基于全球视角的中国丙型肝炎所致肝硬化疾病负担及变化趋势分析

Burden of cirrhosis due to hepatitis C in China based on a global perspective and changing trends

目的分析中国1990—2019年丙型肝炎(丙肝)所致肝硬化疾病负担及其变化趋势,为合理配置卫生资源和制定针对性的丙肝所致肝硬化防治策略提供依据。方法收集2019年全球疾病负担(GBD2019)中1990—2019年中国丙肝所致肝硬化相关数据,利用发病率、患病率、死亡率等指标,采用R软件ggplot2包与全球各级社会人口学指数(SDI)地区平均水平进行比较,使其结果可视化,分析丙肝所致肝硬化危险因素的变化情况。结果1990—2019年间,我国丙肝所致肝硬化发病率呈上升趋势,患病率呈先下降后上升趋势,死亡率呈下降趋势,随着年龄的增加,死亡率与患病率逐渐上升。中国男性及50岁以上年龄组人群面临疾病负担较严重。与全球不同SDI等级地区相比,自1996年后,中国伤残损失寿命年(YLDs)、早死损失寿命年(YLLs)、伤残调整寿命年(DALYs)均处于最低水平。饮酒和药物滥用是导致我国丙肝引起的肝硬化的主要行为危险因素。结论丙肝所致肝硬化造成的伤残负担增大,尽管其所致的过早死亡得到了有效的控制,但仍为疾病负担的主要来源。加强对丙肝的预防和控制,减少饮酒和药物滥用两种行为危险因素是防治工作的优先措施。

Objective To analyze the disease burden of hepatitis C-induced cirrhosis and its changing trend in China from 1990 to 2019,and to provide a basis for rational allocation of health resources and formulation of targeted prevention and treatment strategies for hepatitis C-induced cirrhosis.Methods The relevant data of hepatitis C-induced cirrhosis in China from 1990 to 2019 in the global burden of disease(GBD2019)were collected,and the R-software ggplot2 package was used to compare with the national and regional averages of the socio-demographic index(SDI)at all levels of the world by using the incidence,prevalence and mortality,so as to visualize the results and analyze the changes of risk factors for hepatitis C-induced cirrhosis.Results Between 1990 and 2019,the incidence of hepatitis C-induced cirrhosis in China showed an increasing trend,the prevalence showed a decreasing trend followed by an increasing trend,and the mortality rate showed a decreasing trend,and the mortality rate and prevalence rate gradually increased with increasing age.Chinese men and people in the age group above 50 years face a more serious disease burden.Compared with global regions with different SDI classes,China has the lowest disability adjusted life years(DALY)rate,years lived with disability(YLD)rate,and years of life lost(YLL)rate since 1996.Alcohol consumption and drug use were the main behavioral risk factors for hepatitis C-induced cirrhosis in China.Conclusion The burden of disability due to hepatitis C-induced cirrhosis has increased and remains a major source of disease burden despite the effective control of premature death due to it.Strengthening the prevention and control of hepatitis C and reducing both behavioral risk factors of alcohol and drug use are priority measures for prevention and control.