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摘要:
目的 分析1990―2019年中国2型糖尿病(type 2 diabetes mellitus, T2DM)疾病负担。 方法 用2019全球疾病负担研究数据，分析中国T2DM疾病负担指标。 结果 2019年中国T2DM发病率、患病率、死亡率、伤残调整寿命年(disability adjusted life years, DALY)率、死亡寿命损失年(years of life lost, YLL)率及伤残寿命损失年(years lived with disability, YLD)率分别为262.88/10万、6 328.79/10万、11.84/10万、675.18/10万、234.65/10万及440.52/10万。与1990年相比，2019年中国T2DM发病率、患病率、死亡率、DALY率、YLL率和YLD率分别增高了63.56%、116.09%、118.67%、104.19%、80.32%和119.67%。2019年中国T2DM各项疾病负担指标经年龄标化后，均低于美国和全球相关标化指标。2019年中国男性T2DM疾病负担指标经标化后均高于女性。DALY率从1990年的330.67/10万上升至2019年的675.18/10万，升幅高达104.19%。 结论 中国T2DM各项疾病负担指标经标化后均低于美国和全球，但各项疾病指标无论粗化或标化后都呈现出逐年上升的趋势。因此，中国对T2DM的防治力度仍需进一步加强。 Abstract:Objective This study aims to evaluate the disease burden of type 2 diabetes mellitus(T2DM) in China from 1990 to 2019. Methods Data from the Global Burden of Disease Study 2019 data were employed to analyze the T2DM burden in China. Results In 2019, the rates of incidence, prevalence, mortality, disability adjusted life years (DALY), years of life lost (YLL), and years lived with disability (YLD) of T2DM in China were 262.88/100 000, 6 328.79/100 000, 11.84/100 000, 675.18/100 000, 234.65/100 000 and 440.52/100 000, respectively. These metrics showed an increase by 63.56%, 116.09%, 118.67%, 104.19%, 80.33% and 119.67%, respectively, in comparison to 1990. In 2019, the disease burden of T2DM in China, after standardized age, was lower than that in the United States and globally. In 2019, Chinese men exhibited a higher burden of T2DM compared to women after standardization. The DALY rate of T2DM increased from 330.67/100 000 in 1990 to 675.18/100 000 in 2019, marking an increase of 104.19%. Conclusions China′s standardized disease burden indicators for T2DM are lower than those of the United States and the world, but these indicators have been following an upward trajectory year after year, both in crude and after standardization. Therefore, China′s efforts to prevent and treat T2DM still need to be further strengthened. -
Key words:
- Type 2 diabetes mellitus /
- Disease burden /
- Morbidity /
- Mortality /
- Disability adjusted life year
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表 1 2019年中国、美国及全球T2DM疾病负担情况
Table 1. Disease burden of T2DM in China, the United States and the world in 2019
疾病负担 粗化/标化 中国 美国 全球 1990年/10万-1 2019年/10万-1 增幅/% 1990年/10万-1 2019年/10万-1 增幅/% 1990年/10万-1 2019年/10万-1 增幅/% 发病率 粗化 160.72 262.88 63.56 259.26 477.53 84.19 157.23 280.07 78.13 标化 174.27 201.06 15.37 241.18 360.83 49.61 184.55 259.94 40.85 患病率 粗化 2 928.78 6 328.79 116.09 5 474.54 11 036.93 101.60 2 774.93 5 659.56 103.95 标化 3 669.15 4 496.38 22.55 4 657.63 7 145.57 53.42 3 546.54 5 282.85 48.96 死亡率 粗化 5.41 11.84 118.85 17.32 22.38 29.21 11.34 19.04 67.90 标化 8.63 9.17 6.26 13.40 12.67 -5.44 16.69 18.49 26.91 YLD率 粗化 200.54 440.52 119.67 406.30 842.06 107.25 217.33 454.29 108.99 标化 256.44 309.16 20.56 342.75 534.14 55.84 282.05 423.72 50.23 YLL率 粗化 130.13 234.65 80.32 337.90 416.39 23.23 258.91 402.58 55.49 标化 179.38 167.36 -6.70 276.00 255.84 -7.30 346.28 377.82 9.11 DALY率 粗化 330.67 675.18 104.19 744.19 1 258.44 69.10 476.24 856.87 79.92 标化 435.81 476.52 9.34 618.75 789.98 27.67 628.33 801.55 27.57 注：1. YLD：伤残寿命损失年。2. YLL：死亡寿命损失年。3. DALY：伤残调整寿命年。 
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表 2 1990年和2019年中国T2DM疾病负担性别分布情况
Table 2. Disease burden of T2DM with gender distribution in China between 1990 and 2019
