1990—2021年“一带一路”共建主要国家慢性阻塞性肺疾病疾病负担变化趋势及其死亡危险因素归因分析

王娅宁; 刘奕彤; 陆如建; 仲亚琴

doi:10.11847/zgggws1146346

1990—2021年“一带一路”共建主要国家慢性阻塞性肺疾病疾病负担变化趋势及其死亡危险因素归因分析

Trends in chronic obstructive pulmonary disease burden and attributable death risk factors in major Belt and Road Initiative participating countries, 1990–2021

摘要

摘要:
目的了解1990—2021年“一带一路”共建主要国家慢性阻塞性肺疾病（COPD）疾病负担的变化趋势及其死亡的主要危险因素，为制定“一带一路”共建国家COPD的预防控制策略提供参考依据。
方法从2021全球疾病负担研究（GBD 2021）数据库中提取1990—2021年中国、埃及、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国、土耳其、伊朗、印度、印度尼西亚和越南共13个“一带一路”共建主要国家COPD标化发病率、标化死亡率、标化伤残调整寿命年（DALY）率和COPD死亡危险因素归因占比等相关数据，采用年估计百分比变化（EAPC）描述各国标化发病率、标化死亡率和标化DALY率的变化趋势，并通过绘制蝴蝶图比较2021年各国不同性别人群COPD死亡危险因素的归因占比。
结果 1990—2021年13个“一带一路”共建主要国家中埃及、土耳其、伊朗、印度尼西亚和越南的COPD标化发病率总体均呈上升趋势，分别从1990年的129.68/10万、199.53/10万、114.36/10万、155.06/10万和159.48/10万上升到2021年的177.45/10万、225.79/10万、152.05/10万、176.01/10万和179.64/10万，EAPC（95%CI）分别为0.92%（0.90%～0.95%）、0.38%（0.34%～0.42%）、0.96%（0.94%～0.98%）、0.36%（0.33%～0.38%）和0.28%（0.24%～0.33%）；中国、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国和印度的COPD标化发病率总体均呈下降趋势，分别从1990年的271.22/10万、243.66/10万、162.10/10万、191.76/10万、260.88/10万、241.21/10万、164.34/10万和275.49/10万下降到2021年的215.62/10万、231.91/10万、144.19/10万、165.78/10万、238.94/10万、234.81/10万、125.47/10万和262.45/10万，EAPC（95%CI）分别为–0.84%（–0.88%～–0.81%）、–0.18%（–0.22%～–0.14%）、–0.53%（–0.59%～–0.46%）、–0.14%（–0.16%～–0.12%）、–0.29%（–0.35%～–0.23%）、–0.91%（–0.94%～–0.88%）、–0.67%（–0.74%～–0.59%）和–0.18%（–0.19%～–0.17%）。1990—2021年13个“一带一路”共建主要国家中中国、埃及、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国、土耳其、伊朗、印度尼西亚和越南COPD标化死亡率总体均呈下降趋势，分别从1990年的231.78/10万、48.30/10万、83.97/10万、29.81/10万、46.58/10万、101.94/10万、135.53/10万、55.13/10万、57.54/10万、21.01/10万、53.00/10万和54.29/10万下降到2021年的73.23/10万、25.87/10万、73.80/10万、13.04/10万、32.81/10万、59.65/10万、104.53/10万、19.80/10万、40.77/10万、17.44/10万、49.53/10万和43.96/10万，EAPC（95%CI）分别为–4.25%（–4.48%～–4.02%）、–0.32%（–0.44%～–0.19%）、–0.66%（–0.92%～–0.40%）、–3.23%（–3.60%～–2.86%）、–1.11%（–1.22%～–1.00%）、–1.97%（–2.33%～–1.61%）、–4.05%（–4.36%～–3.75%）、–0.92%（–1.01%～–0.84%）、–0.72%（–1.11%～–0.33%）、–2.12%（–2.32%～–1.92%）、–0.19%（–0.31%～–0.06%）和–0.66%（–0.76%～–0.55%）。1990—2021年13个“一带一路”共建主要国家中中国、埃及、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国、土耳其、伊朗、印度、印度尼西亚和越南的COPD标化DALY率总体均呈下降趋势，分别从1990年的3 852.57/10万、1 015.46/10万、1 783.98/10万、677.94/10万、961.37/10万、2 281.06/10万、2 710.62/10万、1 179.10/10万、1 199.96/10万、478.53/10万、2 508.84/10万、1 140.65/10万和1 054.72/10万下降到2021年的1 227.66/10万、602.17/10万、1 541.67/10万、352.01/10万、807.05/10万、1 301.68/10万、1 958.92/10万、461.07/10万、850.19/10万、424.08/10万、2 171.16/10万、1 040.41/10万和863.32/10万，EAPC（95%CI）分别为–4.19%（–4.38%～–3.99%）、–0.17%（–0.27%～–0.07%）、–0.68%（–0.91%～–0.45%）、–2.74%（–3.07%～–2.42%）、–1.32%（–1.44%～–1.21%）、–1.91%（–2.14%～–1.68%）、–3.70%（–3.96%～–3.43%）、–0.45%（–0.53%～–0.38%）、–0.90%（–1.16%～–0.63%）、–1.92%（–2.12%～–1.71%）、–0.36%（–0.47%～–0.25%）、–0.25%（–0.35%～–0.16%）和–0.60%（–0.68%～–0.52%）。COPD死亡危险因素归因分析结果显示，归因于烟雾烟草和职业风险的死亡占比存在明显性别差异，男性普遍高于女性；归因于空气污染的死亡占比性别差异较小。
结论 1990—2021年13个“一带一路”共建主要国家的COPD疾病负担总体上均呈一定下降趋势，不同国家间存在明显差异；男性归因于烟雾烟草和职业风险的COPD死亡占比均高于女性。

