Analysis of disease burden and risk factors of Alzheimer disease in China from 1990 to 2019
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摘要:
目的 分析1990—2019年中国阿尔茨海默病(Alzheimer disease, AD)与其他痴呆症的疾病负担变化趋势及其危险因素，为合理配置卫生资源和制定针对AD与其他痴呆症防治策略提供依据。 方法 收集2019年全球疾病负担(global burden of disease 2019, GBD 2019)研究中1990、2000、2010和2019年中国AD与其他痴呆症疾病负担的相关数据，采用伤残损失健康寿命年(years lived with disability, YLD)、死亡损失寿命年(years of life lost, YLL)、伤残调整寿命年(disability adjusted life years, DALY)、人群归因分值(population attributable fraction, PAF)等指标对1990—2019年中国AD与其他痴呆症及其危险因素疾病负担进行描述，并对比分析与全球AD疾病负担的差异性。 结果 2019年中国AD的YLD率、YLL率和DALY率均随年龄增大而升高，其中≥95岁人群疾病负担最重。中国1990—2019年AD的标化YLD率、YLL率和DALY率分别增加了1.35%、-0.12%和0.29%，全球的标化YLD率、YLL率和DALY率分别增加了0.28%、0.15%和0.19%。1990—2019年中国AD危险归因分析可见，行为因素和代谢因素均导致AD疾病负担的增加。女性由行为因素造成的疾病风险高于男性，而由代谢因素造成的疾病风险低于男性。 结论 尽管AD的疾病负担仍持续增加，但可以通过对包括行为和代谢因素等危险因素制定有针对性的预防和控制策略来进行有效控制。 Abstract:Objective To analyze the trend and their risk factors of the burden of Alzheimer disease (AD) and other dementia in China from 1990 to 2019, and to provide theoretical foundation for rational allocation of health resources and developing strategies for the prevention and treatment of AD and other dementias. Methods The data of disease burden of AD and other dementias in China in 1990, 2000, 2010, and 2019 were collected from the global burden of disease 2019 study (GBD 2019). Indicators such as years lived with disability (YLD), years of life lost (YLL), disability adjusted life years (DALY) and population attributable fraction (PAF) were used to describe the disease burden and risk factors of AD and other dementias in China from 1990 to 2019. The differences in disease burden of AD between China and the world were compared. Results In 2019, disease burden such as YLD, YLL and DALY of AD in China increased with age, and the highest disease burden was found in people over 95 years old. From 1990 to 2019, the age standardized YLD rate, YLL rate, and DALY rate of AD in China increased by 1.35%, -0.12%, and 0.29%, respectively. However, the global standardized YLD rate, YLL rate and DALY rate increased by 0.28%, 0.15% and 0.19%, respectively. The risk attribution analysis of AD in China from 1990 to 2019 showed that both behavioral and metabolic factors contributed to the increase of the disease burden of AD. The risk of disease due to behavioral factors was higher in females than in males. However, the risk of disease due to metabolic factors was higher in males. Conclusions Although the burden of AD continues to increase, it can still be effectively controlled through the development of targeted prevention and control strategies for risk factors, including behavioral and metabolic factors. -
Key words:
- Alzheimer disease /
- Risk factors /
- Disease burden /
- Dementia
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图 1 1990—2019年不同人群的AD标化发病率趋势的Joinpoint回归分析
AD：阿尔茨海默病。
Figure 1. Joinpoint regression analysis of trends in the standardized incidence of AD in different populations from 1990 to 2019
AD: Alzheimer disease.
