摘要
目的:分析1990~2021年中国心肌炎的疾病负担、趋势和性别差异。方法:基于全球疾病负担研究2021,收集1990~2021年中国(不包含台湾地区)的心肌炎数据,按照年龄和性别分析患病、发病、死亡例数和伤残调整寿命年(DALY)的疾病负担及其估计年度百分比变化(EAPC)。应用Joinpoint回归分析1990~2021年心肌炎疾病负担的分段时间趋势并得出疾病负担的平均年度百分比变化(AAPC)。应用分解分析解释疾病负担变化的因素构成。采用贝叶斯年龄-时期-队列(BAPC)模型描述至2035年的心肌炎疾病负担趋势。结果:1990~2021年中国心肌炎的患病率、发病率、死亡率和DALY率的EAPC分别为1.22%(95%CI:1.13%~1.30%)、0.62%(95%CI:0.57%~0.67%)、1.09%(95%CI:0.89%~1.30%)、-1.72%(95%CI:-1.82%~-1.61%)。心肌炎的患病率、发病率及死亡率逐渐上升,DALY率呈下降趋势,其中男性和女性疾病负担变化趋势与总人群相同。2021年中国心肌炎的患病率、发病率及死亡率较1990年增幅分别为38.5%、23.4%和40.8%,DALY率降幅达39.1%。Joinpoint回归分析将1990~2021年中国心肌炎疾病负担指标的变化分为各自的4个时间段,结果显示,患病率、发病率、死亡率和DALY率的AAPC分别为1.078%(95%CI:0.993%~1.163%)、0.676%(95%CI:0.661%~0.691%)、1.127%(95%CI:0.848%~1.405%)和-1.532%(95%CI:-1.733%~-1.332%)。1990年和2021年,整体和大部分年龄段人群中男性心肌炎的患病、发病、死亡和DALY数量和率均高于女性。与1990年比,2021年<5岁年龄段人群患病、死亡和DALY数量明显减小但疾病负担仍高。各疾病负担数量的主体人群均向高年龄段移动,在65岁以上人群中显著增加。患病和DALY数量的变化主要由流行病学因素导致,而发病和死亡数量的变化主要由老龄化引起。基于BAPC模型预测,至2035年,中国心肌炎的年龄标准化患病率将持续上升,而其余疾病负担指标将下降。结论:中国(不包含台湾地区)心肌炎疾病负担总体控制有效。男性的心肌炎疾病负担高于女性。未来疾病负担的预防和管理需要更关注男性及老年人群。
Objective:To analyze the myocarditis burden,trends,and sex differences from 1990 to 2021 in China.Methods:Data were sourced from the Global Burden of Disease Study 2021.Myocarditis data for China(excluding Taiwan region)from 1990 to 2021 were collected.Burden of prevalence,incidence,mortality,and disability adjusted life years(DALY)were analyzed by age and sex,along with their changes.Joinpoint regression was used to analyze time-specific trends in the burden of myocarditis and to derive the average annual percentage change(AAPC)in the burden of disease.Decomposition analyses revealed the factors behind the burden changes.The estimated annual percentage changes(EAPC)were calculated for these burden metrics.A Bayesian age-period-cohort(BAPC)model was used to project disease burden trends up to 2035.Results:From 1990 to 2021,the EAPCs for the prevalence rate,incidence rate,mortality rate,and DALY rate of myocarditis in China were 1.22%(95%CI:1.13%to 1.30%),0.62%(95%CI:0.57%to 0.67%),1.09%(95%CI:0.89%to 1.30%),and-1.72%(95%CI:-1.82%to-1.61%),respectively.The prevalence,incidence,and death rates of myocarditis gradually increased,while the DALY rate showed a downward trend;the trends in disease burden changes for both males and females were consistent with the total population.In 2021,the increases of prevalence,incidence,and mortality from myocarditis in China compared to 1990 were 38.5%,23.4%,and 40.8%,respectively,while the DALY rate decreased by 39.1%.Joinpoint regression analysis segmented the changes in Chinese myocarditis disease burden indicators from 1990 to 2021 into four distinct periods each.The results showed that the AAPCs for prevalence,incidence,mortality,and DALY rate were 1.078%(95%CI:0.993%to 1.163%),0.676%(95%CI:0.661%to 0.691%),1.127%(95%CI:0.848%to 1.405%),and-1.532%(95%CI:-1.733%to-1.332%),respectively.In both 1990 and 2021,the number and annual rates of prevalence,incidence,mortality,and DALY for myocarditis were higher in males than in females across the overall population and in most age groups.Compared with 1990,the number of prevalent cases,deaths,and DALY in the population under 5 years old in 2021 decreased significantly,but the disease burden in this age group remained high.The main population carrying the burden of each disease metric shifted towards older age groups,with a significant increase observed in the population aged 65 and above.Changes of prevalent cases and DALY were primarily driven by epidemiological factors,whereas changes of incident cases and deaths were mainly attributable to population aging.Projections based on the BAPC model up to 2035 indicate that the age-standardized prevalence rate of myocarditis in China will continue to rise,while the other disease burden metrics are projected to decline.Conclusions:The overall disease burden of myocarditis in China(excluding Taiwan region)has been effectively controlled.The disease burden of myocarditis is higher in males than in females.Future prevention and management of myocarditis burden require specific focus on male and elderly populations.
作者
方章
罗晓钫
张宇辉
张健
FANG Zhang;LUO Xiaofang;ZHANG Yuhui;ZHANG Jian(Heart Failure Center,State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
出处
《中国循环杂志》
北大核心
2026年第1期48-54,共7页
Chinese Circulation Journal
基金
中央高水平医院临床科研业务费(2022-GSP-GG-9)
北京自然科学基金(7222143)。
关键词
心肌炎
负担
趋势
性别差异
myocarditis
burden
trend
sex difference
