1990－2019年全球0～14岁儿童慢性肾脏病疾病负担分析

姚青奎; 李玥臻; 罗琪丹; 朱蔓婷; 姚梦馨; 胡佳; 姚娜; 尹洁云

doi:10.3784/jbjc.202306280300

1990－2019年全球0～14岁儿童慢性肾脏病疾病负担分析

Disease burden of chronic kidney disease in children aged 0−14 years woeldwide, 1990−2019

摘要

摘要:
目的分析1990—2019年全球0～14岁儿童慢性肾脏病（CKD）的现状及疾病负担情况，为儿童CKD的疾病预防控制策略提供科学依据。
方法利用2019年全球疾病负担数据库（GBD 2019），分析204个国家和不同社会人口指数（SDI）水平的地区儿童CKD发病率、患病率、死亡率和伤残调整寿命年率（DALYs）的现状及变化趋势，其中DALYs由早死损失寿命年（YLL）和伤残损失寿命年（YLD）两部分组成。采用平均年度变化百分比（AAPC）综合评价1990—2019年全球0～14岁儿童CKD负担的变化趋势。
结果 2019年全球儿童慢性肾脏病发病率、患病率、死亡率和DALYs率分别为38.11/10万、483.6/10万、0.86/10万和92.99/10万；女童的发病率和患病率为39.72/10万和504.99/10万，分别高于男童的36.61/10万和463.55/10万；男童的死亡率和DALYs率为0.90/10万和95.59/10万，分别高于女童的0.83/10万和90.22/10万；＜1岁年龄组的发病率、死亡率和DALYs率均高于其他年龄组。 1990—2019年，儿童CKD的发病率和患病率呈增长趋势［AAPC=0.42%，95%置信区间（CI）：0.38%～0.46%；AAPC=0.55%，95%CI：0.52%～0.57%］，而死亡率和DALYs率呈下降趋势（AAPC=−2.02%，95%CI：−2.21%～−1.84%；AAPC=−1.62%，95%CI：−1.76%～−1.49%）；YLL率呈下降趋势（变化率=−0.46%，95%CI：−0.58%～−0.17%），而YLD率呈上升趋势（变化率=0.28%，95%CI：0.23%～0.33%）。儿童CKD的负担更多集中于低、中低、中等SDI地区。
结论全球儿童CKD的发病负担在增加，死亡负担在减少。总的DALYs负担在下降，但考虑到YLD负担的增加，YLL负担降低带来的贡献可能更大。儿童CKD的疾病负担在不同年龄、性别、国家和地区存在着较大差异。

Abstract:
Objective To analyze the prevalence and disease burden of chronic kidney disease (CKD) in children aged 0–14 years worldwidw during 1990−2019, and provide evidence for prevention and control of pediatric CKD.
Methods Based on the data of pediatric CKD from the database of Global Burden of Disease Study 2019, we analyzed the morbidity, prevalence, mortality, and disability-adjusted life years (DALYs) of pediatric CKD and their changes in 204 countries and regions with different socio-demographic index (SDI). DALYs consisted of years of life lost (YLL) and years lived with disability (YLD). The average annual percentage change (AAPC) was calculated to evaluate the trend of global CKD burden in children aged 0–14 years from 1990 to 2019.
Results Globally, the morbidity, prevalence, mortality, and DALYs rates of pediatric CKD were 38.11/100 000, 483.6/100 000, 0.86/100 000, and 92.99/100 000, respectively, in 2019. The morbidity and prevalence in girls were 39.72/100 000 and 504.99/100 000 respectively, which were higher than those in boys (36.61/100 000 and 463.55/100 000). The mortality and DALYs rates in boys were 0.9/100 000 and 95.59/100 000 respectively, which were higher than those in girls (0.83/100 000 and 90.22/100 000). The morbidity, mortality, and DALYs rates in age group <1 year were higher than those in other age groups. From 1990 to 2019, the morbidity and prevalence rates of pediatric CKD showed increasing trends (AAPC=0.42%, 95%CI: 0.38%–0.46%; AAPC=0.55%, 95%CI: 0.52%–0.57%), while the mortality and DALYs rates showed decreasing trends (AAPC=−2.02%, 95%CI: −2.21%–−1.84%; AAPC=−1.62%, 95%CI: −1.76%–−1.49%). In addition, the YLL rate showed a downward trend (rate of change =−0.46%, 95%CI: −0.58%–−0.17%), while the YLD rate showed an upward trend (rate of change =0.28%, 95%CI: 0.23%–0.33%). The burden of CKD in children aged 0−4 years was severer in regions with low, low-moderrate and moderate SDI.
Conclusion Pediatric CKD morbidity rate increased while the mortality rate decreased in the world. The overall DALYs declined, but given the increased YLD, the contribution of lower YLL was likely to be greater. Moreover, the disease burden of CKD in children aged 0−4 years varied with age, gender, country, and region.

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