中国全科医学 ›› 2024, Vol. 27 ›› Issue (02): 233-244.DOI: 10.12114/j.issn.1007-9572.2023.0470

所属专题: 心血管最新文章合集

• 论著·流行病学研究 • 上一篇    下一篇

1990—2019年中国心血管疾病流行现状、疾病负担及发病预测分析

杨继1,2, 张垚1,2, 马腾3, 田昕彤3, 赵英强4,*()   

  1. 1300381 天津市,天津中医药大学第一附属医院
    2300381 天津市,国家中医针灸临床医学研究中心
    3301617 天津市,天津中医药大学
    4300250 天津市,天津中医药大学第二附属医院
  • 收稿日期:2023-07-20 修回日期:2023-08-20 出版日期:2024-01-15 发布日期:2023-10-23
  • 通讯作者: 赵英强

  • 作者贡献:杨继提出研究思路,负责设计文章研究方案、检索GBD 2019数据库,进行数据整理、统计分析及撰写论文;张垚负责检索GBD 2019数据库资料,数据整理,全文相关图表绘制;马腾、田昕彤负责检索GBD 2019数据库,提取数据资料并进行汇总、整理、二次校对;赵英强进行论文的质量控制及审校,对论文最终版本进行修订,对论文负责、全部作者已确认论文终稿。
  • 基金资助:
    国家重点研发计划(2019YFC1710005)

Epidemic Status, Disease Burden and Prediction of Cardiovascular Diseases in China, 1990-2019

YANG Ji1,2, ZHANG Yao1,2, MA Teng3, TIAN Xintong3, ZHAO Yingqiang4,*()   

  1. 1First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
    2National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China
    3Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
    4The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300250, China
  • Received:2023-07-20 Revised:2023-08-20 Published:2024-01-15 Online:2023-10-23
  • Contact: ZHAO Yingqiang

摘要: 背景 心血管疾病是严重危害人类健康的重大慢病,且仍是我国乃至全球一个亟待解决的公共卫生问题。目的 探讨1990—2019年中国心血管疾病流行特征和疾病负担情况,预测2020—2050年中国心血管疾病发病情况,为心血管疾病相关防治策略的制订提供参考。方法 检索2019年全球疾病负担研究(GBD 2019)数据库,提取1990—2019年中国及全球心血管疾病负担及危险因素的相关数据并进行分析,使用基于GBD 2019数据库可公开的发病率、患病率、死亡率以及对应的年龄标准化(简称标化)率来量化心血管疾病的疾病流行情况,使用伤残损失寿命年(YLD)、早死损失寿命年(YLL)、伤残调整寿命年(DALY)量化疾病负担情况,构建ARIMA模型预测2020—2050年中国心血管疾病的发病情况。结果 1990—2019年中国心血管疾病的发病率、患病率及死亡率呈逐年上升趋势,其中发病率、患病率及死亡率分别增长了93.75%、99.75%、57.39%。女性的标化发病率、标化患病率均高于男性,标化死亡率低于男性(P<0.05)。从2019年数据上看,中国心血管疾病总体发病率随着年龄升高呈上升趋势,在95岁及以上年龄组达到最高值。男性和女性的发病率趋势与总体趋势相似,但略有差异。总体患病率随着年龄升高呈上升趋势,女性高于男性。在45岁以后心血管疾病的死亡率呈现上升趋势,男性的死亡率在各个年龄段均高于女性。1990—2019年男性YLL率、YLD率、DALY率增长了36.99%、102.42%、40.78%,女性增长了2.79%、107.13%、11.50%。从2019年数据来看,中国总人群心血管疾病的YLL率、YLD率、DALY率总体随着年龄的增加呈上升趋势,尚无拐点出现。男性YLL率、DALY率随人口老龄化进展逐渐升高并远高过女性,女性YLD率在55~59岁年龄组后逐渐升高并远高过男性。1990—2019年,全球心血管疾病的标化发病率、标化患病率及标化死亡率呈逐年下降趋势,而中国的标化发病率和标化患病率仍有所增加,标化死亡率虽有所降低,但仍高于全球范围。从全球整体水平上看,中国心血管疾病的标化YLL率、标化DALY率虽同全球一样呈下降趋势,但2000年以后中国心血管疾病的疾病负担高于全球整体水平,且标化YLD率逐年增加。与心血管疾病死亡相关的危险因素主要是吸烟、吸二手烟、饮酒、体力活动少、高空腹血糖、高收缩压、高BMI、高低密度脂蛋白胆固醇以及肾功能不全。从中国及全球相关数据来看,高收缩压(高血压)依然是造成心血管疾病死亡的首要危险因素,且死亡人数逐年增加。高低密度脂蛋白胆固醇(高脂血症)是全球及近年来中国心血管疾病死亡的第二因素。2020—2050年中国心血管疾病标化发病率仍呈上升趋势,预计到2050年心血管疾病的标化发病率将达到663.618/10万。结论 1990—2019年我国心血管疾病的发病率、患病率及死亡率呈逐年上升趋势,因心血管疾病导致的疾病负担较重,在未来50年尚无拐点出现,疾病流行及负担情况均高于全球范围。预计到2050年心血管疾病的标化发病率将达到663.618/10万。