表 1 1990—2019年中国AD疾病负担及其变化趋势
Table 1. Disease burden of AD and its changing trend in China, 1990-2019
指标Index 年份Year YLD率/10万-1 YLD rate/100 000-1 YLL率/10万-1 YLL rate/100 000-1 DALY率/10万-1 DALY rate/100 000-1 男性Male 女性Female 合计Total 男性Male 女性Female 合计Total 男性Male 女性Female 合计Total 50~54岁years 1990 23.30 25.61 24.39 82.44 93.22 87.52 105.74 118.84 111.90 1999 23.86 25.93 24.86 79.93 89.08 84.32 103.79 115.02 109.18 2009 24.97 27.46 26.18 78.39 85.91 82.06 103.36 113.37 108.24 2019 26.31 28.99 27.64 72.24 78.63 75.42 98.54 107.62 103.06 ARC/% 1990—2000 0.24 0.12 0.19 -0.31 -0.45 -0.37 -0.19 -0.33 -0.25 2000—2010 0.45 0.57 0.52 -0.19 -0.36 -0.27 -0.04 -0.14 -0.09 2010—2019 0.58 0.61 0.61 -0.90 -0.98 -0.93 -0.53 -0.58 -0.54 1990—2019 0.64 0.65 0.66 -0.69 -0.89 -0.78 -0.37 -0.52 -0.43 55~59岁years 1990 50.37 55.83 52.97 180.73 207.50 193.46 231.09 263.33 246.43 1999 53.31 57.98 55.54 174.48 191.92 182.82 227.79 249.90 238.36 2009 56.49 61.31 58.87 179.95 208.91 194.26 236.44 270.22 253.13 2019 61.34 67.56 64.44 166.01 191.37 178.63 227.36 258.93 243.07 ARC/% 1990—2000 0.57 0.38 0.48 -0.35 -0.78 -0.56 -0.14 -0.52 -0.33 2000—2010 0.58 0.56 0.58 0.31 0.85 0.61 0.37 0.78 0.60 2010—2019 0.92 1.08 1.01 -0.89 -0.97 -0.93 -0.43 -0.47 -0.45 1990—2019 2.21 2.14 2.20 -0.94 -0.89 -0.88 -0.18 -0.19 -0.15 60~64岁years 1990 95.20 108.76 101.77 340.08 404.23 371.18 435.27 513.00 472.96 1999 108.17 119.88 113.78 331.57 382.71 356.08 439.74 502.59 469.87 2009 115.08 125.59 120.22 360.07 432.15 395.32 475.15 557.74 515.55 2019 126.09 139.44 132.73 334.95 403.34 368.98 461.04 542.77 501.71 ARC/% 1990—2000 1.29 0.98 1.12 -0.25 -0.55 -0.41 0.10 -0.20 -0.07 2000—2010 0.62 0.47 0.55 0.83 1.22 1.05 0.78 1.05 0.93 2010—2019 1.02 1.17 1.11 -0.80 -0.76 -0.76 -0.33 -0.30 -0.30 1990—2019 3.17 2.80 2.99 -0.17 -0.02 -0.07 0.64 0.63 0.66 65~69岁years 1990 161.36 195.88 178.91 573.72 704.79 640.35 735.08 900.67 819.25 1999 193.45 230.21 211.65 554.35 661.82 607.55 747.79 892.04 819.20 2009 204.92 238.56 221.49 601.01 734.14 666.57 805.93 972.70 888.06 2019 223.26 262.43 243.20 569.12 696.76 634.11 792.38 959.19 877.32 ARC/% 1990—2000 1.83 1.63 1.69 -0.34 -0.63 -0.52 0.17 -0.10 0.00 2000—2010 0.58 0.36 0.46 0.81 1.04 0.93 0.75 0.87 0.81 2010—2019 0.96 1.07 1.04 -0.60 -0.58 -0.55 -0.19 -0.16 -0.14 1990—2019 1.72 1.55 1.63 -0.04 -0.06 -0.05 0.40 0.33 0.36 70~74岁years 1990 331.66 430.64 384.75 933.44 1 196.15 1 074.33 1 265.10 1 626.79 1 459.08 1999 403.43 530.09 468.73 902.46 1 139.40 1 024.61 1 305.89 1 669.49 1 493.33 2009 426.51 547.17 487.04 982.31 1 224.18 1 103.63 1 408.82 1 771.34 1 590.67 2019 463.14 602.24 534.44 941.42 1 176.62 1 061.97 1 404.56 1 778.86 1 596.40 ARC/% 1990—2000 1.98 2.10 1.99 -0.34 -0.48 -0.47 0.32 0.26 0.23 2000—2010 0.56 0.32 0.38 0.85 