中国先天性心脏病疾病负担三十年变化分析  

Trends in the disease burden of congenital heart disease in China over the past three decades

作　　者：潘飞霞 徐玮泽[1] 李嘉斌 黄子嫣 舒强[1] PAN Feixia;XU Weize;LI Jiabin;HUANG Ziyan;SHU Qiang(The Heart Center,Children’s Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,National Regional Medical Center for Children,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院心脏中心,国家儿童健康与疾病临床医学研究中心,国家儿童区域医疗中心,浙江杭州310052

出　　处：《浙江大学学报（医学版）》2022年第3期267-277,共11页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省重点研发计划(2020C03120)。

摘　　要：目的:分析1990—2019年中国先天性心脏病(先心病)的疾病负担变化趋势。方法:采用2019年全球疾病负担(GBD)研究数据,分析中国1990—2019年先心病发病人数、标化发病率、死亡人数、标化死亡率、伤残调整生命年(DALY)、标化DALY率的变化趋势。采用Joinpoint回归模型对以上指标进行时间趋势分析;采用年龄-时期-队列模型进行先心病死亡率的年龄、时期和出生队列效应分析;采用Pearson相关性分析分析以上指标与人类发展指数(HDI)的相关性。结果:1990—2019年,中国先心病标化发病率、死亡率及DALY率年平均变化百分比(AAPC)分别为-0.1%(95%CI:-0.7%~0.4%)、-3.5%(95%CI:-3.7%~-3.2%)及-3.5%(95%CI:-3.7%~-3.2%)。先心病发病主要集中在1岁之前:新生儿平均发病率为2497.9/10万;1岁以下儿童平均发病率为2626.6/10万。1995—2000年新生儿及1岁以下儿童的发病率呈指数级上升,随后呈平稳下降趋势,但2010—2013年与2014—2015年1岁以下儿童的发病率有两次呈指数级上升,随后呈指数级下降,在2019年下降至近三十年最低值。先心病死亡率随年龄增长呈下降趋势,5岁以下儿童先心病死亡率为101.67/10万人年,5岁及以上人群死亡率下降;但55~<60岁人群死亡率呈短暂上升。1995—2019年,先心病患者的相对死亡风险呈下降趋势,与1995—1999年比较,2015—2019年先心病患者死亡的率比(RR)下降了24%;1945年以后的出生队列相对死亡风险呈下降趋势,与1945—1949年出生队列比较,2015—2019年出生队列先心病患者RR值下降了75%。当HDI小于0.58时(1999年以前),先心病标化发病率与HDI呈正相关(r=0.74,P<0.05);当HDI为0.58及以上时(1999年及以后),先心病标化发病率与HDI呈负相关(r=-0.76,P<0.01)。标化死亡率、标化DALY率与HDI均呈负相关(r=-0.95和-0.93,均P<0.01)。结论:我国先心病1990—1999年标化发病率上升,与社会发展程度呈正相关;1999—2019年标化发病率下Objective:To investigate the disease burden of congenital heart disease(CHD)in China from 1990 to 2019.Methods:Using the data from Global Burden of Disease(GBD)study 2019,the incidence,age-standardized incidence rates,the mortality,age-standardized mortality rates,disability-adjusted life year(DALY)and agestandardized DALY rates of CHD were calculated.Time trend analysis of disease burden-related indicators was analyzed by Joinpoint regression model.Age-period-cohort model was used to describe age,period,and birth cohort effects in CHD mortality population.The relationship between age-standardized incidence,mortality,DALY rates of congenital heart disease and human development index(HDI)were analyzed by Pearson correlation.Results:From 1990 to 2019,the mean annual percentage change(AAPC)in age-standardized incidence rate,mortality rate and DALY rate of CHD in China were-0.1%(95%CI:-0.7%-0.4%)、-3.5%(95%CI:-3.7%--3.2%)and-3.5%(95%CI:-3.7%--3.2%),respectively.CHD usually occurred in the first year of life.The mean incidence rate at birth was 2497.9/100000,and the mean incidence rate under 1 year of age was 2626.6/100000.During the period of 1995—2000,the incidence rate in newborn and<1 year children showed an exponential upward trend,then it remained a steady downward trend.However,there was an exponential increase in<1 year children during 2010—2013 and 2014—2015,followed by an exponential decrease to the lowest value in the last three decades.The mortality of CHD tended to decrease with age,with mortality of 101.67/100000 for children under 5 years of age and a decrease after 5 years of age.However,there was a transient increase in mortality in age group 55-<60.From 1995 to 2019,the relative risk of death of patients with CHD showed a downward trend.Compared with 1995—1999,the rate ratio of death decreased by 24%in 2015—2019.Such downward trend was also observed in the birth cohort after 1945.Compared with the 1945—1949 birth cohort,the rate ratio of death for patients with CHD decreased by 75%in the

关 键 词：先天性心脏病 疾病负担 人类发展指数 Joinpoint回归模型 时期-年龄-队列模型 

分 类 号：R722[医药卫生—儿科] R195.4[医药卫生—临床医学]