2000–2021年中国60岁及以上老年人群死亡谱变化特征

张彩婧; 蔡羽琪; 陈子菲; 王童岩; 田丹; 彭瑞莎; 胡国清; 宁佩珊

doi:10.16462/j.cnki.zhjbkz.2025.09.002

2000–2021年中国60岁及以上老年人群死亡谱变化特征

doi: 10.16462/j.cnki.zhjbkz.2025.09.002

中南大学湘雅公共卫生学院流行病与卫生统计学系，长沙 410013

基金项目:

国家重点研发计划 2022YFC3603000

详细信息

通讯作者:
宁佩珊, E-mail: ningpeishan@csu.edu.cn

中图分类号: R211;R195
计量
- 文章访问数: 11
- HTML全文浏览量: 3
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-02-24
- 修回日期: 2025-05-06
- 网络出版日期: 2025-10-10
- 刊出日期: 2025-09-10

Characteristics of the death spectrum of the elderly aged 60 and above in China from 2000 to 2021

Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410013, China

Funds:

National Key Research and Development Plan 2022YFC3603000

More Information

Corresponding author: NING Peishan, E-mail: ningpeishan@csu.edu.cn

摘要

摘要: 目的分析2000–2021年中国≥60岁老年人群死亡谱的变化特征，为优化医疗资源配置、促进健康老龄化提供参考。方法利用2021年全球疾病负担估算数据，计算中国≥60岁老年人群不同疾病的年龄标化死亡率、年龄别死亡率及其构成比、死因顺位。采用面积图和Joinpoint回归分析反映2000–2021年老年人群死亡谱的变化特征，采用平均年度变化百分比(average annual percent change, AAPC)及其95% CI量化总体变化趋势。结果 2000–2021年中国≥60岁老年人群的年龄标化死亡率从4 863.8/10万下降至3 573.2/10万(AAPC=-1.5%, 95% CI: -1.9%~-1.1%)。其中，肠道感染(AAPC=-6.9%, 95% CI: -7.1%~-6.7%)、其他传染病(AAPC=-3.8%, 95% CI: -4.3%~-3.3%)、被忽视的热带病和疟疾(AAPC=-4.6%, 95% CI: -5.0%~-4.2%)下降趋势最大(均P < 0.05)；而人类免疫缺陷病毒/艾滋病和性传播疾病(AAPC=3.5%, 95% CI: 2.1%~5.1%)、神经系统疾病(AAPC=0.8%, 95% CI: 0.6%~0.9%)呈上升趋势(均P < 0.05)。与2000年相比，2021年老年人群死亡谱发生变化。2021年年龄标化死亡率前5位疾病为心血管病、肿瘤、慢性呼吸系统疾病、神经系统疾病、糖尿病和肾病，分别占当年全死因死亡率的47.2%、21.7%、13.2%、6.0%和3.3%。2021年≥60岁年龄组男性的年龄标化死亡率(4 195.5/10万)总体高于女性(3 000.6/10万)，但其死亡谱构成相似。随着年龄增长，高龄老年人的年龄别死亡率快速上升，其中≥80岁年龄组人群的死亡率达13 583.3/10万，不同年龄组老年人的死亡谱构成存在差异。结论 2000–2021年中国≥60岁老年人群的死亡谱发生变化，心血管病、肿瘤和慢性呼吸系统疾病的年龄标化死亡率虽呈现出下降趋势，但仍是当前老年人群最主要的健康威胁。针对老年人群死亡谱变化，相关部门应及时调整疾病防控策略，加大对上述重点疾病的防控力度，通过加强高危人群疾病筛查、生活方式干预等措施，推动实现健康老龄化的战略目标。
- 老年人群 /
- 死亡谱 /
- 变化特征
Abstract: Objective To analyze the characteristics of changes in the death spectrum among the elderly population aged 60 years and older in China from 2000 to 2021, thereby providing references for optimizing the allocation of medical resources and promoting healthy aging. Methods Based on the Global Burden of Disease (GBD) 2021 estimates, we calculated age-standardized mortality rates, age-specific mortality rates, proportion of mortality by disease, rankings of causes of death for diseases among the elderly population aged 60 years and older in China. An area map and Joinpoint regression analysis were employed to reflect the temporal changes in the death spectrum among the elderly population from 