1990—2021年中国环境O_(3)导致的COPD疾病负担分析  

Analysis of the disease burden of COPD due to O_(3) in the outdoor environment in China from 1990 to 2021

作　　者：吴兴露 刘起勇 潘伟璐 李京 唐云锋 WU Xinglu;LIU Qiyong;PAN Weilu;LI Jing;TANG Yunfeng(School of Public Health,Shandong Second Medical University,Weifang 261053,Shandong Province,China;Institute of Infectious Disease Prevention and Control,Chinese Center for Disease Control and Prevention,Bejing 102206,China)

机构地区：[1]山东第二医科大学公共卫生学院,山东潍坊261053 [2]中国疾病预防与控制中心传染病预防控制所,北京102206

出　　处：《预防医学情报杂志》2025年第2期152-161,共10页Journal of Preventive Medicine Information

基　　金：2021年山东省高等学校“青年创新人才引进培养计划”;山东省教育督导学会课题(项目编号:SDJYDDXH2023-2159,SDJYDDXH2023-1008)。

摘　　要：目的了解中国1990—2021年因暴露于O_(3)而导致的慢性阻塞性肺病(COPD)疾病负担并对2020—2040年该疾病的死亡率趋势进行预测。方法从全球疾病负担研究数据库2021中获取中国暴露于O_(3)导致的死亡人数、年龄标准化死亡率(age-standardised mortality rate,ASMR)、伤残调整生命年(disability-adjusted life year,DALY)和年龄标准化DALY率(age-standardised DALY rate,ASDR)。通过Joinpoint 5.0.2软件构建连接点回归模型并计算年度百分比变化(annual percentage change,APC)和平均年度百分比变化(average annual percentage change,AAPC);采用R 4.4.1软件构建年龄-时期-队列模型分析年龄、时期和队列效应对COPD死亡率的影响;并基于R 4.4.1软件中的“BAPC”包构建贝叶斯APC模型预测2020—2040年因暴露于O_(3)而导致的COPD死亡率趋势。结果均以P<0.05为差异有统计学意义。结果1990—2021年因暴露于O_(3)的COPD死亡人数呈上升趋势,变化率为0.04%;死亡率从1990年的22.59/10万下降至2021年的7.19/10万,年度百分比变化估计值(EAPC)为-3.93%(95%CI:-4.57%~-3.29%);DALY和年龄标准化DALY率分别从1990年的2354881和353.86/10万下降至2021年的1917486和100.73/10万,年龄标准化DALY率的EAPC值为-4.30%(95%CI:-4.91%~-3.68%);Joinpoint回归分析表明,因暴露O_(3)引起的COPD总体死亡率呈下降趋势,AAPC为-3.734%(95%CI:-4.317%~-3.147%),男性死亡率高于女性(男女AAPC分别为:-3.338%和-4.241%)。此外,APC模型结果显示因暴露O_(3)导致的COPD疾病负担随着年龄的增长而增加,35岁及以上人群为高风险人群。据预测,在2020—2040年中国因暴露于O_(3)而导致的COPD死亡率将下降;但自2035年开始,女性的死亡风险将高于男性,女性死亡率达0.37/10万。结论中国因暴露于O_(3)导致的COPD死亡人数在增加,但死亡率和DALY率却在下降,预测显示2020—2040年COPD死亡率将持续下降,而男性和35岁及以上人群仍是高危人群。因此,需针对Objective To understand the disease burden of chronic obstructive pulmonary disease(COPD)due to O_(3)exposure in China and to predict the mortality trend of the disease from 2020to 2040.Methods The number of deaths,age-standardised mortality rate(ASMR),disabilityadjusted life year(DALY)and age-standardised DALY rate(ASDR)due to O_(3)exposure in China were obtained from the Global Burden of Disease Study(GBD)2021.Joinpoint 5.0.2 software was used to construct a joinpoint regression model and calculate the annual percentage change(APC)and the average annual percentage change(AAPC).Age-period-cohort models were constructed by R 4.4.1 software to analyze the effects of age,period and cohort on COPD mortality.A Bayesian APC model was constructed to predict the trend in COPD mortality due to O_(3)exposure from 2020to 2040 based on the“BAPC”package in R 4.4.1 software.The results were all statistically significant with P<0.05.Results From 1990 to 2021,the number of deaths from COPD due to O_(3)exposure showed an increasing trend with a chane rate of 0.04%.The motality rate decreased from 22.59/105in 1990 to 7.19/105in 2021,with an estimated annual percentage change(EAPC)value of-3.93%(95% confidence interval CI:-4.57%--3.29%).The DALY and ASDR decreased from 2354881 and 353.86/105in 1990 to 1917486 and 100.73/105 in 2021,respectively,with an ASDR EAPC of-4.30%(95%CI:-4.91%--3.68%).Joinpoint regression analysis showed a decreasing trend in the overall ASMR of COPD caused by exposure to O_(3),with an AAPC of-3.734%(95%CI:-4.317%--3.147%),and males had a higher mortality rate than females(AAPC:-3.338% and-4.241%for males and females,respectively).In addition,as shown by the results of the APC model,the burden of COPD disease due to O_(3)exposure increased with age,and people aged 35 years and above were at high risk.COPD mortality due to O_(3)exposure in China was predicted to decrease between 2020 and 2040,however,the risk of death would be higher for females than that for males from 2035 onwards,with an ASMR of 0.37/

关 键 词：慢性阻塞性肺疾病 O_(3) 连接点回归 年龄-时期-队列分析 BAPC 

分 类 号：R181.2[医药卫生—流行病学]