湖南省1990-2017年脑卒中疾病负担

刘源; 徐巧华; 殷蕾; 金东辉

doi:10.16462/j.cnki.zhjbkz.2021.01.019

湖南省1990-2017年脑卒中疾病负担

doi: 10.16462/j.cnki.zhjbkz.2021.01.019

410005 长沙, 湖南省疾病预防控制中心慢性非传染疾病防控科

基金项目:

湖南省卫生健康委2020年度立项课题 20201255

详细信息

通讯作者:
金东辉，E-mail：942019814@qq.com

中图分类号: R181
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出版历程
- 收稿日期: 2020-03-19
- 修回日期: 2020-09-13
- 刊出日期: 2021-01-10

Disease burden of stroke from 1990 to 2017 in Hunan Province

Department of Non-communicable Disease Control and Prevention, Hunan Center for Disease Control and Prevention, Changsha 410005, China

Funds:

Hunan Health Committee in 2020 20201255

More Information

Corresponding author: JIN Dong-hui, E-mail:942019814@qq.com

摘要

摘要: 目的描述1990-2017年湖南省脑卒中疾病负担及变化趋势，为其防控政策的制定提供依据。方法描述2017年全球疾病负担研究(global burden of diseases study, GBD)结果中包括湖南省脑卒中死亡数、过早死亡损失寿命年(years of life lost, YLLs)、伤残损失寿命年(years lived with disability, YLDs)、伤残调整寿命年(disability-adjusted life years, DALYs)及各指标的年龄标化率，并计算各指标1990-2017年变化幅度。结果 1990-2017年，湖南省脑卒中死亡数从7.69万上升至11.43万人年，升幅85.84%，男性、女性分别上升122.56%、2.12%；年龄标化死亡率从218.55/10万降至136.41/10万，降幅37.58%，男性、女性分别下降4.16%、58.18%。YLLs从163.74万人年升至203.57万人年，升幅84.79%，男性上升94.94%，女性下降22.62%；年龄标化YLL率下降从3 742.85/10万降至2 183.06/10万，降幅41.67%，女性下降64.45%，高于男性的6.62%。YLDs从11.35万人年上升至30.83万人年，升幅171.63%，男性、女性分别上升197.58%、151.72%；年龄标化YLD率升幅41.74%(1990年：235.13/10万，2017年：333.28/10万)，男性、女性分别上升58.89%、28.22%。脑卒中DALYs从175.09万人年升至234.41万人年，升幅33.88%；年龄标化DALY率从3 977.98/10万降至2 516.34/10万，降幅36.74%。其中脑出血DALYs占比最高，缺血性卒中DALYs升幅最高，达142.64%。结论 1990-2017年，湖南省脑卒中疾病负担整体呈增长趋势，有明显性别差异，脑出血疾病负担最重，缺血性卒中疾病负担上升最明显。
- 心脑血管疾病 /
- 脑卒中 /
- 疾病负担 /
- 全球疾病负担
Abstract: Objective The objective of this study is to investigate the disease burden of stroke in Hunan Province, which may help to guide priority in control and prevention of stroke. Methods Data were extracted from Global Burden of Diseases Study 2017 (GBD 2017). Mortality, years of life lost (YLLs), years lived with disability (YLDs), disability adjusted life years (DALYs) associated with stroke, together with the age-standardized rates and change of the indexes mentioned above between 1990 and 2017 in Hunan were selected and described. Results From 1990-2017, death number of stroke in Hunan witnessed an increase of 85.84% (1990 vs 2017: 76 900 vs 114 300), and death number of male increased by 122.56%, while that of females increased only by 2.12%. Age-standardized mortality rate of stroke decreased by 37.58% (1990 vs 2017: 218.55/100 000 vs 136.41/100 000). Males' age-standardized mortality of stroke decreased only by 4.16%, while that of female decreased sharply by 58.18%. YLLs of stoke increased by 84.79% (1990 vs 2017: 1 637 400 vs 2 035 700 person years); Males' YLLs of stroke increased largely by 94.94%, while that of females decreased by 22.62%. Age-standardized rate of YLL of stoke decreased by 41.67% (1990 vs 2017: 3 742.85/100 000 vs 2 183.06/100 000), while females' age-standardized rate of YLL decreased by 64.45%, ahead of that of male's 6.62%. YLDs of stroke increased by 171.63% (1990 vs 2017: 113 500 vs 308 300 person years). Males' YLDs of stroke increased by 197.58%, and that of females also increased by 151.72%. Age-standardized rate of YLD also witnessed an increase of 41.74%(1990 vs 2017: 235.13/100 000 vs 333.28 /100 000); Males' age-standardized rate of YLD increased by 58.89%, while that of females increased by 28.22%. DALYs increased by 33.88% (1990 vs 2017: 1 750 900 vs 2 344 100 person years), while age-standardized rate of DALY decreased by 36.74% (1990 vs 2017: 3 977.98/100 000 vs 2 516.34/100 000). Hemorrhagic stroke contributed the most part for DALYs among different kinds of stroke, while DALYs of ischemic stroke increased rapidest by 142.64%. Conclusions Disease burden of stroke from 1990-2017 in Hunan witnessed an increase, with an obvious gender difference. Hemorrhagic stroke contributed the most part for disease burden compared with other strokes, while ischemic stroke increased most rapidly.
- Cardiovascular diseases /
- Stroke /
- Disease burden /
- Global burden of diseases study

