School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
BMJ Open. 2022 Mar 23;12(3):e050080. doi: 10.1136/bmjopen-2021-050080.
To explore possible reasons for the difference in chronic obstructive pulmonary disease (COPD) incidence/mortality rates between China and high socio-demographic index (SDI) countries.
A cross-sectional analysis of summary statistics from the Global Burden of Disease Study 2017.
Data were publicly available and de-identified, and individuals were not involved.
We extracted the age-standardised and age-specific incidence/mortality rates, and risk factors attributed to COPD in China and high SDI countries from the Global Burden of Disease Study 2017. We first described differences in COPD patterns (ie, incidence and mortality rates) in China and high SDI countries briefly, and then explored possible reasons for driving such differences by comparing rankings for six well-established COPD risk factors and estimating change points in age-specific incidence and mortality rates for COPD and several commonly encountered competing risks using segmented regression models.
Differences in age-standardised incidence and mortality rates for COPD between China and high SDI countries converged during 1990-2017 but still differed, particularly for mortality rates. Smoking was the leading attributable risk factor followed by ambient air pollution, with higher rankings for occupational risks in China than in high SDI countries. The change point was 80 years for age-specific COPD mortality rate in both China and high SDI countries. However, the change point for COPD incidence was 5-year later in China (65 years) than in high SDI countries (~60 years). The change points for mortality rates due to competing risks (eg, ischaemic heart disease) also varied between settings.
Differences in risk factors largely shaped the differences in COPD patterns between China and high SDI countries. Varying patterns of mortality due to competing risks might also contribute to the discrepancy in COPD mortality rates, by affecting the survival of the underlying population.
探究中国与高社会人口指数（SDI）国家间慢性阻塞性肺疾病（COPD）发病率/死亡率差异的可能原因。
对 2017 年全球疾病负担研究的汇总统计数据进行的横断面分析。
数据公开且去识别，不涉及个体。
我们从 2017 年全球疾病负担研究中提取了中国和高 SDI 国家的 COPD 的年龄标准化和年龄特异性发病率/死亡率以及归因于 COPD 的危险因素。我们首先简要描述了中国和高 SDI 国家 COPD 模式（即发病率和死亡率）的差异，然后通过比较六个公认的 COPD 危险因素的排名，并使用分段回归模型估计 COPD 和几种常见的竞争风险的特定年龄发病率和死亡率的转折点，探讨导致这种差异的可能原因。
1990-2017 年期间，中国和高 SDI 国家的 COPD 的年龄标准化发病率和死亡率差异趋同，但仍存在差异，尤其是死亡率。吸烟是主要的归因危险因素，其次是环境空气污染，中国的职业风险排名高于高 SDI 国家。中国和高 SDI 国家的 COPD 死亡率的特定年龄变化点均约为 80 岁。然而，中国 COPD 发病率的变化点比高 SDI 国家晚 5 年（约 65 岁）。竞争风险（如缺血性心脏病）导致的死亡率的变化点也因环境而异。
危险因素的差异在很大程度上塑造了中国与高 SDI 国家 COPD 模式的差异。由于竞争风险导致的死亡率模式的不同，也可能通过影响基础人群的生存，导致 COPD 死亡率的差异。
