Analysis on disease burden of interstitial lung disease and pulmonary sarcoidosis in China, 1990−2019
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摘要:
目的 基于2019 年全球疾病负担研究数据库（GBD 2019），分析1990—2019年中国间质性肺疾病和肺结节病（ILD&PS）的疾病负担及变化趋势，为中国ILD&PS防控工作提供依据。 方法 通过GBD 2019获取1990—2019年中国ILD&PS的患病、死亡病例数与伤残调整寿命年（DALYs）绝对数，同时收集相应的年龄标化率（ASR）来评价中国ILD&PS疾病负担。运用Joinpoint线性回归模型计算平均年度变化百分比（AAPC），分析疾病负担变化趋势。 进一步运用年龄−时期−队列模型（APC）分析定量评估年龄、时期和出生队列对死亡率的影响。 结果 1990—2019年中国ILD&PS的患病、死亡病例数与DALYs绝对数均呈上升趋势。 2019年中国患病数722 410［95%不确定区间（UI）：586 951～872 704］例，死亡数8 181（95% UI：5 796～10 302）例，DALYs绝对数240 576（95% UI：189 934～299 740）人年。总体年龄标化患病率（ASPR）（AAPC=0.58%，P<0.05）呈上升趋势，而年龄标化死亡率（ASMR）（AAPC=−0.07%，P>0.05）、年龄标化DALYs率（ASDR）（AAPC=−0.20%，P<0.05）则呈下降趋势。 女性群体与总体趋势类似，但男性ASMR（AAPC=0.23%，P<0.05）、ASDR（AAPC=0.04%，P>0.05）呈上升趋势。 2019年中国患病、死亡病例数及DALYs绝对数一般随年龄增长呈现先升后降的变化趋势，峰值在70岁左右；ASPR及ASDR均随年龄增长呈先升后降趋势，而ASMR呈持续上升趋势。 死亡率APC模型分析提示，1990—2019年总体净偏移值为负值（−0.50%，P<0.05），死亡风险随年龄增加而增高，2010年以后及1955年以后出生队列的死亡风险呈下降趋势，但男性人群死亡风险相对较大。 结论 虽然1990—2019年中国ILD&PS总体ASMR、ASDR呈下降趋势，APC分析亦提示死亡率下降，但患病例数及ASPR、死亡例数和DALYs绝对数仍呈逐步增加趋势，疾病负担依然沉重，尤其是男性人群。 所以中国ILD&PS的防治工作仍任重而道远。 -
关键词:
- 间质性肺疾病 /
- 肺结节病 /
- 全球疾病负担数据库 /
- 年龄−时期−队列模型 /
- 中国
Abstract:Objective To analyze the disease burden of interstitial lung disease and pulmonary sarcoidosis (ILD&) and its trend in China from 1990 to 2019, and provide theoretical evidence for the prevention and control of ILD&PS. Methods Based on the data of Global Burden of Disease (GBD) Study 2019, the prevalence, mortality and absolute number of disability-adjusted life years (DALYs) of ILD&PS in China from 1990 to 2019 were obtained, including age-standardized rate (ASR). Joinpoint linear regression model was used to calculate average annual percent change (AAPC) and analyze the change trends of prevalence, mortality and DALYs of ILD&PS. Age-period-cohort (APC) model was used to analyze the effects of age, period and cohort on changes in the mortality. Results The prevalence, mortality and absolute number of DALYs of ILD&PS showed increasing trends in China from 1990 to 2019. In 2019, there were 722410 cases [95% uncertain interval (UI): 586951–872704], 8181 deaths (95%UI: 5796–10302) of ILD&PS, and the absolute number of DALYs was 240576 person years (95%UI: 189934–299740). In general, the age-standardized prevalence rate (ASPR) (AAPC=0.58%, P<0.05) showed an upward trend, while the age-standardized mortality rate (ASMR) (AAPC=−0.07%, P>0.05）and age-standardized DALYs rate (ASDR) (AAPC=−0.20%, P<0.05) showed downward trends, from 1990 to 2019. The trends in women were similar to the general trends, but the ASMR (AAPC=0.23%, P<0.05) and ASDR (AAPC=0.04%, P>0.05) in men showed upward trends. The prevalence, mortality and absolute number of DALYs of ILD&PS generally increased first and then decreased with age, with the peaks at about 70 years old. Except for the sustained growth of ASMR, ASPR and ASDR increased first and then decreased with age. The mortality APC model suggested that the net drift value during 1990-2019 was negative (−0.50%, P<0.05), the death risk increased with age, and the risk of death decreased in the period after 2010 and in birth cohort after 1955. But the risk of death was higher in men. Conclusion Although the overall ASMR and ASDR of ILD&PS showed downward trends in China from 1990 to 2019, and APC analysis also showed a downtrend in mortality rate, the prevalence, ASPR, mortality and absolute number of DALYs still showed gradual increase trends. The burden of ILD&PS remains heavy, especially in men. So more works are need to do in the prevention and treatment of ILD&PS in China. -