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图 1 湖南省1990-2017年脑卒中的年龄标化死亡率时间分布

Figure 1. Age-standardized mortality rates of stroke in Huan Province from 1990 to 2017

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表 1 两组患者一般资料比较^a

Table 1. Comparison of basic features of the two group^a

年份	性别	脑出血		缺血性卒中		蛛网膜下腔出血		脑卒中合计
年份	性别	死亡数(万人)	标化死亡率(/10万)	死亡数(万人)	标化死亡率(/10万)	死亡数(万人)	标化死亡率(/10万)	死亡数(万人)	标化死亡率(/10万)
1990	男	1.54(1.18~2.34)	86.14(66.49~128.57)	0.56(0.42~0.83)	36.67(27.98~53.42)	0.87(0.23~1.26)	46.80(11.68~68.28)	2.97(2.65~3.45)	169.60(152.08~195.96)
	女	2.15(1.76~3.69)	121.07(99.40~206.59)	0.90(0.71~1.55)	57.13(45.41~97.88)	1.67(0.58~2.10)	88.77(29.74~111.33)	4.72(4.10~5.98)	266.97(233.58~342.19)
	合计	3.70(3.05~5.93)	103.71(86.05~165.32)	1.46(0.75~1.56)	46.87(38.04~73.98)	2.54(0.87~3.18)	67.96(22.38~84.97)	7.69(6.97~9.35)	218.55(198.89~267.87)
1995	男	1.68(1.28~2.58)	78.11(60.13~118.94)	0.63(0.47~0.98)	33.74(25.53~50.88)	1.07(0.26~1.53)	48.04(11.08~69.19)	3.38(3.07~3.92)	159.89(145.64~184.44)
	女	1.91(1.60~3.34)	93.76(78.88~164.73)	0.78(0.63~1.39)	43.06(35.37~76.75)	1.55(0.51~1.89)	72.54(23.50~88.23)	4.23(3.78~5.43)	209.36(186.59~271.90)
	合计	3.60(2.98~5.86)	85.64(71.29~139.05)	1.41(1.15~2.35)	38.14(31.27~62.65)	2.61(0.86~3.25)	59.96(19.13~74.50)	7.62(7.01~9.24)	183.74(168.98~225.04)
2000	男	2.31(1.82~3.26)	90.35(71.87~126.45)	0.90(0.70~1.29)	39.87(31.54~56.20)	1.15(0.28~1.68)	43.68(10.41~63.63)	4.36(3.89~4.90)	173.90(156.91~194.88)
	女	1.89(1.60~2.88)	77.97(66.34~119.03)	0.81(1.26~0.68)	37.22(31.29~57.43)	1.05(0.37~1.27)	41.85(14.49~50.71)	3.76(3.32~4.62)	157.05(138.85~193.81)
	合计	4.21(3.55~6.03)	84.22(71.48~120.42)	1.71(1.43~2.49)	38.47(32.53~55.49)	2.20(0.73~2.84)	42.71(13.91~54.84)	8.12(7.46~9.40)	165.40(152.39~191.98)
2005	男	3.17(2.75~3.85)	106.4(92.96~127.68)	1.37(1.18~1.66)	51.23(44.64~61.63)	0.79(0.28~1.08)	25.76(8.95~35.20)	5.33(4.89~5.90)	183.40(169.27~201.98)
	女	2.10(1.86~2.63)	69.92(62.38~87.64)	0.99(0.88~1.24)	35.99(32.03~44.81)	0.60(0.28~0.71)	19.34(8.77~22.66)	3.69(3.34~4.20)	125.25(113.91~142.39)
	合计	5.27(4.75~6.38)	87.8(79.51~105.52)	2.36(2.13~2.85)	43.28(39.18~52.06)	1.40(0.63~1.74)	22.48(10.17~27.78)	9.03(8.42~9.97)	153.56(143.47~169.54)
2010	男	3.33(2.93~3.91)	97.18(86.12~112.99)	1.76(1.53~2.08)	56.88(50.11~66.92)	0.63(0.27~0.85)	17.86(7.63~23.89)	5.71(5.15~6.41)	171.91(155.55~192.23)
	女	2.24(1.97~2.64)	62.35(55.39~73.69)	1.34(1.18~1.58)	39.36(35.01~45.90)	0.50(0.28~0.58)	13.69(7.75~15.86)	4.08(3.67~4.58)	115.39(103.90~129.34)
	合计	5.56(5.06~6.50)	79.17(72.38~92.20)	3.10(2.82~3.63)	47.57(43.53~55.35)	1.13(0.67~1.37)	15.73(9.37~18.91)	9.79(9.08~10.81)	142.48(132.43~157.50)
2015	男	3.55(2.95~4.35)	88.69(74.38~107.97)	2.07(1.73~2.52)	56.50(47.55~67.98)	0.68(0.30~0.95)	16.66(23.02~7.54)	6.31(5.38~7.45)	161.85(139.28~190.43)
	女	2.54(2.10~3.07)	60.90(50.58~73.49)	1.64(1.35~2.00)	41.22(34.33~49.84)	0.59(0.34~0.72)	13.81(7.93~16.78)	4.77(3.98~5.63)	115.92(97.38~136.39)
	合计	6.09(5.29~7.23)	74.59(64.97~88.01)	3.71(3.23~4.40)	48.61(42.57~57.30)	1.27(0.79~1.59)	15.28(9.55~18.99)	11.08(9.73~12.66)	138.48(122.24~157.53)
2017	男	3.69(2.96~4.62)	88.60(71.77~110.13)	2.18(1.78~2.68)	56.66(46.77~69.39)	0.74(0.32~1.07)	17.30(7.66~24.90)	6.61(5.39~8.14)	162.55(134.55~197.88)
	女	2.58(2.07~3.19)	58.96(47.48~72.71)	1.63(1.30~2.05)	38.95(47.42~48.95)	0.61(0.34~0.78)	13.73(7.71~17.38)	4.82(3.95~5.80)	111.64(91.75~134.17)
	合计	6.27(5.30~7.56)	73.44(62.36~88.15)	3.80(3.21~4.59)	47.42(40.43~56.72)	1.35(0.82~1.75)	15.54(9.41~19.85)	11.43(3.95~13.33)	136.41(117.26~158.14)
变化	男	139.61	2.86	289.29	54.51	-14.94	-63.03	122.56	-4.16
幅度(%)	女	20.00	-51.30	81.11	-31.82	-63.47	-84.53	2.12	-68.43
	合计	69.46	-29.19	160.27	1.81	-47.03	-77.13	48.63	-37.58
注：^a括号内表示95% UIs。