2000 to 2021. The average annual percent change (AAPC) and its 95% CI were used to quantify the overall changing trend. Results From 2000 to 2021, the overall age-standardized mortality rate for the elderly population aged 60 years and older in China decreased from 4 863.8 to 3 573.2 per 100 000 (AAPC=-1.5%, 95% CI: -1.9%-1.1%). Among them, enteric infections (AAPC=-6.9%, 95% CI: -7.1-6.7), other infectious diseases (AAPC=-3.8%, 95% CI: -4.3%-3.3%), neglected tropical diseases and malaria (AAPC=-4.6%, 95% CI: -5.0%-4.2%) showed the most significant declines (all P < 0.05). Conversely, human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infections (AAPC=3.5%, 95% CI: 2.1%-5.1%) and neurological disorders (AAPC=0.8%, 95% CI: 0.6%-0.9%) exhibited an upward trend (all P < 0.05). Compared to 2000, the death spectrum of the elderly population in 2021 underwent significant changes. In 2021, the top five age-standardized mortality rate diseases were cardiovascular diseases, neoplasms, chronic respiratory diseases, neurological disorders, as well as diabetes and kidney diseases. These diseases accounted for 47.2%, 21.7%, 13.2%, 6.0%, and 3.3%, respectively. In 2021, the age-standardized mortality rate for elderly males (4 195.5 per 100 000) was consistently higher than that for females (3 000.6 per 100 000), despite similarities in their overall death spectrum. With increasing age, the age-specific mortality rate among the elderly increased rapidly; among those aged 80 years and older, the mortality rate reached 13 583.3 per 100 000, and the death spectrum varied across different age groups within the elderly population. Conclusions Between 2000 and 2021, the death spectrum of the elderly population aged 60 years and older in China underwent substantial changes. Although there has been a decline in age-standardized mortality rates for cardiovascular diseases, neoplasms, and chronic respiratory diseases, these conditions remain the most significant health threats to the current elderly population. In view of the changes in the mortality spectrum of the elderly population, relevant departments should adjust the disease prevention and control strategies in a timely manner, increase the prevention and control of the above-mentioned key diseases, and promote the realization of the strategic goal of healthy aging by strengthening disease screening and lifestyle interventions for high-risk groups.
- Elderly population /
- Death spectrum /
- Change characteristics

