1990至2021年全球中年人群缺血性脑卒中发病趋势及年龄-时期-队列模型分析

Incidence trend and age-period-cohort model analysis of ischemic strokes in the global middle-aged population from 1990 to 2021

目的分析1990至2021年全球中年人群缺血性脑卒中发病趋势并进一步探究年龄、时期和队列三因素对缺血性脑卒中发病率的影响,为全球中年缺血性脑卒中患者的预防提供参考。方法从2021年全球疾病负担数据库中提取全球中年人群(40~64岁)缺血性脑卒中发病人数、粗发病率、标化发病率等数据。运用Joinpoint回归模型分析1990至2021年这32年缺血性脑卒中的标化发病率趋势,通过年度变化百分比(annual percentage change,APC)与平均年度变化百分比(average annual percentage change,AAPC)2个指标进行评估。同时,通过年龄-时期-队列(age-period-cohort)模型分析年龄效应、时期效应及队列效应对全球中年脑卒中发病率的影响。结果1990至2021年,全球中年人群缺血性脑卒中的发病数从1340634例升至2326850例,升幅73.56%;粗发病率从124.47/10万降至109.0110万,降幅84.21%;标化发病率从125.71/10万降至107.49/10万,降幅14.49%。Joinpoint回归模型分析显示,1990至2021年全球中年人群缺血性脑卒中全人群、男性和女性标化发病率均呈下降趋势。其中全人群组在1995年、2000年、2005年、2015年和2019年出现拐点,AAPC值为-0.51%,差异具有统计学意义(P<0.01)。1990至2021年全球中年人群缺血性脑卒中净漂移值(95%CI)为-0.52%(-0.55%,-0.49%)。全球40-64岁人群缺血性脑卒中发病率局部漂移值均<0,并且随着年龄增长而降低,在60-64岁达到最低值-0.81%。结论通过分析2021年全球疾病负担数据库数据,我们首次对1990至2021年全球中年人群缺血性脑卒中发病的负担进行报道。中年人群缺血性脑卒中发病人数逐年增加,疾病负担形势严峻。尤其在男性人群中发病率上升明显,因此需要对不同性别制定针对性的预防措施以降低缺血性卒中疾病负担。

Objective To analyze the incidence trend of ischemic stroke among the global middle-aged population from 1990 to 2021,and further investigate the influences of age,period,and cohort on ischemic stroke incidence,which can provide valuable insights for the prevention of ischemic stroke in middle-aged individuals worldwide.Methods Incidence rates,crude incidence rates,and standardized incidence rates of ischemic strokes were extracted from the Global Burden of Disease Database 2021 for individuals aged 40-64 years.The Joinpoint regression model was employed to assess trends in standardized incidence over a span of 32 years(1990-2021).Annual percentage change(APC)and average annual percentage change(AAPC)were utilized for result evaluation.Additionally,an age-period-cohort model was applied to analyze the effects of age,period,and cohort on global incidences of strokes among middle-aged populations.Results From 1990 to 2021,the incidence number of ischemic strokes in middle-aged people increased from 1,340,634 cases to 2,326,850 cases,with an increase rate of 73.56%.The crude incidence rate decreased from 124.47 per 100,000 to 109.01 per 100,000,a reduction of 84.21%,and the standardized incidence rate decreased from 125.71 per 100,000 to 107.49 per 100,000,a reduction of 14.49%.Joinpoint regression model analysis showed that within the overall population,male and female standardized incidence had a decreasing trend.The segment point of the overall group occurred in 1995,2000,2005,2015 and 2019,and the AAPC value was-0.51%(P<0.01).The global net drift(95%CI)was-0.52%(-0.55%,-0.49%)and all the local drift values were all below zero,and it decreased with the increase of age,reaching the lowest value of-0.81%at the age of 60-64 years segment.Conclusions Through the analysis of the data from the Global Burden of Disease Database 2021,a comprehensive assessment of the global burden of ischemic strokes among middle-aged individuals from 1990 to 2021 is made for the first time.The incidence of ischemic strokes in this demographic group has been rising annually,indicating a significant disease burden.Notably,there is a marked increase in incidence within the male population,underscoring the necessity for gender-specific preventive strategies to mitigate the impact of ischemic strokes.