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表 2 湖南省1990-2017年卒中的YLLs、YLDs与其变化(/10万)^a

Table 2. YLLs, YLDs and changes caused by stroke in Hunan Province from 1990 to 2017 (/100 000)^a

年份(年)	性别	YLLs(万人年)	年龄标化YLL率	YLDs(万人年)	年龄标化YLD率
1990	男	65.39(58.21~76.43)	2935.99(2617.65~3417.26)	4.95(3.51~6.41)	201.19(143.47~259.19)
	女	98.35(86.20~121.66)	4552.58(3997.03~5667.79)	6.40(4.49~8.18)	270.29(191.13~345.34)
	合计	163.74(148.82~195.68)	3742.85(3404.47~4509.73)	11.35(8.11~14.47)	235.13(167.18~300.43)
1995	男	73.36(66.15~85.59)	2809.96(2545.52~3253.93)	5.84(4.13~7.49)	209.34(149.32~268.73)
	女	88.01(78.51~109.02)	3588.45(3207.68~4496.81)	6.95(4.88~8.93)	264.84(188.13~338.89)
	合计	161.37(148.90~192.2)	3189.46(2941.56~3833.43)	12.79(9.04~16.36)	236.15(168.80~301.83)
2000	男	91.05(80.87~103.08)	3020.05(2696.11~3407.41)	7.07(5.06~9.12)	224.55(160.54~287.46)
	女	73.91(65.08~88.35)	2598.35(2293.43~3129.91)	7.74(5.51~9.89)	259.92(186.10~331.96)
	合计	164.96(151.10~189.03)	2813.79(2584.03~3234.67)	14.82(10.57~18.94)	241.72(173.94~308.60)
2005	男	106.91(97.54~119.12)	3110.29(2851.75~3450.53)	8.22(5.89~10.51)	233.55(166.68~298.70)
	女	66.47(60.18~75.34)	1980.65(1797.18~2246.08)	8.73(6.21~11.15)	256.90(182.30~328.01)
	合计	173.38(161.06~190.94)	2547.58(2371.57~2806.83)	16.95(12.13~21.52)	245.21(175.58~310.79)
2010	男	109.30(97.69~123.23)	2817.05(2529.15~3170.49)	9.77(7.00~12.45)	247.35(177.85~315.95)
	女	65.71(58.89~74.00)	1693.99(1519.60~1908.07)	10.46(7.49~13.28)	270.29(193.72~344.66)
	合计	175.01(161.59~194.85)	2252.88(2084.48~2505.46)	20.22(14.49~25.64)	258.95(185.93~327.69)
2015	男	124.39(104.90~148.56)	2785.07(2362.77~3315.24)	12.88(9.19~16.54)	292.11(208.54~376.08)
	女	76.37(63.56~90.72)	1703.35(1418.65~2015.69)	13.95(9.94~17.86)	317.08(226.56~405.27)
	合计	200.76(174.80~230.89)	2245.53(1960.84~2579.16)	26.83(19.17~34.31)	304.73(218.38~391.19)
2017	男	127.47(103.05~158.59)	2753.51(2235.62~3393.69)	14.73(10.52~19.08)	319.67(228.21~411.87)
	女	76.10(61.64~93.01)	1618.25(1315.04~1972.89)	16.11(11.43~20.76)	346.57(245.84~446.02)
	合计	203.57(172.64~238.38)	2183.06(1862.24~2550.31)	30.83(22.00~39.60)	333.28(228.52~427.64)
变化	男	94.94	-6.22	197.58	58.89
幅度(%)	女	-22.62	-64.45	151.72	28.22
	合计	24.33	-41.67	171.63	41.74
注：^a括号内表示95%UIs。

