1990-2019年中国哮喘患病、疾病负担趋势及其危险因素研究

Trends in Prevalence and Burden of Asthma and Its Risk Factors in China,1990-2019

背景哮喘是最常见的慢性呼吸道疾病之一,了解其流行现状、趋势及危险因素,对采取有针对性的哮喘防控措施具有重要意义。目的本研究分析1990—2019年我国哮喘患病、疾病负担情况及其趋势,并进行哮喘危险因素的顺位分析,为我国哮喘的有效防控提供借鉴。方法本研究基于全球疾病负担数据库(GBD)2019,通过伤残调整寿命年(DALY)、早死损失寿命年(YLL)、伤残损失寿命年(YLD)和患病率分析我国1990—2019年不同性别、不同年龄的疾病负担变化趋势,并通过标化DALY率和死亡率的人群归因分值(PAF)分析哮喘危险因素的顺位变化情况。结果2019年我国哮喘年龄标化DALY率、YLL率、YLD率分别为102.81人年/10万、24.50人年/10万和78.31人年/10万,标化患病率为1974.16人年/10万,男性的哮喘年龄标化DALY率、YLL率、YLD率均高于女性,1~9岁和≥65岁组的哮喘年龄标化DALY率、YLL率、YLD率高于其他人群。1990—2019年,≥40岁人群的YLL粗率在逐渐下降,DALY粗率、YLD粗率和患病率在<65岁人群中都有所交叉,但之后呈现出逐年下降的趋势。哮喘二级危险因素的顺位为烟草使用、高BMI和职业性危害。吸烟始终居于造成哮喘疾病负担危险因素的首位,2019年高BMI上升至造成哮喘疾病负担的第二危险因素,且高BMI死亡率的PAF上升至第一位。结论1990—2019年,我国哮喘人群的人均健康损失总体呈下降趋势,1~9岁和≥65岁人群的哮喘疾病负担仍处于较高水平。男性哮喘疾病负担高于女性。哮喘相关危险因素的PAF发生了变化,职业性危害的重要性相对下降,烟草使用、高BMI的影响日益突出。哮喘防治重点可侧重于高危人群(1~9岁、≥65岁、男性、烟草使用、有职业暴露)筛查、戒烟教育、体质量控制以及职业场所监测管理。

Background Asthma is one of the most common chronic respiratory diseases.Understanding its prevalence,trend and risk factors is of great significance to take targeted preventive and control measures.Objective To analyze the prevalence,burden and trend of asthma in China from 1990 to 2019,and analyze the rank of asthma risk factors,so as to provide a basis for effective prevention and control of asthma in China.Methods Based on the Global Burden of Disease Database 2019(GBD 2019),disability-adjusted life years(DALY),years of life lost(YLL),years lived with disability(YLD)and prevalence rates were used to analyse trends in the burden of disease by gender and age in China from 1990 to 2019.Changes in asthma risk factors were analyzed by population attributable faction(PAF)of standardized DALY rate and mortality rate.Results In 2019,the age-standardized DALY rate,YLL rate and YLD rate for asthma in China was 102.81/100000,24.50/100000 and 78.31/100000,respectively,and the standardized prevalence rate was 1974.16/100000,which was higher in all males than females,and higher in the 1-9 and≥65 years old groups than the other groups.1990-2019,the crude YLL rate was gradually decreasing in the≥40 years old group,with DALY crude rates,YLD crude rates and prevalence all crossing over in the<65 years old group,but then showing a decreasing trend year on year.Secondary risk factors for asthma were ranked in order of tobacco use,high body mass index(BMI)and occupational hazards.Tobacco uses consistently ranked as the top risk factor for the burden of asthma,with high BMI rising to second place in 2019 and its PAF for mortality rising to first place.Conclusion From 1990 to 2019,there was an overall downward trend in per capita health loss in the asthma population,but the burden of asthma remained at a high level in the 1 to 9 and≥65 years age groups.The burden of asthma disease was higher in men than women.The PAF of asthma-related risk factors has changed,with a relative decline in the importance of occupational hazards and the increasingly prominent impact of tobacco use and high BMI.The focus of asthma prevention and control can be focused on screening of high-risk groups(aged 1 to 9 years,aged≥65 years,males,tobacco use,with occupational exposure),smoking cessation education,weight control,monitoring and management of occupational settings.