图 1 1990－2019年全球和中国间质性肺疾病和肺结节病年龄标化率变化趋势
注：DALYs. 伤残调整寿命年
Figure 1. Trends of age-standardized rates of ILD&PS in the world and China, 1990−2019
图 2 1990－2019年中国间质性肺疾病和肺结节病总体及男女性病例数及年龄标化率变化趋势
注：DALYs. 伤残调整寿命年
Figure 2. Trends in overall and gender specific prevalence and age-standardized rates of ILD&PS in China, 1990−2019
图 3 2019年中国间质性肺疾病和肺结节病病例数及年龄标化率随年龄的变化趋势
注：DALYs. 伤残调整寿命年
Figure 3. Age specific prevalence and age-standardized rates of ILD&PS in China, 2019
图 4 1990－2019年中国总体和男女性间质性肺疾病和肺结节病死亡率的年龄–时期–队列效应图
注：ILD&PS. 间质性肺疾病和肺结节病
Figure 4. Age-period-cohort effect maps of overall and gender specific mortality rates of ILD&PS in China, 1990−2019
表 1 1990和2019年全球和中国ILD&PS的患病、死亡、DALYs情况及1990－2019年的AAPC情况
Table 1. Prevalence, mortality and DALYs of ILD&PS in 1990 and 2019, with AAPC (1990−2019) in the world and China
组别 1990年 2019年 1990－2019年
AAPC
［%（95%CI）］绝对数
［例（95%UI）］年龄标化率
［/10万（95%UI）］绝对数
［例（95%UI）］年龄标化率
［/10万（95%UI）］全球 患病情况 2 199 426
（1 857 409～2 566 793）52.66
（44.49～61.07）4 710 180
（4020397～5401700）57.62
（49.42～65.67）0.33
（0.25～0.40）女性 1 148 716
（968 103～1 344 666）52.20
（43.98～60.98）2 432 444
（2074827～2797609）56.45
（48.18～64.80）0.31
（0.19～0.42）男性 1 050 710
（887936～1223533）53.93
（45.41～62.61）2 277 736
（1946302～2613887）59.67
（51.21～68.03）0.37
（0.29～0.45）死亡情况 63 697
（50958～80625）1.76
（1.41～2.22）169 833
（118756～204802）2.17
（1.50～2.62）0.73
（0.61～0.84）女性 27 210
（20775～50833）1.34
（1.02～1.87）76 869
（48378～94366）1.76
（1.11～2.16）1.00
（0.93～1.08）男性 36 487
（24519～50833）2.34
（1.60～3.18）92 964
（57581～120738）2.72
（1.66～3.55）0.53
（0.43～0.64）DALYs情况 1 691 993
（1378827～2120371）41.57
（33.93～51.92）3 770 894
（2864234～4468319）46.45
（35.12～54.98）0.44
（0.30～0.58）女性 714 872
（560083～948574）32.86
（25.81～43.75）1 685 476
（1210211～2023720）38.99
（28.09～46.80）0.62
（0.54～0.70）男性 977 121
（692233～1364033）52.38
（37.18～71.76）2 085 418
（1399512～2652671）55.48
（36.90～70.33）0.24
（0.11～0.35）中国 患病情况 282 517
（226776～346000）30.06
（24.12～36.53）722 410
（586951～872704）35.62
（29.20～42.12）0.58
（0.24～0.92）女性 137 664
（103449～ 170424）29.16
（23.10～36.11）346 767
（279411～22628）33.23
（27.14～40.02）0.44
（0.07～0.81）男性 144 853
（117482～175808）31.78
（25.76～38.11）375 643
（305588～451234）39.22
（32.32～46.44）0.73
（0.43～1.04）死亡情况 3 383
（2572～5583）0.47
（0.35～0.76）8 181
（5796～10302）0.45
（0.32～0.57）−0.07
（−0.30～0.15）a女性 1 391
（922～2972）0.35
（0.23～0.74）2 887
（1572～4070）0.29
（0.16～0.41）−0.61
（−0.76～−0.47）男性 1 992
（1369～3128）0.68
（0.46～1.06）5 294
（3274～7118）0.72
（0.43～0.95）0.23
（0.05～0.41）DALYs情况 119 336
（93659～72370）13.22
（10.38～19.37）240 576
（189934～299740）12.36
（9.78～15.40）−0.20
（−0.31～−0.09）女性 51 350
（36893～92168）11.06
（7.95～20.14）95 494
（68176～125957）9.51
（6.77～12.46）−0.55
（−0.70～−0.40）男性 67 986
（50212～100349）16.22
（11.99～23.66）145 082
（106739～188382）16.14
（11.73～20.79）0.04
（−0.11～0.18）a注：ILD&PS. 间质性肺疾病和肺结节病；AAPC. 平均年度变化百分比；UI. 不确定区间；CI. 置信区间；DALYs. 伤残调整寿命年；a. P＞0.05 
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