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表 3 湖南省1990-2017年不同种卒中的DALYs与变化情况^a

Table 3. DALYs caused by stroke and changes in Hunan Province from 1990 to 2017^a

时间(年)	负担指标	脑出血	缺血性卒中	蛛网膜下腔出血	脑卒中合计
1990	DALYs(万人年)	82.71(68.91~128.42)	34.52(28.77~50.34)	57.87(23.05~71.46)	175.09(160.01~206.75)
	年龄标化DALY率(/10万)	1 864.03(1 552.75~2 917.66)	841.39(699.56~1 238.16)	1 272.55(479.15~1 576.35)	3 977.98(3 642.06~4 748.04)
1995	DALYs(万人年)	80.86(67.36~127.35)	34.34(28.37~51.28)	58.96(22.86~72.5)	174.16(161.03~204.99)
	年龄标化DALY率(/10万)	1 573.03(1 313.15~2 496.17)	718.25(596.51~1076.09)	1 134.32(417.06~1 397.05)	3 425.61(3 165.37~4 051.61)
2000	DALYs(万人年)	91.49(77.66~128.62)	39.80(33.48~53.95)	48.49(19.17~61.59)	179.78(165.57~203.54)
	年龄标化DALY率(/10万)	1 532.53(1 301.80~2 161.65)	714.46(603.89~967.39)	808.51(309.91~1 028.43)	3 055.51(2 819.92~3 476.85)
2005	DALYs(万人年)	108.73(97.99~130.87)	51.12(45.31~59.88)	30.49(15.82~37.34)	190.33(177.40~208.78)
	年龄标化DALY率(/10万)	1 572.31(1 420.91~1 889.94)	784.69(698.59~918.37)	435.79(222.57~533.39)	2 792.79(2 609.06~3 061.44)
2010	DALYs(万人年)	108.43(98.60~126.97)	62.62(56.21~71.71)	24.17(15.60~28.86)	195.23(180.18~215.77)
	年龄标化DALY率(/10万)	1 374.40(1 255.53~1 607.00)	832.58(748.28~951.51)	304.84(196.63~361.93)	2 511.83(2 323.42~2 776.29)
2015	DALYs(万人年)	120.74(104.23~142.70)	79.53(69.13~92.15)	27.32(17.68~34.31)	227.59(199.55~257.58)
	年龄标化DALY率(/10万)	1 333.45(1154.55~1582.06)	913.57(796.23~1 057.96)	303.23(197.21~378.85)	2 550.26(2 243.46~2 883.71)
2017	DALYs(万人年)	122.12(102.82~147.20)	83.76(71.68~98.03)	28.53(17.82~36.95)	234.41(76.83~270.24)
	年龄标化DALY率(/10万)	1 294.65(1 096.17~1 561.53)	917.64(789.18~1 070.71)	304.05(191.87~391.89)	2 516.34(1 635.78~2 896.3)
变化	DALYs(万人年)	47.65	142.64	-50.70	33.88
幅度(%)	年龄标化DALY率(/10万)	-30.55	9.06	-76.11	-36.74
注：^a括号内表示95%UIs。

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