1990~2021年中国、日本、韩国慢性阻塞性肺疾病负担与变化趋势分析

Analysis of the Burden and Trends of Chronic Obstructive Pulmonary Disease in China,Japan and Korea,1990-2021

目的中国慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者占全球COPD患者总数的四分之一,已造成严重的疾病经济负担。本文旨在比较中国、日本、韩国和全球COPD疾病负担情况,分析中国、日本、韩国和全球COPD的发病、患病、死亡、伤残调整寿命年(Disability-adjusted life year,DALY)情况,及其在1990~2021年相应的时间变化趋势。方法利用全球疾病负担研究2021(Global Burden of Disease Study 2021,GBD 2021)数据,采用Joinpoint(5.2.0)软件计算年度变化百分比(Annual percent change,APC)和平均年度变化百分比(Average annual percent change,AAPC),分析比较中国、日本、韩国和全球COPD疾病负担的长期趋势以及风险因素对COPD相关死亡和DALY的影响。结果与1990年相比,2021年中国、日本、韩国和全球COPD发病人数和患病人数均有增加;COPD导致的死亡增加,日本、韩国和全球DALY增加,但中国DALY数由1990年的2609.767(2279.056,2921.635)万人年下降至2021年的2364.032(1999.866,2792.193)万人年。2021年中国COPD患病率和全球接近,高于日本和韩国;中国发病率、死亡率、DALY同样高于日本和韩国。1990~2021年中国、日本和全球COPD的年龄标化率(发病率、患病率、死亡率、DALY)均持续下降;但中国年均降幅最大[发病率AAPC:-0.7361(-0.7446,-0.7278)、患病率AAPC:-0.3256(-0.3353,-0.3170)、死亡率AAPC:-3.6895(-3.7513,-3.6175)、DALY APCC:-3.6351(-3.6821,-3.5865)];韩国死亡率和DALY也呈下降趋势,但发病率[AAPC:0.0609(0.0426,0.0795)]和患病率[AAPC:0.2246(0.2020,0.2455)]却呈增长趋势。COPD相关死亡和DALY的首要风险因素是吸烟,而环境颗粒物污染是中国女性COPD死亡和DALY的主要风险因素。结论与日本、韩国相比,1990~2021年中国COPD发病率、患病率、死亡率和DALY仍较高,但年均下降幅度最大。COPD仍然是中国一个重要的公共卫生问题,而吸烟和环境颗粒物污染是导致COPD患者死亡和DALY的重要因素。未来应继续积极推动控烟工作,加强环境治理,对吸烟男性等高危人群开展肺功能检查,进行早诊早治。

Objective Chronic obstructive pulmonary disease(COPD)patients in China account for onefourth of the total number of COPD patients in the world,which has resulted in a serious economic burden of disease.The purpose of this paper is to compare the disease burden of COPD in China,Japan,South Korea,and globally,and to analyze the incidence,prevalence,death,and disability-adjusted life year(DALY)of COPD in China,Japan,South Korea,and globally,as well as the corresponding temporal trends from 1990 to 2021.Methods Using Global Burden of Disease Study 2021(GBD 2021)data,Joinpoint(5.2.0)software was used to calculate the annual percent change(APC)and average annual percent change(AAPC).Average annual percent change(APC)and Average annual percent change(AAPC)were calculated using Joinpoint(5.2.0)software to analyze and compare the longterm trends of COPD disease burden and the impact of risk factors on COPD-related mortality and DALY in China,Japan,Korea,and globally.Results Compared with 1990,the number of COPD incidence and prevalence increased in 2021 in China,Japan,Korea,and globally;deaths due to COPD increased,and DALY increased in Japan,Korea,and globally,but DALY in China decreased from 2609.767(2279.056,2921.635)million person-years in 1990 to 2364.032(1999.866,2792.193)million person-years.The prevalence of COPD in China in 2021 is close to that of the world and higher than that of Japan and South Korea;China's mortality,and DALY rates are higher than those of Japan and South Korea.Age-standardized rates of COPD(incidence,prevalence,mortality,DALY)continued to decline in China,Japan,and globally from 1990 to 2021;China had the largest average annual decline[incidence AAPC:-0.7361(-0.7446,-0.7278),prevalence AAPC:-0.3256(-0.3353,-0.3170),mortality AAPC:-3.6895(-3.7513,-3.6175),and DALY APCC:-3.6351(-3.6821,-3.5865)];Korea's mortality rate and DALY were also on a downward trend,but incidence[AAPC:0.0609(0.0426,0.0795)]and prevalence[AAPC:0.2246(0.2020,0.2455)]were increased.The primary risk factor for COPD mortality and DALY was smoking,and ambient particulate matter pollution was the main risk factor for COPD mortality and DALY in Chinese women.Conclusion Compared with Japan and South Korea,the incidence,prevalence,mortality,and DALY of COPD in China from 1990 to 2021 were still high,but with the largest average annual decrease.COPD is still an important public health problem in China,and cigarette smoking is an important factor contributing to death and DALY in COPD patients.In the future,tobacco control should continue to be actively promoted,environmental management should be strengthened,and lung function tests should be carried out in high-risk groups such as smoking men for early diagnosis and treatment.