关键词: 心血管疾病, 疾病负担, 伤残调整寿命年, 危险因素, 预测

Abstract:

Background

Cardiovascular disease is a major chronic disease that seriously endangers human health, and remains a public health problem to be solved in China and even globally.

Objective

To explore the epidemic characteristics and disease burden of cardiovascular diseases in China from 1990 to 2019, forecast the incidence of cardiovascular diseases in China from 2020 to 2050, and provide a reference for the formulation of relevant prevention and treatment strategies of cardiovascular diseases.

Methods

The 2019 Global Burden of Disease Study (GBD 2019) database was searched to extract and analyze relevant data on cardiovascular disease burden and risk factors in China and globally from 1990 to 2019. The prevalence of cardiovascular diseases was quantified by using the publicly available incidence, prevalence, mortality, and corresponding age-standardized rate (referred to as standardized rate) based on GBD 2019 database, and the burden of diseases was quantified by years lived with disability (YLD), years of life lost (YLL) and disability adjusted life year (DALY), and the ARIMA model was constructed to predict the incidence of cardiovascular diseases in China from 2020 to 2050.

Results

Compared with 1990, the incidence, prevalence and mortality of cardiovascular diseases in China showed an increasing trend by year up to 2019, in which the incidence, prevalence and mortality increased by 93.75%, 99.75% and 57.39%, respectively. The standardized incidence and prevalence of females were higher than those of males, while the standardized mortality was lower than that of males (P<0.05). According to the data in 2019, the overall incidence of cardiovascular diseases in China showed an increasing trend with age, reaching its highest value in the age group of 95 years and above. Incidence trends for both men and women were similar to the overall trend, with slight differences. The overall prevalence also increases with age and is higher in women than men. There is an increasing trend in cardiovascular disease mortality after the age of 45, with males having a higher mortality rate than females at all ages. Compared with 1990, the rates of YLL, YLD and DALY in Chinese men increased by 36.99%, 102.42% and 40.78%, respectively, and increased by 2.79%, 107.13% and 11.50% in women in 2019. According to the data in 2019, the YLL rate, YLD rate and DALY rate of cardiovascular diseases in Chinese population showed an upward trend with the increase of age, with no inflection point. YLL rate and DALY rate of males gradually increased with the progress of population aging and were much higher than females, YLD rate gradually increased in the age group of 55-59 years and was much higher than males. From 1990 to 2019, the global standardized incidence, standardized prevalence and standardized mortality of cardiovascular diseases showed a downward trend by year, while the standardized morbidity and standardized mortality still increased in China, the standardized incidence and prevalence decreased, but that was still higher than the global scale. From the global level, the standardized YLL rate and DALY rate of cardiovascular diseases in China showed a downward trend along with the global level, but the disease burden of cardiovascular diseases in China was higher than the global level after 2000, and the standardized YLD rate increased by year. Risk factors associated with death from cardiovascular diseases mainly included smoking, second-hand smoke, alcohol consumption, low physical activity, high fasting blood glucose, high systolic blood pressure, high BMI, high low density lipoprotein cholesterol and renal insufficiency. From the relevant data in China and globally, high systolic blood pressure (hypertension) was still the primary risk factor for death from cardiovascular diseases, and the number of deaths was increasing by year. High density lipoprotein cholesterol (hyperlipidemia) was the second cause of death from cardiovascular diseases globally and in China in recent years. From 2020 to 2050, the standardized incidence of cardiovascular diseases in China is still on the rise, and it is expected that the standardized incidence of cardiovascular diseases will reach 663.618 per 100 000 by 2050.

Conclusion

The incidence, prevalence and mortality of cardiovascular diseases in China from 1990 to 2019 have shown an increasing trend by year. The disease burden caused by cardiovascular diseases is more severely, and there is no inflection point in the next 50 years. The prevalence and burden of diseases are higher than those of the world. It is expected that the standardized incidence of cardiovascular diseases will reach 663.618 per 100 000 by 2050.

Key words: Cardiovascular diseases, Burden of illness, Disability-adjusted life years, Risk factors, Forecasting