摘要
目的 基于全球疾病负担研究数据库(GBD 2021)分析中国≥60岁老年人群传染病疾病负担时间变化趋势,同时从年龄、时期、出生年代3个维度对负担影响进行分析,并预测到2045年相关疾病负担情况,探讨疾病负担对老年人群用药的影响,提出相关用药建议。方法 应用连接点回归分析(JPR)、年龄-时期-队列分析(APC)以及预测分析(Nordpred)开展1990—2021年中国老年人传染病疾病负担分析。结果 32年间中国老年人传染病除艾滋病及性传播感染外,其余病因呈现不同程度下降趋势,肠道感染所致的死亡率和伤残调整生命年率(DALYR)下降最为迅速,AAPC分别为-7.85(P<0.001)和-7.18(P<0.001),其次是热带病和疟疾的发病情况大幅下降(AAPC=-6.77,P<0.001)。APC分析发现,年龄效应上,除艾滋病及性传播感染外,各疾病的死亡率和DALYR年度变化百分比大多为负值,时期风险随时间推移整体下降,早期出生群体的发病和死亡风险普遍较高,随着出生年份推移,各疾病风险整体下降,但艾滋病及性传播感染的死亡和DALY时期及队列风险呈增长趋势。尽管部分疾病男性总体风险略高于女性,但两性变化趋势基本一致。从预测角度看,呼吸道感染及结核病在病例数和年龄标准化率方面绝对流行,艾滋病及性传播感染疾病负担增长尤为突出,成为未来重要的健康挑战。老年人疾病负担导致可能存在的多药共用等情况,需针对性加强用药管理。结论 32年间,我国老年人各类传染病疾病负担总体显著下降,艾滋病及性传播感染是未来重要的健康挑战。可针对疾病负担情况加强相关传染病防控,制定更加精准的用药方案,保障我国老年人群健康。
Objective To analyze temporal trends in infectious disease burden among Chinese elderly(≥60 years)using data from the Global Burden of Disease Study(GBD 2021),evaluate age-period-cohort effects on disease burden,predict trends through 2045,and propose evidence-based medication management strategies.Methods We conducted a threefold analysis of infectious disease burden from 1990 to 2021 using Joinpoint regression to identify temporal trends,Age-Period-Cohort(APC)modeling to disentangle epidemiological effects,and Nordpred projections for 2045 disease burden estimates.Results Over 32 years,all infectious disease categories except HIV/AIDS and sexually transmitted infections demonstrated significant declines.Enteric infections showed the most rapid reductions in mortality(AAPC=-7.85,P<0.001)and disability-adjusted life year rates(DALYR;AAPC=-7.18,P<0.001).We also found a significant decrease in the incidence of tropical diseases and malaria(AAPC=-6.77,P<0.001).APC analysis found that the age effect was mostly negative in terms of the annual percentage change in mortality and DALYR for each disease,except for HIV/AIDS,with an overall decline in period risk over time,and a generally higher risk of morbidity and mortality for the early birth cohort,and an overall decline in the risk of each disease as the year of birth progressed,but the risk of HIV/AIDS death and DALY period and cohort risks trended upward.While the overall risk for certain diseases was slightly higher in males compared to females,the trends were largely consistent across both sexes.In terms of projections,the absolute prevalence of respiratory infections and tuberculosis in terms of number of cases and age-standardized rates,and the growth of the disease burden of HIV/AIDS were particularly prominent,making them important health challenges for the future.The burden of disease in the elderly often results in issues such as potential polypharmacy,which must be addressed to improve medication management.Conclusions China has achieved remarkable progress in reducing infectious disease burdens among older adults,though HIV/AIDS and sexually transmitted infections present an escalating public health threat.These findings advocate for enhanced surveillance systems,age-specific prevention strategies,and precision medication protocols to optimize therapeutic outcomes in geriatric populations.
作者
尹林
林书智
刘茜
刘炜
朱小莹
李梓萌
沈仪方
冯变玲
YIN Lin;LIN Shuzhi;LIU Qian;LIU Wei;ZHU Xiaoying;LI Zimeng;SHEN Yifang;FENG Bianling(Department of Pharmaceutical Administration,School of Pharmacy,Institute of Drug Safety and Monitoring,Xi'an Jiaotong University,Xi'an 710061,China)
出处
《医药导报》
北大核心
2025年第12期1940-1948,共9页
Herald of Medicine
基金
中央高校西安交通大学基本科研业务费项目(xzy02204030)。
