Hou S S, Shi J D, Yin X, Xu Q, Jiang F, Wang N, Jiang Qingwu
Department of Epidemiology,School of Public Health,Fudan University,Shanghai 200032, China.
Department of Respiratory and Critical Care Medicine, Fifth People's Hospital of Shanghai City, Fudan University, Shanghai 200240, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2022 Oct 10;43(10):1554-1561. doi: 10.3760/cma.j.cn112338-20211009-00773.
To examine the trend of the burden on chronic obstructive pulmonary diseases (COPD) and epidemiologic transition on related risk factors among the Chinese population from 1990 to 2019. Based on the data from the Global Burden of Disease 2019 Study, we used the indicator numbers such as disability-adjusted life year (DALY), years of life lost (YLD), years lived with disability (YLL), and prevalence rate to describe the changes of COPD burden stratified by different sex and age groups from 1990 to 2019. We applied population attribution faction () to analyze the burden attributed to risk factors and epidemiological transition. In 2019, the age-standard rate for DALY, YLD, and YLL and prevalence rate for COPD were 1 102.77/100 000 population,862.37/100 000 population, 240.40/100 000 population, and 2 404.41/100 000. Both age-standardized DALY and YLL rates for COPD in males were higher than in females, except for the YLD rate in females. COPD's top five risk factors were particulate matter pollution, smoking, occupational particulate matter, gases, and fumes, low temperature, and secondhand smoke. Smoking surpassed environmental particulate pollution in 1994 and became the first factor causing the disease burden of COPD. Since then, the order of risk factors has not changed. The of environmental particulate pollutants increased by 1.78% annually, from 15.22% in 1990 to 25.37%, and the of household air pollution from solid fuels decreased by 5.59% annually, from 40.30% in 1990 to 7.59%. From 1990 to 2019, the per person health loss caused by COPD in China showed an overall downward trend. The of relevant risk factors has also changed, the importance of environmental factors is relatively declined, and the status of smoking and other related risk behaviors has become increasingly prominent. The prevention and control of COPD can focus on screening high-risk groups (≥40 years old, smoking, heavy air pollution, having occupational exposure), smoking cessation, and environmental treatment.
为研究1990年至2019年中国人群慢性阻塞性肺疾病（COPD）负担趋势及相关危险因素的流行病学转变。基于《2019年全球疾病负担研究》的数据，我们使用伤残调整生命年（DALY）、寿命损失年（YLD）、带病生存年（YLL）和患病率等指标数字来描述1990年至2019年不同性别和年龄组分层的COPD负担变化。我们应用人群归因分数（）来分析归因于危险因素的负担和流行病学转变。2019年，COPD的DALY、YLD和YLL年龄标准化率以及患病率分别为1102.77/10万人口、862.37/10万人口、240.40/10万人口和2404.41/10万。除女性的YLD率外，男性COPD的年龄标准化DALY和YLL率均高于女性。COPD的前五大危险因素是颗粒物污染、吸烟、职业颗粒物、气体和烟雾、低温以及二手烟。吸烟在1994年超过环境颗粒物污染，成为导致COPD疾病负担的首要因素。此后，危险因素的顺序未变。环境颗粒物污染物的归因分数每年增加1.78%，从1990年的15.22%增至25.37%，而固体燃料家庭空气污染的归因分数每年下降5.59%，从1990年的40.30%降至7.59%。1990年至2019年，中国COPD导致的人均健康损失呈总体下降趋势。相关危险因素的归因分数也发生了变化，环境因素的重要性相对下降，吸烟及其他相关风险行为的地位日益突出。COPD的防控可侧重于筛查高危人群（≥40岁、吸烟、重度空气污染、有职业暴露）、戒烟和环境治理。