HTML全文

图 1 2000–2021年中国≥60岁老年人群死亡谱变化特征

图中“其他”包含死因顺位在第11位及以后的9类疾病(包括肠道感染、人类免疫缺陷病毒/艾滋病和性传播疾病、肌肉骨骼疾病、被忽视的热带病和疟疾、营养缺乏、其他传染病、其他非传染性疾病、皮肤病和皮下疾病、物质使用障碍)，因其年龄标化死亡率相对较低(低于15.4/10万)，故在图中合并呈现。

Figure 1. Change characteristics of death spectrum among the elderly population aged 60 years and older in China from 2000 to 2021

"Others" in the figure includes 9 types of diseases ranked 11 th and lower in the order of causes of death (including: enteric infections, human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infections, musculoskeletal diseases, neglected tropical diseases and malaria, nutritional deficiencies, other infectious diseases, other non-communicable diseases, skin and subcutaneous diseases, and substance use disorders). These are aggregated in the figure due to their relatively low age-standardized mortality rates (less than 15.4/100 000).

下载: 全尺寸图片幻灯片

图 2 2021年中国≥60岁老年人群不同性别、不同疾病类型的年龄标化死亡率

图中“其他”包含死因顺位在第11位及以后的9类疾病(包括：其他非传染性疾病、肌肉骨骼疾病、营养缺乏、其他传染病、皮肤病和皮下疾病、人类免疫缺陷病毒/艾滋病和性传播疾病、肠道感染、物质使用障碍、被忽视的热带病和疟疾)，因其死亡率相对较低(低于14.9/10万)，故在图中合并呈现。

Figure 2. Age-standardized mortality rates of the elderly population aged 60 years and older by gender and disease type in China in 2021

"Others" in the figure includes 9 types of diseases ranked 11th and lower in the order of cause of death (including: other non-communicable diseases, musculoskeletal diseases, nutritional deficiencies, other infectious diseases, skin and subcutaneous diseases, human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infections, enteric infections, substance use disorders, neglected tropical diseases and malaria). These are aggregated in the figure due to their relatively low mortality rates (less than 14.9 per 100 000).

下载: 全尺寸图片幻灯片

图 3 2021年中国≥60岁老年人群不同年龄组、不同疾病类型的死亡率

图中“其他”包含死因顺位在第11位及以后的9类疾病(包括：其他非传染性疾病、肌肉骨骼疾病、营养缺乏、其他传染病、皮肤病和皮下疾病、人类免疫缺陷病毒/艾滋病和性传播疾病、肠道感染、物质使用障碍、被忽视的热带病和疟疾)，因其死亡率相对较低(低于44.7/10万)，故在图中合并呈现。

Figure 3. Mortality rates of the elderly population aged 60 years and older in China by different age groups and disease types in 2021

下载: 全尺寸图片幻灯片

表 1 2000–2021年中国≥60岁老年人群年龄标化死亡率的变化趋势

Table 1. Trends of age-standardized mortality rates among the elderly population aged 60 years and older in China, 2000-2021

疾病名称Disease name	AAPC值value(95% CI)/%	P值value
人类免疫缺陷病毒/艾滋病和性传播疾病 Human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infections	3.5(2.1~5.1)	< 0.001
肠道感染Enteric infections	-6.9(-7.1~-6.7)	< 0.001
其他传染病Other infectious diseases	-3.8(-4.3~-3.3)	< 0.001
被忽视的热带病和疟疾Neglected tropical diseases and malaria	-4.6(-5.0~-4.2)	< 0.001
自残和人际暴力Self-harm and interpersonal violence	-3.8(-4.1~-3.4)	< 0.001
慢性呼吸系统疾病Chronic respiratory diseases	-3.8(-4.3~-3.3)	< 0.001
呼吸道感染和结核病Respiratory infections and tuberculosis	-3.5(-4.1~-2.9)	< 0.001
物质使用障碍Substance use disorders	-3.2(-3.4~-3.0)	< 0.001
皮肤病和皮下疾病Skin and subcutaneous diseases	-3.2(-3.7~-2.7)	< 0.001
消化系统疾病Digestive diseases	-3.0(-3.3~-2.7)	< 0.001
其他Others	-0.8(-1.1~-0.5)	< 0.001
注：图中“其他”包含变化幅度在第11位及以后的9类疾病(包括：神经系统疾病、肌肉骨骼疾病、非故意伤害、糖尿病和肾病、肿瘤、交通伤害、心血管病、其他非传染性疾病、营养缺乏)，因其年龄标化死亡率的AAPC相对较低(低于1.1%)，故在表中合并呈现。 Note: "Others" in the figure includes 9 types of diseases ranked 11th and lower in the order of cause of death (including: neurological diseases, musculoskeletal diseases, unintentional injuries, diabetes and kidney diseases, neoplasms, transport injuries, cardiovascular diseases, other non-communicable diseases, and nutritional deficiencies). These are aggregated in the figure due to their relatively low the AAPC of age-standardized mortality rates (less than 1.1%).

