1990-2019年中国归因于烟草暴露的缺血性脑卒中疾病负担及其变化趋势分析

Burden and Temporal Trends of Ischemic Stroke Attributed to Tobacco Exposure From 1990 to 2019 in China

目的:分析1990~2019年中国归因于烟草暴露(包括主动吸烟和被动吸烟)的缺血性脑卒中疾病负担及其变化趋势,为缺血性脑卒中的精准防控提供参考。方法:基于2019年全球疾病负担研究数据库,分析1990~2019年中国不同年龄和性别人群中归因于烟草暴露的缺血性脑卒中疾病负担及其变化趋势,并比较归因于主动吸烟与被动吸烟的缺血性脑卒中疾病负担的流行病学差异。结果:1990~2019年,中国及全球归因于烟草暴露的缺血性脑卒中疾病负担呈下降趋势,但中国的下降幅度较小。2019年,中国归因于烟草暴露的缺血性脑卒中年龄标准化死亡率(ASMR)和年龄标准化伤残调整生命年率(ASDR)分别为10.64/10万和239.39/10万,均高于全球平均水平(分别为5.85/10万和140.23/10万)。与1990年相比,2019年中国归因于烟草暴露的缺血性脑卒中实际死亡率和伤残调整生命年(DALY)率分别增加103.79%和90.48%。主动吸烟和被动吸烟导致的缺血性脑卒中疾病负担存在性别差异。在男性中,主动吸烟导致的缺血性脑卒中死亡人数、死亡率、DALY、DALY率均显著高于女性;相反,女性中被动吸烟导致的缺血性脑卒中疾病负担更重。在年龄层面,在≥70岁人群中,主动吸烟和被动吸烟导致的缺血性脑卒中均呈现最高的死亡人数、死亡率和DALY率;归因于主动吸烟的缺血性脑卒中DALY主要集中在50~69岁人群,归因于被动吸烟的缺血性脑卒中DALY则主要集中在≥70岁人群。结论:中国归因于烟草暴露的缺血性脑卒中疾病负担较重,高于全球平均水平。主动吸烟和被动吸烟导致的缺血性脑卒中疾病负担在不同性别和年龄人群中存在显著差异,应制定更有针对性的控烟政策。

Objectives:To analyze and compare the disease burden of ischemic stroke due to tobacco exposure(including active and passive smoking)and its changing trends in China from 1990 to 2019,and to provide a reference for precise prevention and control of ischemic stroke.Methods:Based on the Global Burden of Disease Study 2019 database,we analyzed the burden of ischemic stroke disease attributable to tobacco exposure and its trends in different age and sex populations in China from 1990 to 2019,and compared the epidemiological differences in the burden of ischemic stroke disease attributable to active versus passive smoking.Results:Between 1990 and 2019,the disease burden of ischemic stroke attributable to tobacco exposure showed a decreasing trend in China and globally,but the decrease was relatively small in China.In 2019,the age-standardized mortality rate(ASMR)and age-standardized disability-adjusted life-year rate(ASDR)of ischemic stroke attributable to tobacco exposure in China were 10.64/100000 and 239.39/100000,both higher than the global average levels(5.85/100000 and 140.23/100000 respectively).The actual mortality and disability-adjusted life year(DALY)rates for ischemic stroke due to tobacco exposure in 2019 increased by 103.79%and 90.48%,respectively,compared with 1990.There was a sex difference in the disease burden of ischemic stroke due to active and passive smoking,with the number of deaths,mortality,DALY,and DALY rates for ischemic stroke due to active smoking being significantly higher in men than in women.Conversely,the burden of ischemic stroke due to passive smoking was higher in women.At the age level,ischemic stroke attributable to both active and passive smoking presented the highest number of deaths,mortality,and DALY rates among those≥70 years of age.Whereas DALY for ischemic stroke attributable to active smoking was mainly concentrated in those aged 50-69 years,DALY for ischemic stroke attributable to passive smoking was mainly concentrated in those aged≥70 years.Conclusions:The disease burden of ischemic stroke attributable to tobacco exposure is higher in China than the global average level.The burden of ischemic stroke disease attributable to active and passive smoking varies significantly by sex and age,and more targeted tobacco control policies should be developed in China.