1990―2019年中国慢性肾病发病趋势及预测

Study on the trend and forecast of the incidence of chronic kidney disease in China from 1990 to 2019

目的分析1990―2019年中国慢性肾病的发病时间趋势,评估年龄、时期和队列效应,并预测2020―2034年中国慢性肾病的发病情况,为慢性肾病相关防治政策和措施提供参考依据。方法利用2019全球疾病负担研究(Global Burden of Disease Study 2019,GBD 2019)数据,应用Joinpoint回归模型分析不同性别慢性肾病发病趋势变化并计算年度变化百分比(annual percentage change,APC)与平均年度变化百分比(average annual percentage change,AAPC);借助年龄-时期-队列模型分析年龄、时期及队列因素对不同性别慢性肾病发病率的影响;采用贝叶斯年龄-时期-队列分析方法预测2020―2034年不同性别慢性肾病的发病率和发病人数。结果1990―2019年中国全人群和男、女性慢性肾病标准化发病率总体均呈上升趋势(AAPC=0.30%、0.30%、0.29%,均P<0.001),女性在1993―1996年(APC=-0.54%,P=0.073)无规律变化,女性较男性有更高的发病率,但近年男性发病率增长速度远高于女性。中国慢性肾病发病率变化受年龄、时期、队列因素影响(均P<0.001),慢性肾病发病风险总体上随年龄增加而增加,在60岁之后明显上升;在1995年之后随时期持续上升;在2005年之前随出生队列上升,在2005年之后随出生队列下降。2020―2034年中国慢性肾病标化发病率和发病人数预计呈上升趋势,且男性增长幅度高于女性。结论1990―2019年中国慢性肾病发病率和发病人数总体不断升高。建议加强对老年人以及高血压和糖尿病患者等高危人群的防护和婴幼儿的营养摄入和健康检查。

Objective To explore the current status of population mortality in different regions and study the changing trends of various causes of death,providing reliable evidence for the rational utilization of health resources.Methods Compared the rank order of death causes in the eastern,central,and western regions in 2010,2015,and 2020,compiled life expectancy tables and cause-eliminated life expectancy tables.Calculated mortality rate,standardized mortality rate,years of potential life lost rate and the seventh national population census data were used for standardization.Results The mortality rate in all regions showed a decreasing trend,and the standardized rate of mortality of western was the highest.The average annual increase in life expectancy was 0.32,0.34 and 0.31 years.Cancer,cerebrovascular disease,heart disease,respiratory disease and injury were the top five causes of death in each region.Cancer was the leading cause of death in the eastern region,while the cerebrovascular disease is the leading cause in the central region.The rate of life lost due to heart disease showed an increasing trend in all regions,with the central region recording a heart disease of 49.50%in the age group above 85 in 2020.The rate of life lost due to respiratory system decreased annually,but showed an increasing trend with age and had the greatest impact on the lifespan in the western regions.The rate of life lost due to injuries showed an increasing trend in the age group above 75 years.Conclusions Life expectancy increased gradually in all regions,but the rate of life lost due to cardiovascular diseases continued to rise,and injuries also had an increasing impact on the lifespan of the elderly.Different diseases had varying impacts on the lifespan in different regions,and disease prevention and control strategies should be tailored to different ages and regions.