下载: 导出CSV

表 2 2000年和2021年中国≥60岁老年人群年龄标化死亡率前10位疾病及其构成比

Table 2. Top 10 diseases and their proportions of age-standardized mortality rates among the elderly population aged 60 years and older in China in 2000 and 2021

顺位 Rank	2000年Year			顺位 Rank	2001年Year
顺位 Rank	疾病名称 Disease	死亡率 Mortality rate /100 000^-1	构成比 Proportion /%	顺位 Rank	疾病名称 Disease	死亡率 Mortality rate /100 000^-1	构成比 Proportion /%
1	心血管病Cardiovascular diseases	2 053.7	42.2	1	心血管病Cardiovascular diseases	1 686.7	47.2
2	慢性呼吸系统疾病 Chronic respiratory diseases	1 053.1	21.7	2	肿瘤Neoplasms	777.0	21.7
3	肿瘤Neoplasms	929.4	19.1	3	慢性呼吸系统疾病 Chronic respiratory diseases	473.4	13.2
4	神经系统疾病Neurological disorders	181.2	3.7	4	神经系统疾病Neurological disorders	215.4	6.0
5	呼吸道感染和结核病 Respiratory infections and tuberculosis	167.2	3.4	5	糖尿病和肾病 Diabetes and kidney diseases	119.1	3.3
6	消化系统疾病Digestive diseases	139.8	2.9	6	呼吸道感染和结核病 Respiratory infections and tuberculosis	77.9	2.2
7	糖尿病和肾病 Diabetes and kidney diseases	131.4	2.7	7	消化系统疾病Digestive diseases	74.2	2.1
8	非故意伤害Unintentional injuries	62.1	1.3	8	非故意伤害Unintentional injuries	59.6	1.7
9	自残和人际暴力 Self-harm and interpersonal violence	58.7	1.2	9	交通伤害Transport injuries	28.6	0.8
10	交通伤害Transport injuries	34.5	0.7	10	自残和人际暴力 Self-harm and interpersonal violence	26.4	0.7
合计 Total		4 811.0	98.9	合计 Total		3 538.2	99.0

下载: 导出CSV

参考文献(27)