0.72 0.75 0.76 0.59 0.63 2010—2019 0.92 1.07 1.04 -0.47 -0.44 -0.43 -0.03 0.05 0.04 1990—2019 1.77 1.78 1.74 0.04 -0.09 -0.06 0.55 0.47 0.47 75~79岁years 1990 628.26 859.36 759.91 1 627.68 2 212.06 1 960.58 2 255.95 3 071.43 2 720.49 1999 757.47 1 061.22 925.00 1 573.34 2 081.00 1 853.34 2 330.80 3 142.22 2 778.35 2009 795.62 1 088.56 950.40 1 746.15 2 237.14 2 005.58 2 541.78 3 325.70 2 955.98 2019 863.48 1 196.18 1 038.60 1 665.32 2 133.84 1 911.93 2 528.81 3 330.02 2 950.53 ARC/% 1990—2000 1.89 2.13 1.99 -0.34 -0.61 -0.56 0.33 0.23 0.21 2000—2010 0.49 0.25 0.27 1.05 0.73 0.79 0.87 0.57 0.62 2010—2019 0.91 1.05 0.99 -0.53 -0.52 -0.53 -0.06 0.01 -0.02 1990—2019 1.69 1.76 1.66 0.12 -0.19 -0.13 0.60 0.43 0.43 80~84岁years 1990 1 461.65 2 043.27 1 818.88 3 933.21 5 486.99 4 887.53 5 394.86 7 530.26 6 706.41 1999 1 721.42 2 426.38 2 147.29 3 871.94 5 201.01 4 674.85 5 593.36 7 627.39 6 822.14 2009 1 800.76 2 471.26 2 186.77 4 246.31 5 481.02 4 957.15 6 047.07 7 952.28 7 143.92 2019 1 962.60 2 683.94 2 367.10 4 067.13 5 217.81 4 712.38 6 029.73 7 901.74 7 079.48 ARC/% 1990—2000 1.65 1.73 1.67 -0.16 -0.53 -0.44 0.36 0.13 0.17 2000—2010 0.45 0.18 0.18 0.93 0.53 0.59 0.78 0.42 0.46 2010—2019 0.96 0.92 0.88 -0.48 -0.55 -0.56 -0.03 -0.07 -0.10 1990—2019 1.56 1.45 1.40 0.18 -0.26 -0.19 0.59 0.25 0.29 85~89岁years 1990 2 334.71 3 232.45 2 952.37 6 987.88 9 464.96 8 692.14 9 322.60 12 697.41 11 644.51 1999 2 695.47 3 667.51 3 351.29 6 965.32 9 241.85 8 501.26 9 660.79 12 909.36 11 852.55 2009 2 810.94 3 725.37 3 423.81 7 579.83 9 367.65 8 778.07 10 390.78 13 093.02 12 201.88 2019 3 089.05 4 016.90 3 692.05 7 348.73 8 958.48 8 394.89 10 437.78 12 975.38 12 086.94 ARC/% 1990—2000 1.45 1.27 1.28 -0.03 -0.24 -0.22 0.36 0.17 0.18 2000—2010 0.42 0.16 0.21 0.85 0.14 0.32 0.73 0.14 0.29 2010—2019 1.05 0.84 0.84 -0.34 -0.50 -0.49 0.05 -0.10 -0.11 1990—2019 1.48 1.15 1.18 0.27 -0.29 -0.18 0.60 0.11 0.20 90~94岁years 1990 3 366.72 4 532.20 4 307.90 10 678.81 13 651.76 13 079.61 14 045.53 18 183.96 17 387.51 1999 3 865.89 5 025.84 4 793.06 10 556.12 13 340.70 12 781.88 14 422.02 18 366.54 17 574.94 2009 3 988.05 5 117.55 4 916.75 11 954.13 13 999.78 13 636.10 15 942.18 19 117.34 18 552.85 2019 4 426.48 5 453.83 5 276.96 11 618.24 13 591.63 13 251.88 16 044.72 19 045.45 18 528.84 ARC/% 1990—2000 1.39 1.04 1.07 -0.12 -0.23 -0.23 0.26 0.10 0.11 2000—2010 0.31 0.18 0.26 1.25 0.48 0.65 1.01 0.40 0.54 2010—2019 1.17 0.71 0.79 -0.32 -0.33 -0.32 0.07 -0.04 -0.01 1990—2019 1.45 0.98 1.07 0.44 -0.02 0.07 0.70 0.24 0.34 ≥95岁years 1990 4 637.21 6 064.25 5 867.66 14 373.06 18 651.47 18 062.07 19 010.28 24 715.72 23 929.73 1999 5 261.87 6 599.62 6 420.54 13 861.40 17 539.90 17 047.48 19 123.28 24 139.51 23 468.03 2009 5 337.57 6 755.72 6 574.48 16 165.76 19 