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[2030年中国危险因素控制对非传染性疾病死亡率、预期寿命及劳动力损失的影响评估]

[Estimation of the impact of risk factors control on non-communicable diseases mortality, life expectancy and the labor force lost in China in 2030].

作者信息

Zeng X Y, Li Y C, Liu J M, Liu Y N, Liu S W, Qi J L, Zhou M G

机构信息

National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2017 Dec 6;51(12):1079-1085. doi: 10.3760/cma.j.issn.0253-9624.2017.12.006.

Abstract

To estimate the impact of risk factors control on non-communicable diseases (NCDs) mortality, life expectancy and the numbers of labor force lost in China in 2030. We used the results of China from Global Burden of Disease Study 2013, according to the correlation between death of NCDs and exposure of risk factors and the comparative risk assessment theory, to calculate population attributable fraction (PAF) and disaggregate deaths of NCDs into parts attributable and un-attributable. We used proportional change model to project risk factors exposure and un-attributable deaths of NCDs in 2030, then to get deaths of NCDs in 2030. Simulated scenarios according to the goals of global main NCDs risk factors control proposed by WHO were constructed to calculate the impact of risk factors control on NCDs death, life expectancy and the numbers of labor force lost. If the risk factors exposure changed according to the trend of 1990 to 2013, compared to the numbers (8.499 million) and mortality rate (613.5/100 000) of NCDs in 2013, the death number (12.161 million) and mortality rate (859.2/100 000) would increase by 43.1% and 40.0% respectively in 2030, among which, ischemic stroke (increasing by 103.3% for death number and 98.8% for mortality rate) and ischemic heart disease (increasing by 85.0% for death number and 81.0% for mortality rate) would increase most quickly. If the risk factors get the goals in 2030, the NCDs deaths would reduce 2 631 thousands. If only one risk factor gets the goal, blood pressure (1 484 thousands NCDs deaths reduction), smoking (717 thousands reduction) and BMI (274 thousands reduction) would be the most important factors affecting NCDs death. Blood pressure control would have greater impact on ischemic heart disease (662 thousands reduction) and hemorrhagic stroke (449 thousands reduction). Smoking control would have the greatest effect on lung cancer (251 thousands reduction) and chronic obstructive pulmonary disease (201 thousands reduction). BMI control would have the greatest impact on ischemic heart disease (86 thousands reduction) and hypertensive heart disease (45 thousands reduction). If the risk factors exposure changed according to the trend of 1990 to 2013, in 2030, the life expectancy of Chinese population would reach to 79.0 years old, compared to 2013, increasing by 3.3 years old, the labor force at the age of 15-64 years old would loss 1.932 million. If the risk factors get the goals in 2030, life expectancy would increase to 81.7 years old and the number of labor force lost would decrease to 1.467 million. Blood pressure, smoking and BMI control would have much greater impact on life expectancy (4.9, 4.0 and 3.8 years old respectively) and labor force lost (630 thousands, 496 thousands and 440 thousands respectively). Risk factors control would play an important role in reducing NCD death, improving life expectancy of residents and reducing loss of labor force. Among them, the control of blood pressure raising, smoking and BMI raising would have a greater contribution to the improvement of population health status.

摘要

为估算危险因素控制对2030年中国非传染性疾病(NCD)死亡率、预期寿命及劳动力损失数量的影响。我们采用了《2013年全球疾病负担研究》中中国的研究结果,根据非传染性疾病死亡与危险因素暴露之间的相关性以及比较风险评估理论,计算人群归因分数(PAF),并将非传染性疾病死亡分解为可归因部分和不可归因部分。我们使用比例变化模型预测2030年危险因素暴露及非传染性疾病不可归因死亡情况,进而得出2030年非传染性疾病死亡人数。根据世界卫生组织提出的全球主要非传染性疾病危险因素控制目标构建模拟情景,以计算危险因素控制对非传染性疾病死亡、预期寿命及劳动力损失数量的影响。如果危险因素暴露按照1990年至2013年的趋势变化,与2013年非传染性疾病死亡人数(849.9万)和死亡率(613.5/10万)相比,2030年死亡人数(1216.1万)和死亡率(859.2/10万)将分别增加43.1%和40.0%,其中缺血性中风(死亡人数增加103.3%,死亡率增加98.8%)和缺血性心脏病(死亡人数增加85.0%,死亡率增加81.0%)增长最快。如果危险因素在2030年达到控制目标,非传染性疾病死亡人数将减少263.1万。若仅一种危险因素达到目标,血压(减少148.4万非传染性疾病死亡人数)、吸烟(减少71.7万)和体重指数(BMI,减少27.4万)将是影响非传染性疾病死亡的最重要因素。血压控制对缺血性心脏病(减少66.2万)和出血性中风(减少44.9万)影响更大。吸烟控制对肺癌(减少25.1万)和慢性阻塞性肺疾病(减少20.1万)效果最为显著。BMI控制对缺血性心脏病(减少8.6万)和高血压性心脏病(减少4.5万)影响最大。如果危险因素暴露按照1990年至2013年的趋势变化,2030年中国人口预期寿命将达到79.0岁,与2013年相比增加3.3岁,15 - 64岁劳动力将损失193.2万。如果危险因素在2030年达到目标,预期寿命将增至81.7岁,劳动力损失数量将降至146.7万。血压、吸烟和BMI控制对预期寿命(分别增加4.9岁、4.0岁和3.8岁)和劳动力损失(分别减少63万、49.6万和44万)影响更大。危险因素控制在降低非传染性疾病死亡、提高居民预期寿命及减少劳动力损失方面将发挥重要作用。其中,控制血压升高、吸烟及BMI升高对改善人群健康状况贡献更大。

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