[1]	Zhou MG, Wang HD, Zeng XY, 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[J]. Lancet, 2019, 394(10204): 1145-1158. DOI: 10.1016/S0140-6736(19)30427-1.
[2]	Qi JL, Li ML, Wang LJ, et al. National and subnational trends in cancer burden in China, 2005-20: an analysis of national mortality surveillance data[J]. Lancet Public Health, 2023, 8(12): e943-e955. DOI: 10.1016/S2468-2667(23)00211-6.
[3]	苏健婷, 王晶, 杜婧, 等. 北京市2007–2020年60岁及以上户籍居民死亡率趋势及死亡谱特征分析[J]. 中华流行病学杂志, 2024, 45(8): 1079-1083. DOI: 10.3760/cma.j.cn112338-20240411-00188. Su JT, Wang J, Du J, et al. Changing trend of mortality rate and death cause spectrum among household-registered residents aged 60 and above in Beijing, 2007-2020[J]. Chin J Epidemiol, 2024, 45(8): 1079-1083. DOI: 10.3760/cma.j.cn112338-20240411-00188.
[4]	李琰, 陈艺成. 浙江省某三甲医院2017–2021年住院患者死亡病例分析[J]. 医学信息, 2023, 36(15): 88-91. DOI: 10.3969/j.issn.1006-1959.2023.15.016. Li Y, Chen YC. Analysis of inpatient death cases in a top-three hospital in Zhejiang Province from 2017 to 2021[J]. Med Inf, 2023, 36(15): 88-91. DOI: 10.3969/j.issn.1006-1959.2023.15.016.
[5]	Zhang KT, Qi JL, Zuo PJ, et al. The mortality trends of falls among the elderly adults in the mainland of China, 2013-2020: a population-based study through the national disease surveillance points system[J]. Lancet Reg Health West Pac, 2021, 19: 100336. DOI: 10.1016/j.lanwpc.2021.100336.
[6]	丁鑫羽, 杨孝光, 晏亚, 等. 2011至2020年老年恶性肿瘤住院患者疾病谱调查分析[J]. 河北医药, 2023, 45(22): 3489-3492, 3497. DOI: 10.3969/j.issn.1002-7386.2023.22.030. Ding XY, Yang XG, Yan Y, et al. Investigation on disease spectrum of elderly inpatients with malignant tumors from 2011 to 2020[J]. Hebei Med J, 2023, 45(22): 3489-3492, 3497. DOI: 10.3969/j.issn.1002-7386.2023.22.030.
[7]	Institute for Health Metrics and Evaluation. GBD results[EB/OL]. (2024-05-16)[2024-08-05]. https://www.healthdata.org/research-analysis/gbd.
[8]	World Health Organization. WHO methods and data sources for country-level causes of death 2000-2021[R]. Geneva: WHO, 2024.
[9]	中华人民共和国国家卫生健康委员会. 健康中国行动(2019-2030年)[EB/OL]. (2019-07-15)[2024-11-11]. https://www.nhc.gov.cn/cms-search/downFiles/470339610aea4a7887d0810b4c00c9bd.pdf.
[10]	中华人民共和国国家疾病预防控制局. 国家疾控局综合司关于组织开展2024年世界防治结核病日宣传活动的通知[EB/OL]. (2024-03-01)[2024-12-02]. https://www.ndcpa.gov.cn/jbkzzx/c100014/common/content/content_1763498326281367552.html.
[11]	央视网. "三减三健"从我做起这份健康攻略请查收[EB/OL]. (2023-09-14)[2025-05-22]. https://news.cctv.com/2023/09/14/ARTIf4OUvGGM4SRDNDP9sTlV230914.shtml.
[12]	中华医学会肾脏病学分会专家组. 糖尿病肾脏疾病临床诊疗中国指南[J]. 中华肾脏病杂志, 2021, 37(3): 255-304. DOI: 10.3760/cma.j.cn441217-20201125-00041. Chinese Society of Nephrology Expert Group. Chinese guidelines for diagnosis and treatment of diabetic kidney disease[J]. Chin J Nephrol, 2021, 37(3): 255-304. DOI: 10.3760/cma.j.cn441217-20201125-00041.
[13]	丁钢强, 马爱国. 中国居民膳食指南科学研究报告. 2021[M]. 人民卫生出版社, 2021: 59-60. Ding GQ, Ma AG. Scientific research report on dietary guidelines for Chinese residents. 2021[M]. People's Medical Publishing House, 2021: 59-60.
[14]	杨凡, 潘越, 邹泽宇. 中国老年人体育锻炼状况及影响因素研究[J]. 中国体育科技, 2019, 55(10): 10-21, 40. DOI: 10.16470/j.csst.2019028. Yang F, Pan Y, Zou ZY. Patterns and Determinants of Physical Activity of Elderly People in China[J]. China Sport Science and Technology, 2019, 55(10): 10-21, 40. DOI: 10.16470/j.csst.2019028.