297.40 18 897.17 21 503.33 26 053.12 25 471.65 2019 5 881.54 7 066.06 6 970.11 16 271.13 18 875.74 18 664.75 22 152.67 25 941.79 25 634.86 ARC/% 1990—2000 1.27 0.85 0.90 -0.36 -0.61 -0.58 0.06 -0.24 -0.19 2000—2010 0.14 0.23 0.24 1.55 0.96 1.04 1.18 0.77 0.82 2010—2019 1.08 0.50 0.65 0.07 -0.25 -0.14 0.33 -0.05 0.07 1990—2019 1.26 0.81 0.91 0.65 0.06 0.17 0.81 0.26 0.36 合计Total 1990 27.43 51.50 39.09 83.63 152.22 116.86 111.06 203.72 155.95 1999 40.85 75.61 57.67 102.63 180.48 140.31 143.48 256.10 197.99 2009 60.56 106.44 82.95 155.49 263.03 207.96 216.05 369.47 290.91 2019 94.36 169.08 131.00 212.40 369.04 289.22 306.77 538.12 420.22 ARC/% 1990—2000 4.06 3.91 3.97 2.07 1.72 1.85 2.59 2.31 2.42 2000—2010 4.02 3.48 3.70 4.24 3.84 4.01 4.18 3.73 3.92 2010—2019 5.05 5.28 5.21 3.53 3.83 3.73 3.97 4.27 4.17 1990—2019 6.72 6.46 6.57 5.03 4.77 4.89 5.49 5.25 5.36 注：AD, 阿尔茨海默病；YLL，早死损失寿命年；YLD，伤残损失寿命年；DALY，伤残调整寿命年；ARC，年均变化率。
Note: AD, Alzheimer disease; YLL, years of life loss; YLD, years lived with disability; DALY, disability adjusted life years; ARC, annual rate of change.
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表 2 1990—2019年中国与全球AD疾病负担趋势比较
Table 2. Comparison of trends in the burden of AD in China and globally, 1990-2019
指标Index 年龄标化YLD率/10万-1 Age-standardized YLD rate/100 000-1 年龄标化YLL率/10万-1 Age-standardized YLL rate/100 000-1 年龄标化DALY率/10万-1 Age-standardized DALY rate/100 000-1 中国China 全球Globally 中国China 全球Globally 中国China 全球Globally 男性Male 女性Female 合计Total 男性Male 女性Female 合计Total 男性Male 女性Female 合计Total 男性Male 女性Female 合计Total 男性Male 女性Female 合计Total 男性Male 女性Female 合计Total 年份Year 1990 72.90 96.96 88.39 79.51 101.90 93.71 217.24 284.46 260.15 209.72 245.97 232.99 290.15 381.42 348.54 289.24 347.87 326.71 2000 85.11 112.66 102.32 80.57 104.18 95.37 212.75 271.81 249.95 212.17 249.11 235.61 297.86 384.48 352.27 292.73 353.29 330.99 2009 89.03 115.41 105.24 82.22 105.46 96.52 233.33 287.65 266.23 220.39 256.87 243.02 322.36 403.07 371.47 302.61 362.33 339.53 2019 97.27 125.25 114.07 85.12 108.04 98.86 224.00 274.60 254.42 219.36 253.16 239.78 321.28 399.85 368.49 304.47 361.20 338.64 ARC/% 1990—2000 1.56 1.51 1.47 0.13 0.22 0.18 -0.21 -0.45 -0.40 0.12 0.13 0.11 0.26 0.08 0.11 0.12 0.15 0.13 2000—2010 0.45 0.24 0.28 0.20 0.12 0.12 0.93 0.57 0.63 0.38 0.31 0.31 0.79 0.47 0.53 0.33 0.25 0.26 2010—2019 0.99 0.91 0.90 0.39 0.27 0.27 -0.45 -0.51 -0.50 -0.05 -0.16 -0.15 -0.04 -0.09 -0.09 0.07 -0.03 -0.03 1990—2019 1.53 1.36 1.35 0.36 0.31 0.28 0.16 -0.19 -0.12 0.24 0.15 0.15 0.54 0.25 0.29 0.27 0.20 0.19 注：AD, 阿尔茨海默病；ARC，年均变化率; YLL，早死损失寿命年；YLD，伤残损失寿命年；DALY，伤残调整寿命年。
Note: AD, Alzheimer disease; ARC, annual rate of change; YLL, years of life loss; YLD, years lived with disability; DALY, disability adjusted life years.
