中国15~79岁城乡居民2006—2020年急性心肌梗死死亡趋势年龄-时期-队列分析

Trends in mortality from acute myocardial infarction among urban and rural residents aged 15-79 years in China from 2006 to 2020:an age-period-cohort analysis

目的了解中国15~79岁城乡居民2006—2020年急性心肌梗死(AMI)死亡趋势,为制定AMI防治策略和相关公共卫生政策提供参考依据。方法收集2007—2012年《中国卫生统计年鉴》、2013—2017年《中国卫生和计划生育统计年鉴》和2018—2021年《中国卫生健康统计年鉴》中我国15~79岁城乡居民2006—2020年的AMI死亡率相关数据,以2020年全国人口普查数据中的人口构成进行标化率的计算,采用Joinpoint回归模型分析AMI的死亡趋势,并应用年龄-时期-队列模型(APC)分析AMI死亡风险的年龄、时期和出生队列效应。结果中国15~79岁城乡居民、城市居民和农村居民AMI粗死亡率分别从2006年的43.93/10万、25.53/10万和18.40/10万上升至2020年的138.94/10万、60.29/10万和78.65/10万,标化死亡率分别从2006年的48.54/10万、22.67/10万和25.87/10万上升至2020年的91.95/10万、30.60/10万和61.35/10万,标化死亡率的平均年度变化百分比(AAPC)分别为8.94%、3.44%和5.49%(均P<0.05)。APC模型分析结果显示,从年龄效应看,中国15~19岁城乡居民、城市居民和农村居民AMI死亡风险的年龄效应均最低,分别为-2.477(95%CI=-3.413~0.894)、-2.532(95%CI=-3.741~0.901)和-2.413(95%CI=-3.362~0.790),随后不断增加,到75~79岁时城乡居民、城市居民和农村居民AMI死亡风险的年龄效应均达到最高,分别为2.433(95%CI=1.867~2.802)、2.353(95%CI=2.071~2.827)和2.587(95%CI=1.936~2.911);从时期效应看,中国城乡居民、城市居民和农村居民2006—2010年AMI死亡风险的时期效应均最低,分别为-0.497(95%CI=-0.793~-0.139)、-0.234(95%CI=-0.502~-0.119)和-0.619(95%CI=-0.913~-0.205),2016—2020年AMI死亡风险的时期效应均最高,分别为0.591(95%CI=0.074~0.629)、0.616(95%CI=0.293~0.956)和0.570(95%CI=0.119~0.897);从出生队列效应看,中国1929—1933年出生队列城乡居民、城市居民和农村居民AMI死亡风险的出生队列效应均最高,分别为1.630(95%CI=0.849~1.979)、1.713(95%CI=1.029~1.938)和1.203(95%CI=0.639~1.712),随后不断降低,到1999—2003年出生队列城乡居民、城市居民和农村居民AMI死亡风险的出生队列效应均达到最低,分别为-2.574(95%CI=-2.991~-1.249)、-2.733(95%CI=-3.370~-2.238)和-1.856(95%CI=-2.193~-0.329)。结论中国15~79岁城乡居民2006—2020年AMI死亡率呈上升趋势,其AMI死亡风险与年龄变化呈正相关,且随时期推移而增长、随队列延伸而降低。

Objective To study the trends in mortality from acute myocardial infarction(AMI)among urban and rural residents aged 15-79 years in China from 2006 to 2020,and to provide a reference for the development of AMI prevention and control strategies.Methods Data on AMI mortality for urban and rural residents aged 15-79 years in China from 2006 to 2020 were collected from the 2007-2012 China Health Statistics Yearbook,the 2013-2017 China Health and Family Planning Statistics Yearbook,and the 2018-2021 China Health Statistics Yearbook.Age-standardized mortality rates for AMI were calculated using the population composition of the 2020 Census.The Joinpoint regression model was used to analyze AMI mortality trends,and the age-period-cohort(APC)model was used to analyze the effects of age,period,and birth cohort on AMI mortality.Results From 2006 to 2020,the crude AMI mortality rate(1/100000)increased for all residents(43.93 to 138.94),urban residents(25.53 to 60.29),and rural residents(18.40 to 78.65);the age-standardized mortality rate(1/100000)also increased for all residents(48.54 to 91.95),urban residents(22.67 to 30.60),and rural residents(25.87 to 61.35),with average annual percentage changes(AAPC)of 8.94%,3.44%,and 5.49%,respectively(all P<0.05).The APC model analysis showed different effects of age,period,and birth cohort on AMI mortality trends in the total population and in subgroups as follows:(1)the age effects were lowest in the total,urban,and rural populations aged 15-19 years,with effect values(95%confidence interval[95%CI])of-2.477(-3.413-0.894),-2.532(-3.741-0.901),and-2.413(-3.362-0.790);the age effect increased continuously with increasing age and was highest in the total,urban,and rural populations aged 75-79 years,with effect values(95%CI)of 2.433(1.867-2.802),2.353(2.071-2.827),and 2.587(1.936-2.911),respectively;(2)the period effects were the lowest for the period of 2006-2010,with the effect values(95%CI)of-0.497(-0.793--0.139),-0.234(-0.502--0.119),and-0.619(-0.913--0.205)for all,urban,and rural populations and the highest for the 2016-2020 period,with the effect values(95%CI)of 0.591(0.074-0.629),0.616(0.293-0.956),and 0.570(0.119-0.897)for all,urban,and rural populations,respectively;(3)the birth cohort effects were the highest for all,urban,and rural populations born in 1929-1933,with the effect values(95%CI)of 1.630(0.849-1.979),1.713(1.029-1.938),and 1.203(0.639-1.712)and were the lowest for all,urban,and rural populations born in 1999-2003,with the effect values(95%CI)of-2.574(-2.991-1.249),-2.733(-3.370-2.238),and-1.856(-2.193-0.329),respectively.Conclusion The AMI mortality rate among urban and rural residents aged 15-79 years in China showed an increasing trend from 2006 to 2020,and the risk of AMI mortality was positively correlated with changes in age,increased with time,and decreased with successive birth cohorts during this period.