Abstract:
Objective To understand the changing trends in the burden of chronic obstructive pulmonary disease (COPD) and the main risk factors for death in major countries participating in the Belt and Road Initiative (BRI) from 1990 to 2021, and to provide a reference for formulating COPD prevention and control strategies for these countries.
Methods Data on age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized disability-adjusted life years (DALY) rate, and the attributable fraction of COPD death risk factors from 1990 to 2021 were extracted from the Global Burden of Disease Study 2021 (GBD 2021) database for 13 major BRI participating countries: China, Egypt, Pakistan, Russia, the Philippines, Bangladesh, Myanmar, Thailand, Turkey, Iran, India, Indonesia, and Vietnam. Estimated annual percentage change (EAPC) was used to describe the trends in ASIR, ASMR, and age-standardized DALY rate in each country. Butterfly charts were used to compare the attributable fractions of COPD death risk factors by sex in 2021.
Results From 1990 to 2021, the ASIR of COPD generally showed an upward trend in Egypt, Turkey, Iran, Indonesia, and Vietnam, increasing from 129.68/100 000, 199.53/100 000, 114.36/100 000, 155.06/100 000, and 159.48/100 000 in 1990 to 177.45/100 000, 225.79/100 000, 152.05/100 000, 176.01/100 000, and 179.64/100 000 in 2021, respectively. The corresponding EAPCs (95%CI) were 0.92% (0.90–0.95), 0.38% (0.34–0.42), 0.96% (0.94–0.98), 0.36% (0.33–0.38), and 0.28% (0.24–0.33). The ASIR of COPD generally showed a downward trend in China, Pakistan, Russia, the Philippines, Bangladesh, Myanmar, Thailand, and India, decreasing from 271.22/100 000, 243.66/100 000, 162.10/100 000, 191.76/100 000, 260.88/100 000, 241.21/100 000, 164.34/100 000, and 275.49/100 000 in 1990 to 215.62/100 000, 231.91/100 000, 144.19/100 000, 165.78/100 000, 238.94/100 000, 234.81/100 000, 125.47/100 000, and 262.45/100 000 in 2021, respectively. The corresponding EAPCs (95%CI) were –0.84% (–0.88– –0.81), –0.18% (–0.22– –0.14), –0.53% (–0.59– –0.46), –0.14% (–0.16– –0.12), –0.29% (–0.35– –0.23), –0.91% (–0.94– –0.88), –0.67% (–0.74– –0.59), and –0.18% (–0.19– –0.17). From 1990 to 2021, the ASMR of COPD generally showed a downward trend in China, Egypt, Pakistan, Russia, the Philippines, Bangladesh, Myanmar, Thailand, Turkey, Iran, Indonesia, and Vietnam, decreasing from 231.78/100 000, 48.30/100 000, 83.97/100 000, 29.81/100 000, 46.58/100 000, 101.94/100 000, 135.53/100 000, 55.13/100 000, 57.54/100 000, 21.01/100 000, 53.00/100 000, and 54.29/100 000 in 1990 to 73.23/100 000, 25.87/100 000, 73.80/100 000, 13.04/100 000, 32.81/100 000, 59.65/100 000, 104.53/100 000, 19.80/100 000, 40.77/100 000, 17.44/100 000, 49.53/100 000, and 43.96/100 000 in 2021, respectively. The corresponding EAPCs (95%CI) were –4.25% (–4.48– –4.02), –0.32% (–0.44– –0.19), –0.66% (–0.92– –0.40), –3.23% (–3.60– –2.86), –1.11% (–1.22– –1.00), –1.97% (–2.33– –1.61), –4.05% (–4.36– –3.75), –0.92% (–1.01– –0.84), –0.72% (–1.11– –0.33), –2.12% (–2.32– –1.92), –0.19% (–0.31– –0.06), and –0.66% (–0.76– –0.55). From 1990 to 2021, the age-standardized DALY rate of COPD generally showed a downward trend in all 13 major BRI participating countries. Attributable death risk factor analysis for COPD deaths showed significant sex differences in the proportions of deaths attributed to ambient particulate matter pollution, household air pollution from solid fuels, and occupational risks, with males generally having higher proportions than females.
Conclusions From 1990 to 2021, the burden of COPD generally showed a downward trend in the 13 major BRI participating countries, with significant differences among countries. The proportions of COPD deaths attributed to ambient particulate matter pollution, household air pollution from solid fuels, and occupational risks were higher in males than in females.

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