疾病负担 粗化/标化 男性 女性 1990年/10万-1 2019年/10万-1 增幅/% 1990年/10万-1 2019年/10万-1 增幅/% 发病率 粗化 160.90 265.66 59.52 160.54 260.00 61.95 标化 172.39 212.66 23.36 177.63 189.19 6.51 患病率 粗化 2 919.62 6 631.92 127.15 2 938.53 6 013.81 104.65 标化 3 704.89 4 902.43 32.32 3 620.97 4 089.43 12.94 死亡率 粗化 4.37 11.48 162.70 6.53 12.22 87.14 标化 8.15 10.45 28.22 9.33 8.49 -9.00 YLD率 粗化 199.48 460.66 130.93 201.67 419.59 108.06 标化 260.43 336.75 29.31 251.98 281.96 11.90 YLL率 粗化 110.11 239.00 117.06 151.42 230.15 52.00 标化 162.78 185.85 14.17 197.54 153.42 -22.33 DALY率 粗化 309.59 699.65 126.00 353.09 649.74 84.02 标化 423.21 522.61 23.49 449.52 435.37 -3.15 注：1. T2DM：2型糖尿病。2. YLD：伤残寿命损失年。3. YLL：死亡寿命损失年。4 DALY：伤残调整寿命年。
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表 3 2019年中国不同年龄段人群T2DM疾病负担
Table 3. T2DM disease burden of different age groups in China, 2019
单位: 10万-1 年龄组/岁 发病率 死亡率 患病率 DALY率 YLD率 YLL率 15~<20 88.59 0.04 171.90 11.20 8.59 2.61 20~<25 191.27 0.10 898.20 52.64 45.68 6.96 25~<30 210.59 0.15 1 921.43 108.94 99.58 9.36 30~<35 233.34 0.38 2 971.92 181.96 160.44 21.51 35~<40 301.84 0.71 4 303.30 283.23 246.50 36.73 40~<45 369.34 1.37 5 911.54 421.20 357.29 63.90 45~<50 436.82 2.94 7 835.10 620.00 496.88 123.12 50~<55 446.11 5.80 9 934.44 881.07 665.93 215.14 55~<60 401.10 10.69 11 910.90 1 196.44 849.90 346.54 60~<65 383.48 19.11 13 647.71 1 561.18 1 029.60 531.57 65~<70 389.33 34.08 15 234.74 1 999.13 1 205.00 794.13 70~<75 335.10 61.94 16 553.55 2 495.55 1 314.73 1 180.82 75~<80 227.27 93.52 17 306.21 2 736.70 1 327.73 1 408.97 80~<85 131.42 133.38 17 258.29 2 816.50 1 273.95 1 542.55 85~<90 49.10 195.71 16 383.97 2 895.68 1 162.45 1 733.23 90~<95 10.17 214.71 14 764.04 2 480.35 1 003.24 1 477.11 ≥95 6.29 247.67 13 060.42 2 135.90 846.54 1 289.35 注：1. T2DM：2型糖尿病。2. DALY：伤残调整寿命年。3. YLD：伤残寿命损失年。4. YLL：死亡寿命损失年。
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表 4 1990―2019年中国、美国和全球T2DM疾病负担指标变化趋势
Table 4. Trends of T2DM disease burden indicators in China, the United States and the world between 1990 and 2019
指标 APC/% 95% CI P值 中国 标化发病率 0.44 0.13~0.74 < 0.05 标化死亡率 0.23 0.07~0.39 0.005 标化DALY率 0.24 -0.02~0.50 0.076 标化YLL率 -0.20 -0.42~0.01 0.061 标化YLD率 0.59 0.29~0.88 < 0.001 美国 标化发病率 1.36 1.02~1.70 < 0.001 标化死亡率 -0.17 -0.42~0.09 0.201 标化DALY率 0.84 0.69~1.00 < 0.001 标化YLL率 -0.26 -0.41~-0.11 0.001 标化YLD率 1.49 1.15~1.83 < 0.001 全球 标化发病率 1.18 1.13~1.22 < 0.001 标化死亡率 0.37 0.32~0.41 < 0.001 标化DALY率 0.82 0.74~0.90 < 0.001 标化YLL率 0.32 0.25~0.38 < 0.001 标化YLD率 1.39 1.29~1.49 < 0.001 注：1. T2DM：2型糖尿病。2. DALY：伤残调整寿命年。3. YLL：死亡寿命损失年。4. YLD：伤残寿命损失年。5. APC：年度百分比变化。
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表 5 1990―2019年中国T2DM危险因素的疾病负担
Table 5. Burden of disease attributable to risk factors in China′s T2DM from 1990 to 2019
危险因素 DALY 标化DALY率 1990年/万人年 2019年/万人年 变化率/% 1990年/10万-1 2019年/10万-1 变化率/% 高空腹血糖 391.40 960.34 145.36 435.81 476.52 9.34 BMI过高 77.18 373.76 383.49 80.20 181.54 126.36 环境颗粒污染物 29.08 181.60 524.48 32.64 89.70 174.82 抽烟 57.07 142.01 148.83 61.76 68.42 10.78 被动吸烟 47.86 104.90 119.18 53.80 51.49 -4.29 红肉摄入过多 25.03 101.64 306.07 27.48 49.77 81.11 全谷物摄入不足 19.06 48.02 151.94 21.36 23.70 10.96 体力活动较低 18.07 45.21 150.19 23.64 23.61 -0.13 固体燃料对家庭空气的污染 67.81 43.37 -36.04 76.12 21.31 -72.00 水果摄入过少 31.94 39.79 24.58 35.55 20.01 -43.71 加工肉制品摄入过量 6.54 33.00 404.59 7.21 16.14 123.86 低温 14.49 30.64 111.46 16.87 15.33 -9.13 含糖饮料摄入过多 13.78 25.88 87.81 15.59 12.89 -17.32 低纤维饮食 13.28 18.23 37.27 14.73 9.12 -38.09 坚果和种子摄入不足 9.46 17.47 84.67 10.66 8.70 -18.39 饮酒 0.47 10.90 2 219.15 0.20 5.22 2 510.00 高温 0.40 1.13 182.50 0.47 0.57 21.28 注：1. T2DM：2型糖尿病。2. DALY：伤残调整寿命年。
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