[15]	中国疾病预防控制中心, 中国疾病预防控制中心慢性非传染性疾病预防控制中心. 中国慢性病及危险因素监测报告: 2018[M]. 北京: 人民卫生出版社, 2021: 36. Chinese Center for Disease Control and Prevention, Chronic Non-communicable Disease Prevention and Control Center, Chinese Center for Disease Control and Prevention. China chronic diseases and risk factors surveillance report: 2018[M]. Beijing: People's Medical Publishing House, 2021: 36.
[16]	黄润龙, 沙勇. 我国老年人口死亡率分布及变化特征: 基于近四次人口普查死亡人口数据分析[J]. 人口与经济, 2023, (5): 41-56. DOI: 10.3969/j.issn.1000-4149.2023.00.046. Huang RL, Sha Y. Distribution and change characteristics of mortality of elderly population in China: based on mortality data from the last four censuses[J]. Population and Economics, 2023, (5): 41-56. DOI: 10.3969/j.issn.1000-4149.2023.00.046.
[17]	新华社. 长护险: 49个城市试点保障更多失能老人[N/OL]. (2022-07-21)[2024-11-01]. https://www.news.cn/fortune/2022-07/21/c_1128851577.htm. Xinhua News Agency. Long-term care insurance: 49 cities have piloted to protect more disabled elderly[N/OL]. (2022-07-21)[2024-11-01]. https://www.news.cn/fortune/2022-07/21/c_1128851577.htm.
[18]	王莉莉. 新时代我国老龄健康产业界定、现状及发展趋势[J]. 行政管理改革, 2022, (3): 19-28. DOI: 10.14150/j.cnki.1674-7453.2022.03.007. Wang LL. The definition, current situation and development trend of China's aging health industry in the New Era[J]. Administration and Reform, 2022, (3): 19-28. DOI: 10.14150/j.cnki.1674-7453.2022.03.007.
[19]	中华人民共和国中央人民政府. 关于印发"十四五"健康老龄化规划的通知[EB/OL]. (2022-02-07)[2025-04-11]. https://www.gov.cn/zhengce/zhengceku/2022-03/01/content_5676342.htm.
[20]	Liang X, Deng Y, Xu H, et al. The trend analysis of HIV and other sexually transmitted infections among the elderly aged 50 to 69 years from 1990 to 2030[J]. J Glob Health, 2024, 14: 04105. DOI: 10.7189/jogh.14.04105.
[21]	汤后林, 金怡晨, 吕繁. 我国老年人群艾滋病防控现状与挑战[J]. 中华流行病学杂志, 2023, 44(11): 1669-1672. DOI: 10.3760/cma.j.cn112338-20230629-00402. Tang HL, Jin YC, Lu F. HIV/AIDS epidemic in the elderly and prevention and control challenges in China[J]. Chin J Epidemiol, 2023, 44(11): 1669-1672. DOI: 10.3760/cma.j.cn112338-20230629-00402.
[22]	GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the global burden of disease study 2019[J]. Lancet Neurol, 2021, 20(10): 795-820. DOI: 10.1016/S1474-4422(21)00252-0.
[23]	中国老年医学学会高血压分会, 北京高血压防治协会, 国家老年疾病临床医学研究中心. 中国老年高血压管理指南2023[J]. 中华高血压杂志, 2023, 31(6): 508-538. DOI: 10.16439/j.issn.1673-7245.2023.06.003. Hypertension Branch of China Geriatrics Society, Beijing Hypertension Prevention and Treatment Association, National Clinical Research Center for Geriatric Diseases. Chinese guidelines for the management of hypertension in the elderly 2023[J]. Chin J Hypertens, 2023, 31(6): 508-538. DOI: 10.16439/j.issn.1673-7245.2023.06.003.
[24]	国家体育总局. 国家国民体质监测中心发布《第五次国民体质监测公报》[EB/OL]. (2022-06-07)[2025-02-21]. https://www.sport.gov.cn/n315/n329/c24335066/content.html.
[25]	潘琦, 郭立新. 《中国老年糖尿病诊疗指南(2021年版)》要览[J]. 中国医学前沿杂志(电子版), 2022, 14(4): 1-6. DOI: 10.12037/YXQY.2022.04-01. Pan Q, Guo LX. Overview of the "Chinese guidelines for the diagnosis and treatment of diabetes in the elderly (2021 edition)"[J]. Chinese Journal of the Frontiers of Medical Science(Electronic Version), 2022, 14(4): 1-6. DOI: 10.12037/YXQY.2022.04-01.
[26]	Su ZL, Huang L, Zhu JH, et al. Effects of multimorbidity coexistence on the risk of mortality in the older adult population in China[J]. Front Public Health, 2023, 11: 1110876. DOI: 10.3389/fpubh.2023.1110876.
[27]	Ward ZJ, Goldie SJ. Global Burden of Disease Study 2021 estimates: implications for health policy and research[J]. Lancet, 2024, 403(10440): 1958-1959. DOI: 10.1016/S0140-6736(24)00812-2.