinese population increased with age,while the risk of CKD incidence increased with the increase of period.The risk of death did not change significantly with the increase of period.The cohort born later had a lower risk of CKD incidence and death compared to the cohort born earlier.Conclusion At present,the age effect and period effect of the incidence and death risk of chronic kidney disease in China are dominant.It is important to take effective measures and intervene in a timely manner,especially to strengthen the protection of older high-risk groups born earlier.