基于年龄-时期-队列模型的中国阑尾炎疾病负担分析

Analysis of national burden of appendicitis in China based on the age-period-cohort model

目的了解1990—2019年中国阑尾炎的发病和伤残调整寿命年(disability adjusted life year, DALY)情况, 并探讨年龄、时期和队列对阑尾炎发病和DALY的影响。方法利用全球疾病负担(Global Burden of Disease, GBD)2019数据库, 分析1990—2019年中国阑尾炎发病和DALY情况, 应用Joinpoint软件分析标化发病率和标化DALY率的时间变化趋势, 计算平均年度变化百分比。构建年龄-时期-队列模型, 分析年龄、时期和出生队列对阑尾炎发病及DALY趋势变化的影响。结果 2019年, 中国阑尾炎发病率为174.84/10万, DALY率为4.58/10万, 比1990年分别下降了2.72%和69.14%。2019年男性发病率和DALY率分别为177.45/10万和4.91/10万, 均高于女性(172.11/10万和4.22/10万)。1990—2019年, 中国阑尾炎标化发病率有升高趋势, 平均每年升高0.32%, 标化DALY率有降低趋势, 平均每年下降4.51%, 趋势均有统计学意义(t=10.51和-52.61,P<0.001)。年龄效应结果显示, 1990—2019年中国阑尾炎的发病随年龄呈先上升后降低再升高的趋势, 发病率最高峰为15~<20岁年龄组, 发病率为239.89/10万, 在75~<80岁年龄组发病率达到最低, 为65.62/10万。DALY率呈下降趋势, 在50岁以后趋于平稳趋势, 在60~<65年龄组达到最低, 为3.58/10万。时期效应结果显示, 中国阑尾炎发病风险的时期变化RR值呈升高趋势, 在2015—2019年发病风险最高(RR=1.48), DALY风险的时期变化RR值呈下降趋势, 1990—1994年DALY风险最高(RR=1.63)。队列效应结果显示, 1975—1979年的出生队列发病风险最高(RR=1.11), 越晚出生的人群DALY风险越低。结论 1990—2019年, 中国阑尾炎的发病率有升高趋势, DALY率有降低趋势, 男性的发病率和DALY率高于女性, 越晚出生的人群DALY风险越低。

Objective:To understand the incidence and disability-adjusted life year(DALY)of appendicitis in China from 1990 to 2019,and to explore the influence of age,period and cohort on the incidence and DALY of appendicitis.Methods:Using the Global Burden of Disease(GBD)2019 database,the incidence of appendicitis and DALY situation in China from 1990 to 2019 were analyzed,and the time variation trend of standardized incidence and standardized DALY rate was analyzed by using Joinpoint software,and the average annual variation percentage was calculated.The age-period-cohort model was constructed to assess the influence of age,period and birth cohort on trends in appendicitis onset and DALY.Results:In 2019,the incidence of appendicitis in China was 174.84/100000,and DALY rate was 4.58/100000,which decreased by 2.72%and 69.14%,respectively,compared to 1990.In terms of gender,the incidence rate(177.45/100000)and DALY rate(4.91/100000)of males were higher than those of females(172.11/100000 and 4.22/100000)in 2019.From 1990 to 2019,the standardized incidence of appendicitis in China showed an upward trend,with an average annual increase of 0.32%,and the standardized DALY rate showed a downward trend,with an average annual decrease of 4.51%,with statistical significance(t=10.51 and-52.61,both P<0.001).The age effect analysis revealed that the incidence rate of appendicitis in China showed an initial increase,followed by a decrease and then an increase again from 1990 to 2019.The highest incidence rate was observed in the 15 to<20 age group at 239.89/100000,while the lowest incidence rate was in the 75 to<80 age group at 65.62/100000.The DALY rate showed a downward trend,stabilizing after the age of 50,reaching its lowest point in the age group of 60 to<65 years at 3.58/100000.Period effect analysis indicated an increasing trend in the relative risk(RR)of appendicitis incidence during the periods,peaking from 2015 to 2019(RR=1.48),while the RR of DALY risk showed a declining trend,being highest from 1990 to 1994(RR=1.63).The cohort effect results revealed that the birth cohort from 1975 to 1979 had the highest risk for appendicitis(RR=1.11),with a lower DALY risk observed in later-born cohorts.Conclusions:From 1990 to 2019,the incidence of appendicitis in China showed an upward trend,while the DALY rate showed a downward trend.The incidence and DALY rate among males are higher than those among females,and the later-born cohorts show lower DALY risks.