1990—2019年全球烧伤发病率健康不公平分析

Health inequity analysis in global burn incidence from 1990 to 2019

目的研究1990至2019年全球烧伤发病率的区域分布、时间变化趋势及健康不公平性。方法收集全球疾病负担(GBD)数据库中1990至2019年全球烧伤相关数据,以烧伤发病人数及年龄标准化发病率为基础指标,观察不同年龄、地区、社会人口指数(SDI)分区(分为高、中高、中、中低、低5类SDI地区,分区越高代表社会发展程度越高)及国家和地区的烧伤发病情况,均以估计值表示。使用Joinpoint 4.8.0.1软件进行1990至2019年烧伤年龄标准化发病率的联结点回归分析,观察平均年度变化百分比(AAPC)。使用Rstudio软件进行1990至2019年烧伤年龄标准化发病率和SDI的斯皮尔曼相关性分析。使用健康公平评估工具包中的斜度指数和集中指数评价全球烧伤发病率的不公平情况,其中斜度指数反映了最低SDI国家与最高SDI国家烧伤发病率的绝对差异,而集中指数则表明烧伤发病率集中于低SDI或高SDI国家的程度。结果1990至2019年,全球烧伤发病人数从8378121.71例上升至8955227.68例,增加6.89%;而烧伤年龄标准化发病率总体呈下降趋势,从1990年的149.86/10万下降至2019年的117.51/10万,AAPC为-0.80%。30年间10~19岁人口的烧伤发病率居各年龄段首位。全球6个区域划分中,2019年美洲的烧伤发病人数及烧伤年龄标准化发病率最高,但与1999年相比,此2项指标均有所降低。2019年中SDI地区烧伤发病人数最多,低SDI地区发病人数最少;而高SDI地区烧伤年龄标准化发病率最高,中低SDI地区最低;1990至2019年高及中高SDI地区发病人数减少,其他SDI分类地区发病人数增加;与1990年相比,2019年所有SDI分类地区烧伤年龄标准化发病率均下降,其中降幅最大的是高SDI和中高SDI地区。各国家的烧伤年龄标准化发病率排序中古巴最高,而巴基斯坦最低。斯皮尔曼相关性分析显示,1990至2019年全球204个国家及地区的烧伤年龄标准化发病率与SDI均呈正相关关系(P均<0.05),相关系数从1990年的0.49降至2019年的0.37。健康不公平分析显示,斜度指数由1990年的212.90/10万降低至2019年的59.12/10万,集中指数由1990年的21.77%降至2019年的8.38%。结论1990至2019年全球烧伤发病率不成比例地集中在发展状况较好的国家及区域,在全球烧伤发病率大幅下降的同时,这些不平等现象也明显减少。

Objective To study the regional distribution,temporal trend,and health inequity of burn incidence in the world from 1990 to 2019.Methods The data related to burns worldwide from 1990 to 2019 were collected from the database of Global Burden of Disease(GBD).Based on the number of burn cases and age-standardized incidence rates,the incidence of burn was observed by age,region,socio-demographic index(SDI)area(divided into 5 categories of SDI areas:high,medium-high,medium,medium-low and low,the higher the area,the higher the degree of social development)and country,all of which were expressed as estimated values.Joinpoint regression analysis of the age-standardized incidence of burns from 1990 to 2019 was performed using Joinpoint 4.8.0.1 software to observe the average annual percentage change(AAPC).Rstudio software was used to analyze the Spearman correlation between the age-standardized incidence of burns and SDI from 1990 to 2019.The global inequities of burn incidence were evaluated using the slope index and concentration index from the health equity assessment toolkit,where the slope index reflected the absolute difference in burn incidence between countries with the lowest and highest SDI,and the concentration index indicated the degree to which burn incidence was concentrated in countries with low or high SDI.Results From 1990 to 2019,the number of global burncases increased from 8378121.71 to 8955227.68,with an increase of 6.89%.However,the age-standardized incidence rate of burns showed an overall downward trend,from 149.86/100000 in 1990 to 117.51/100000 in 2019,with an AAPC of-0.80%.The incidence of burns in the population aged 10-19 years ranked the first in all age groups during the 30 years.Among the six regions of the world,the number of burn cases and the age-standardized incidence rate of burn in the Americas were the highest in 2019,but these two indexes were lower than those in 1999.In 2019,the number of burn patients in medium SDI areas was the highest,and the number of burn patients in low SDI areas was the lowest.The age-standardized incidence of burns was the highest in high SDI areas,and the lowest in medium-low SDI areas.From 1990 to 2019,the number of patients in high and medium-high SDI areas decreased,and the number of patients in other SDI areas increased.Compared with 1990,the age-standardized incidence rates of burns decreased in all SDI regions in 2019,with the greatest decline seen in high SDI and medium-high SDI regions.Cuba had the highest standardized incidence of burns,while Pakistan had the lowest.Spearman correlation analysis showed that from 1990 to 2019,the age-standardized incidence rates of burns in 204 countries and regions were positively correlated with SDI(all P<0.05),and the correlation coefficient decreased from 0.49 in 1990 to 0.37 in 2019.The health inequality slope index decreased from 212.90/100000 in 1990 to 59.12/100000 in 2019,and the concentration index decreased from 21.77%in 1990 to 8.38%in 2019.Conclusion From 1990 to 2019,the global burn incidence rates are disproportionately concentrated in countries and regions with better development status.A significant reduction in the global burn incidence has been accompanied by a significant reduction in these inequities.