Lancet：中國疾病負擔報告：中國疾病譜發生重大變化

2019年6月24日，Lancet雜誌在線發表了由中國疾病預防控制中心梁曉峰等與美國華盛頓大學合作完成的最新中國疾病負擔結果。論文題目為Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017。作為全球疾病負擔（GBD）研究的一部分，該研究系統分析了1990-2017中國及其各省的死亡率、發病率和危險因素。報告顯示，從1990年至2017年，中國居民疾病譜發生重大變化：年齡校正的中風死亡率下降33.5%，年齡校正的慢阻肺死亡率降低68.6%。慢性疾病如中風、缺血性心臟病以及肺癌，現已成為中國人群過早死亡的主要原因。

本分析使用2017年《全球疾病、傷害和風險因素負擔研究》(GBD)的數據，採用GBD2017方法，對1990~2017年全國34個省級行政單位的衛生狀況進行分析。研究估計了所有原因和特定原因的死亡率、壽命損失年數(YLLs)、殘疾生活年數(YLDs)、殘疾調整壽命年數(DALYs)、總暴露值(SEVs)和可歸因風險，並將觀察到的結果與基於社會人口指數(SDI)估計的期望值進行了比較。

研究結果發現：

1990-2017年間，中風和缺血性心臟病取代了下呼吸道感染和新生兒疾病，成為疾病負擔的主要原因。2017年全國腦卒中和缺血性心臟病是死亡和DALYs的主要原因。從1990年到2017年，每1000人中年齡標準化DALYs降低了33·1%，缺血性心臟病增加了4·6%。年齡標準化中風、缺血性心臟病、肺癌、慢性阻塞性肺病和肝癌是2017年YLLs的五大主要病因。肌肉骨骼疾病、精神健康障礙和感覺器官疾病是2017年YLDs的三大主要原因，收縮壓高、吸煙、高鈉飲食和環境顆粒物污染是導致死亡和DALYs的四大危險因素。

各省每10萬人肝癌DALYs均高於預期，觀察到的與預期的比率為2·04~6·88。2017年全國10萬人全因年齡標準化DALYs均低於預期，其中缺血性心臟病、阿爾茨海默病、頭痛障礙、下腰痛位列前20位，均低於預期。前10大危險因素中，年齡標準化SEVs在全國水平的變化百分比最大的是高體重指數，其次是環境顆粒物污染。

此外，不同省份的健康問題存在巨大差異。中國東部城市、沿海區域和富裕省份的人們通常比西部農村和貧困地區的人們更健康。

中國在減輕許多疾病和殘疾負擔方面取得了實質性進展。在不斷擴大的中國衛生保健體系中，應對慢性病，特別是老年人的慢性病，採取優先戰略。

Figure 1: Top 25 causes of DALYs in China, 1990–2017 Causes are ranked by number of DALYs in 2017. COPD=chronic obstructive pulmonary disease. DALY=disability-adjusted life-years.

Figure 2: Number of deaths and percentage of DALYs related to the leading level 3 risk factors in China in 2017

該分析是中國疾病預防控制中心與美國華盛頓大學健康測量及評價研究所（IHME）以及中國政府其他機構，包括全國婦幼衛生監測辦公室和國家癌症中心腫瘤登記辦公室，以及全球學術機構的眾多研究人員長期合作的成果。

SUMMARY

Background

Public healthis a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the globalpopulation, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level.

Methods

We used the methods in GBD 2017 to analyse health patterns in the 34 province-leveladministrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived withdisability (YLDs), disability-adjusted life-years (DALYs), summary exposurevalues (SEVs), and attributable risk. We compared the observed results withexpected values estimated based on the Socio-demographic Index (SDI).

Findings

Stroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100?000 population decreased by 33·1% (95% uncertainty interval [UI] 29·8 to 37·4) for stroke and increased by 4·6% (–3·3 to 10·7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes ofYLLs in 2017. Musculo skeletal disorders, mental health disorders, and senseorgan diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100?000 population forliver cancer, with the observed to expected ratio ranging from 2·04 to 6·88.The all-cause age-standardised DALYs per 100?000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes werelower than expected for ischaemic heart disease, Alzheimer"s disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was inhigh body-mass index (185%, 95% UI 113·1 to 247·7]), followed by ambient particulate matter pollution (88·5%, 66·4 to 116·4).

Interpretation

China has madesubstantial progress in reducing the burden of many diseases and disabilities.Strategies targeting chronic diseases, particularly in the elderly, should beprioritised in the expanding Chinese health-care system.

1.MaigengZhou, et al. Mortality, morbidity, and risk factors in China and its provinces,1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet, Published Online June 24, 2019

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30427-1/fulltext

2.曾新穎,齊金蕾,殷鵬,等.1990~2016年中國及省級行政區疾病負擔報告.中國循環雜誌,2018, 33:1147-1158.

本期編輯：Annabella

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