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表 3 1990—2019中国AD标准化发病率的变化趋势
Table 3. Changes in the standardized incidence of AD in China from 1990 to 2019
指标Index 标化发病率Standardized incidence rate 1990年year 2019年year 年份Period APC/% (95% CI) AAPC/% t值value P值value 合计Total 90.44 103.82 1990—1993 1.956(1.818~2.094) 0.479 25.165 < 0.001 1993—1996 0.592(0.323~0.861) 1996—2006 -0.029(-0.053~-0.006) 2006—2010 0.120(-0.009~0.250) 2010—2016 1.031(0.971~1.090) 2016—2019 -0.021(-0.154~0.111) 女性Female 100.28 115.24 1990—1992 2.537(2.277~2.797) 0.486 27.704 < 0.001 1992—1995 1.154(0.904~1.405) 1995—2003 -0.103(-0.136~-0.071) 2003—2010 0.052(0.012~0.092) 2010—2016 1.026(0.971~1.081) 2016—2019 -0.022(-0.146~0.102) 男性Male 75.14 89.65 1990—1994 1.612(1.505~1.718) 0.608 38.089 < 0.001 1994—1999 0.518(0.416~0.620) 1999—2010 0.124(0.098~0.149) 2010—2016 1.209(1.135~1.284) 2016—2019 0.010(-0.157~0.178) 注: AD, 阿尔茨海默病; APC，年度变化百分比; AAPC, 年均变化百分比。
Note: AD, Alzheimer disease; APC, annual percent change; AAPC, average annual percent change.
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表 4 中国1990—2019年AD种危险因素DALY率顺位表
Table 4. Ranking table of the DALY rate of AD risk factors in China from 1990 to 2019
危险因素Risk factor 1990年/10万-1 year/100 000-1 2000年/10万-1 year/100 000-1 2010年/10万-1 year/100 000-1 2019年/10万-1 year/100 000-1 行为因素Behavioural risks 30.18 46.02 62.78 83.40 吸烟Smoking 30.18 46.02 62.78 83.40 代谢因素Metabolic risks 16.25 24.84 42.81 62.16 高空腹血糖High fasting plasma glucose 10.51 15.39 24.89 33.55 高BMI High BMI 6.16 10.23 19.55 31.12 综合因素All risk factors 43.47 65.44 96.88 133.21 注: AD, 阿尔茨海默病；DALY，伤残调整寿命年。
Note: AD, Alzheimer disease; DALY, disability adjusted life years.
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表 5 1990年和2019年AD危险因素分性别PAF值
Table 5. PAF values of AD risk factors by sex in 1990 and 2019
危险因素Risk factor 1990年/% year/% 2019年/% year/% 男性Male 女性Female 合计Total 男性Male 女性Female 合计Total 行为因素Behavioural risks 11.18 66.48 30.56 16.61 68.24 37.39 吸烟Smoking 11.18 66.48 30.56 16.61 68.24 37.39 代谢因素Metabolic risks 80.32 29.78 62.61 71.13 26.92 53.33 高空腹血糖High fasting plasma glucose 92.71 73.05 85.82 85.05 59.62 74.81 高BMI High BMI 87.14 54.82 75.81 84.93 64.33 76.63 注: AD, 阿尔茨海默病; PAF, 人群归因分值。
Note: AD, Alzheimer disease; PAF, population attributable faction.
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