1992—2021年中国耐多药结核病疾病负担变化趋势分析  

Analysis of Changing Trends in Disease Burden of Multidrug-resistant Tuberculosis in China,1992-2021

作　　者：方良梅 苗瑞芬[2] 王荣[2] 仇蓓蓓 洪忻[3] 王莉娜[1] FANG Liangmei;MIAO Ruifen;WANG Rong;QIU Beibei;HONG Xin;WANG Lina(Department of Epidemiology and Health Statistics,School of Public Health,Southeast University,Nanjing 210009,China;Department of Chronic Communicable Disease Prevention and Control,Nanjing Municipal Center for Disease Control and Prevention,Nanjing 210003,China;Department of Chronic and Non-communicable Disease Prevention and Control,Nanjing Municipal Center for Disease Control and Prevention,Nanjing 210003,China)

机构地区：[1]东南大学公共卫生学院流行病与卫生统计学系,江苏省南京市210009 [2]江苏省南京市疾病预防控制中心慢性传染病防制科,210003 [3]江苏省南京市疾病预防控制中心慢性非传染病防制科,210003

出　　处：《中国全科医学》2025年第17期2163-2171,共9页Chinese General Practice

基　　金：江苏省预防医学及血地寄防科研课题(Ym2023002);南京市卫生科技发展专项资金资助项目(ZKX22059)。

摘　　要：背景耐多药结核病(MDR-TB)流行严重危害公众健康。中国是MDR-TB高疾病负担国家之一。目的分析1992—2021年中国MDR-TB疾病负担现状和变化趋势,为制定防控策略提供参考。方法从2021年全球疾病负担数据库(GBD 2021)中提取1992—2021年中国、全球和不同社会人口指数(SDI)地区MDR-TB的疾病负担数据,使用Joinpoint回归模型计算年度变化百分比(APC)及平均年度变化百分比(AAPC)描述变化趋势。使用年龄-时期-队列模型分析中国MDR-TB发病和死亡的年龄、时期和队列效应。结果1992—2021年中国MDR-TB标化发病率和标化死亡率由7.72/10万、2.21/10万分别降至1.49/10万、0.15/10万,下降幅度分别为80.70%、93.21%。2021年中国MDR-TB标化发病率和标化死亡率在全球和不同SDI地区中处于中下等水平,但与高SDI地区相比负担仍较重。Joinpoint分析结果显示,地区差异上看,1992—2021年中国MDR-TB标化发病率和标化死亡率的AAPC值分别为-5.51%、-9.06%,均呈下降趋势(P<0.05)。性别差异上看,女性MDR-TB标化发病率和标化死亡率(AAPC分别为-5.91%、-10.08%,P<0.05)下降速度均高于男性(AAPC分别为-5.26%、-8.51%,P<0.05),男性的疾病负担高于女性。年龄差异上看,85~89岁MDR-TB发病率下降趋势最大(AAPC=-6.04%,P<0.05),15~19岁死亡率下降趋势最大(AAPC=-9.88%,P<0.05)。APC分析结果显示,1992—2021年中国MDR-TB发病率和死亡率的净偏移值分别为-7.78%、-11.07%。年龄效应表明,发病率随年龄增长波动上升,死亡率呈现单调递增,均在85~89岁达到最大值,分别为22.10/10万和16.58/10万。时期效应表明,发病和死亡风险随着年份推移而下降,发病和死亡的风险比(RR)值由1.55、1.87分别降至0.26、0.13。队列效应表明,发病和死亡风险随出生队列后移而降低,发病和死亡率的RR值由44.01、185.33分别降至0.02、0.01。结论1992—2021年中国MDR-TB的疾病负担整体呈下降趋势,但下降速度逐Background The epidemic of multidrug-resistant tuberculosis(MDR-TB)is a serious public health hazard.China is one of the countries with high MDR-TB disease burden.Objective To analyze the current status and changing trends of MDR-TB disease burden in China from 1992 to 2021,and to provide a reference for the development of prevention and control strategies.Methods Disease burden data of MDR-TB of China,the global and different socio-demographic index(SDI)regions from 1992-2021 were extracted from the Global Burden of Disease database 2021(GBD 2021),and the Joinpoint regression model was used to calculate the annual percentage change(APC)and average annual percentage change(AAPC)to describe changing trends.Age-period-cohort model was used to analyze the age,period and cohort effects of MDRTB incidence and mortality in China.Results From 1992 to 2021,the standardized incidence rate and standardized mortality rate of MDR-TB in China decreased from 7.72/100000 and 2.21/100000 to 1.49/100000 and 0.15/100000,respectively,with decreases of 80.70%and 93.21%,respectively.In 2021,China's MDR-TB standardized incidence rate and standardized mortality rate were in the lower middle level among the global and different SDI regions,but the burden was still heavier compared with that in high SDI regions.The results of the Joinpoint analysis showed that,in terms of regional differences,the AAPC of MDR-TB standardized incidence rate and standardized mortality rate in China from 1992 to 2021 were-5.51%and-9.06%,respectively,which were on decreasing trends(P<0.05).In terms of gender differences,both the standardized incidence rate and standardized mortality rate of MDR-TB decreased more rapidly in females(AAPC was-5.91%and-10.08%,respectively,P<0.05)than in males(AAPC was-5.26%and-8.51%,respectively,P<0.05),and the disease burden was higher in males than in females.In terms of age differences,the fastest decrease of the incidence rate of MDR-TB occurred at 85-89 years old(AAPC=-6.04%,P<0.05),and the fastest decrease of the mortality

关 键 词：结核 耐多药结核病 全球疾病负担 连接点回归模型 年龄-时期-队列模型 趋势分析 

分 类 号：R52[医药卫生—内科学]