1990–2021年中国吸烟所致慢性呼吸系统疾病负担分析与预测

谢小花; 林德荣; 黎梅; 叶小琳; 方静雅; 张小文; 薛爱国

doi:10.12182/20260160104

1990–2021年中国吸烟所致慢性呼吸系统疾病负担分析与预测

Analysis and Projection of the Burden of Chronic Respiratory Diseases Attributable to Smoking in China, 1990–2021

摘要

摘要:
目的分析1990–2021年中国吸烟所致慢性呼吸系统疾病（chronic respiratory diseases, CRD）的疾病负担变化趋势，并预测其2022–2035年发展情况，为优化控烟策略与公共卫生决策提供科学依据。
方法基于全球疾病负担研究（Global Burden of Disease, GBD）2021数据，收集1990–2021年中国、日本、欧盟、美国及全球吸烟归因CRD的流行病学数据，包括伤残生存年（years lived with disability, YLDs）、过早死亡损失年（years of life lost, YLLs）、伤残调整寿命年（disability-adjusted life years, DALYs）等指标，涵盖30岁及以上人群。采用Joinpoint回归模型估计平均年度变化百分比（average annual percentage change, AAPC），并应用贝叶斯年龄-时期-队列（Bayesian age-period-cohort, BAPC）模型进行趋势预测。
结果 2021年，中国吸烟所致CRD的DALYs为10320279〔95%不确定性区间（uncertainty interval, UI）：7806610～12875089〕人年，年龄标准化DALYs率（age-standardized disability-adjusted life years rate, ASDR）为522.34（95%UI：394.50～653.32）/10万人年；死亡数为566446（95%UI：416802～720431）例，年龄标准化死亡率（age-standardized mortality rate, ASMR）为31.34（95%UI：23.10～39.69）/10万人；YLLs与YLDs分别为8983486（95%UI：6547449～11421727）人年和1336793（95%UI：981768～1699656）人年，对应年龄标准化率（age-standardised rates, ASR）为458.96（95%UI：337.53～582.19）/10万人年和63.38（95%UI：46.17～80.72）/10万人年。疾病负担在性别与年龄上差异明显，男性与中老年群体风险更高。1990–2021年，中国各项负担率指标均呈下降趋势，预计未来十余年ASMR与ASDR将持续下降。
结论中国在CRD防控和控烟方面已取得积极进展，但人口老龄化等挑战仍需关注。应加强针对性预防干预措施，特别是面向高风险人群，减轻疾病负担。中国的控烟经验亦可为其他发展中国家提供政策借鉴。

Abstract:
Objective To analyze trends in the disease burden of chronic respiratory diseases (CRD) attributable to smoking in China from 1990 to 2021 and to project its development from 2022 to 2035, providing scientific evidence for optimizing tobacco control strategies and public health decision-making.
Methods Using Global Burden of Disease (GBD) 2021 data, epidemiological data on smoking-attributable CRD were collected for China, Japan, the European Union, the United States, and the global population from 1990 to 2021. Indicators included years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs), covering individuals aged 30 years and older. Joinpoint regression models estimated average annual percentage changes (AAPCs), while Bayesian age-period-cohort (BAPC) models projected future trends.
Results In 2021, smoking-attributable CRD DALYs in China reached 10320279 (95% uncertainty interval UI: 7806610-12875089) person-years, with an age-standardized disability-adjusted life years rate (ASDR) of 522.34 (95% UI: 394.50-653.32) per 100000 person-years. The number of deaths was 566446 (95% UI: 416802-720431), with an age-standardized mortality rate (ASMR) of 31.34 (95% UI: 23.10-39.69) per 100000 population. YLLs and YLDs were 8983486 (95% UI: 6547449-11421727) person-years and 1336793 (95% UI: 981768-1699656) person-years, corresponding to age-standardized rates (ASR) of 458.96 (95% UI: 337.53-582.19) and 63.38 (95% UI: 46.17-80.72) per 100000 person-years, respectively. The disease burden showed significant differences by gender and age, with higher risks among males and middle-aged and elderly populations. From 1990 to 2021, all burden indicators in China showed a declining trend, with ASMR and ASDR projected to continue decreasing over the next decade.
Conclusion China has made positive progress in CRD prevention and tobacco control, but challenges such as population aging require continued attention. Targeted prevention interventions, particularly for high-risk populations, should be strengthened to reduce disease burden. The experience and challenges documented in China could offer valuable lessons and policy insights for other countries undergoing similar epidemiological transitions.

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