1990-2019年中国和全球缺血性心脏病疾病负担变化趋势与发病预测分析

Trend and Prediction Analysis of the Changing Disease Burden of Ischemic Heart Disease in China and Worldwide from 1990 to 2019

背景缺血性心脏病是全球公认死亡率最高且最为常见的心血管疾病,致使我国居民的疾病负担不断加重。进行疾病负担的变化趋势及预测分析是医疗卫生政策关注的重要议题。目的比较分析1990—2019年中国与全球缺血性心脏病的疾病负担与风险因素,预测其变化趋势,为开展缺血性心脏病的防治工作提供依据。方法基于2019年全球疾病负担报告(GBD 2019)数据库,采用Joinpoint对数线性模型分析1990—2019年中国和全球缺血性心脏病疾病负担的变化趋势,并进行趋势检验,借助R 4.3.0进行2020—2035年中国缺血性心脏病疾病负担预测。结果1990—2019年,我国缺血性心脏病标化发病率、标化死亡率和标化伤残调整生命年(DALY)率均低于全球水平,但总体均呈上升趋势,而全球均呈下降趋势。中国及全球缺血性心脏病的高发病率、高死亡率、高DALY率多发于老年人群。2020—2035年中国缺血性心脏病疾病负担预计整体呈下降态势[发病率、死亡率、DALY率的年均增长率(AAPC)分别为-0.400、-1.167、-1.318,P<0.001],中国和全球男性人群各指标的降幅均较女性更大。结论我国缺血性心脏病防治形势严峻,男性和老年人群的疾病负担尤为沉重;由伤残所致的疾病负担较重;高收缩压、高低密度脂蛋白是重要风险因素。未来应当关注我国缺血性心脏病的疾病负担增长趋势,重点加强男性及老年人群的预防干预。

Background Ischemic heart disease is recognized as the most common cardiovascular disease with the highest mortality rate worldwide,resulting in an increasing burden of disease on our population.Conducting trend and predictive analysis of the changing burden of disease is an important topic of concern for health care policy.Objective To compare and analyze the burden of disease and risk factors of ischemic heart disease in China and globally from 1990 to 2019,to predict the trend of change,and to provide a basis for carrying out the prevention and treatment of ischemic heart disease.Methods Based on the Global Burden of Disease Study 2019(GBD 2019),the log-linear model in Joinpoint was used to analyze the changing trends of the burden of disease of ischemic heart disease in China and globally from 1990 to 2019,and trend tests were performed to predict the burden of disease of ischemic heart disease in China from 2020 to 2035 with the help of R 4.3.0.Results From 1990 to 2019,the standardized incidence rate,standardized mortality rate,and standardized DALY rate of ischemic heart disease in China were lower than the global level,but all of them showed an overall increasing trend,while all of them showed a decreasing trend globally.The high incidence,mortality,and DALY rates of ischemic heart disease in China and globally are mostly in the elderly population,and the overall burden of ischemic heart disease in China is expected to decrease from 2020 to 2035(AAPC for morbidity,mortality,and DALY rates are-0.400,-1.167,and-1.318,respectively;P<0.001),with greater decreases in all indicators in men than in women in both China and globally.Conclusion The situation of ischemic heart disease prevention and treatment in China is severe,and the disease burden is particularly heavy in the male and elderly populations;the disease burden caused by disability is high;high systolic blood pressure and high-density lipoprotein are important risk factors.In the future,we should pay attention to the increasing trend of disease burden of ischemic heart disease in China,and focus on strengthening preventive interventions in men and the elderly population.