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中国居民1990 — 2019年缺血性脑卒中发病和死亡趋势年龄 – 时期 – 队列分析

Incidence and mortality of ischemic stroke in China, 1990 – 2019: an age-period-cohort analysis

  • 摘要:
      目的  了解中国居民1990 — 2019年缺血性脑卒中发病和死亡趋势,为我国缺血性脑卒中的防控提供参考依据。
      方法  收集2019年全球疾病负担研究(GBD 2019)数据库中1990 — 2019年中国居民缺血性脑卒中发病和死亡相关数据,采用Joinpoint回归模型分析缺血性脑卒中发病率和死亡率变化趋势,并应用年龄 – 时期 – 队列(APC)模型分析缺血性脑卒中发病和死亡风险的年龄、时期和出生队列效应。
      结果  中国总体居民、男性居民和女性居民缺血性脑卒中粗发病率分别从1990年的74.26/10万、64.58/10万和84.55/10万上升至2019年的201.74/10万、183.60/10万和220.59/10万,标化发病率分别从1990年的107.49/10万、 101.14/10万和113.72/10万上升至2019年的144.78/10万、141.10/10万和149.44/10万,标化发病率的平均年度变化百分比(AAPC)分别为1.04%、1.16%和0.94%(均P < 0.001);中国总体居民、男性居民和女性居民缺血性脑卒中粗死亡率分别从1990年的32.08/10万、32.09/10万和32.06/10万上升至2019年的72.37/10万、79.89/10万和64.55/10万,中国总体居民和女性居民标化死亡率分别从1990年的64.32/10万和56.13/10万下降至2019年的62.18/10万和48.26/10万,男性居民标化死亡率从1990年的77.34/10万上升至2019年的83.55/10万,中国总体居民标化死亡率的AAPC为 – 0.12%(P = 0.463),男性居民和女性居民标化死亡率的AAPC分别为0.29%和 – 0.50%(均P < 0.05)。APC模型分析结果显示,中国35~89岁男性居民和45~89岁女性居民缺血性脑卒中发病率的局部漂移值均 > 0,75~94岁男性居民缺血性脑卒中死亡率的局部漂移值均 > 0;在同一出生队列中,男性居民和女性居民缺血性脑卒中发病率和死亡率的纵向年龄曲线均呈上升趋势;男性居民缺血性脑卒中发病风险在1990 — 2004年各时期组保持稳定,2005 — 2009年缓慢上升,在2010 — 2019年各时期组中快速上升;女性居民缺血性脑卒中发病风险在1990 — 2004年各时期组呈下降趋势,2005 — 2009年缓慢上升,2010 — 2014年发病风险快速上升,2015 — 2019年上升趋势极为平缓几乎保持平稳。中国男性和女性居民1990 — 2019年缺血性脑卒中死亡风险均随时期推移整体呈下降趋势,死亡风险均在2015 — 2019年达到最小值;中国男性和女性居民1990 — 2019年缺血性脑卒中发病风险均随出生队列推移呈先上升后下降的趋势,男性和女性居民发病风险的出生队列效应峰值分别出现在1973 — 1977年和1958 — 1962年;男性和女性居民1990 — 2019年缺血性脑卒中死亡风险均随出生队列推移整体呈下降趋势。
      结论  中国居民1990 — 2019年缺血性脑卒中发病率呈上升趋势,年龄、时期和出生队列效应对不同性别居民发病风险均有一定程度影响;虽然死亡风险的时期和队列效应呈下降趋势,但由于持续增加的年龄效应使我国居民尤其是老年男性居民实际死亡负担较重。

     

    Abstract:
      Objective  To examine incidence and mortality trends of ischemic stroke (IS) among Chinese residents from 1990 to 2019 and to provide a reference for the prevention and control of IS in China.
      Methods  The data on IS incidence and mortality among Chinese residents from 1990 to 2019 were collected from the Global Burden of Disease Study 2019 (GBD 2019). Joinpoint regression model was used to analyze changing trend of IS incidence and mortality. The age-period-cohort (APC) model was used to assess the effects of age, period, and birth cohort on the risk of IS incidence and mortality.
      Results  The crude incidence rate (per 100 000 population) of IS increased from 74.26 in 1990 to 201.74 in 2019 for all Chinese residents; and the rate increased from 64.58 to 183.60 for the male residents and from 84.55 to 220.59 for the female residents. The standardized incidence rate (per 100 000 population) of IS also increased from 107.49 in 1990 to 144.78 in 2019 for all Chinese residents; for male and female residents, the standardized incidence rate increased from 101.14 and 113.72 to 141.10 and 149.44, respectively. During 30-year period, the average annual percentage change (AAPC) in standardized IS incidence rate for all, male and female Chinese residents were 1.04%, 1.16% and 0.94% (all P < 0.001). The crude IS mortality rate (per 100 000 population) for all, male and female Chinese residents increased from 32.08, 32.09 and 32.06 in 1990 to 72.37, 79.89 and 64.55 in 2019; the standardized IS mortality rate (per 100 000 population) for all and female Chinese residents decreased from 64.32 and 56.13 in 1990 to 62.18 and 48.26 in 2019; but the standardized IS mortality rate for male Chinese residents increased from 77.34 in1990 to 83.55 in 2019. During 30-year period, the AAPC in standardized IS mortality rate for all, male and female Chinese residents were – 0.12% (P = 0.463), 0.29% and – 0.50% (both P < 0.05). The results of the APC model analysis showed that the local drift values of IS incidence rate for male residents aged 35 – 89 years and female residents aged 45 – 89 years were greater than 0, and the local drift values of IS mortality rate for male residents aged 75 – 94 years were greater than 0. The longitudinal curve for age-specific IS incidence and mortality for both male and female residents in the same birth cohort showed an increasing trend. The IS risk of male residents remained stable in each period group from 1990 to 2004, then increased slowly from 2005 to 2009, and rapidly increased in each period group from 2010 to 2019. The IS risk of the female residents decreased in each period group from 1990 to 2004, and increased slowly from 2005 to 2009; from 2010 to 2014, the risk increased rapidly, and from 2015 to 2019, the increasing trend was very smooth and almost remained stable. From 1990 to 2019, the IS mortality risk of male and female Chinese residents showed a downward trend over the time period and the mortality risk reached the minimum from 2015 to 2019. From 1990 to 2019, the IS risk of male and female Chinese residents increased first and then decreased with the birth cohort. The peak of the birth cohort effect on IS in male residents occurred from 1973 to 1977, and that in female residents occurred from 1958 to 1962. The IS mortality risk in male and female Chinese residents from 1990 to 2019 showed an overall downward trend along with the birth cohort.
      Conclusion  The incidence of ischemic stroke in Chinese residents showed an increasing trend from 1990 to 2019. Age, period, and birth cohort effect have a certain influence on the risk of ischemic stroke with gender disparity. Although the period and cohort effect on IS mortality risk showed a decline trend, the continuous increasing age effect made the actual burden of IS mortality much heavier among Chinese residents, especially among elderly male residents.

     

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