1990–2021年糖尿病肾病的全球、区域及国家和地区负担分析

宁雅娴; 周小春; 王勾琴; 张丽丽; 王俭勤

doi:10.12182/20260560103

摘要:

目的基于全球疾病负担（Global Burden of Diseases, GBD）2021数据，系统分析了1990–2021年全球204个国家和地区糖尿病肾病（diabetic kidney disease, DKD）的疾病负担趋势及未来十年预测。

方法 GBD 1990–2021年DKD数据，采用年龄标准化率（age-standardized rates, ASRs）和平均年度百分比变化（average annual percentage change, AAPC）分析趋势，运用联结点回归模型（Joinpoint regression model, JRM）识别转折点，自回归积分移动平均模型（autoregressive integrated moving average, ARIMA）预测未来趋势，R软件实现统计分析。

结果 1990–2021年全球DKD年龄标准化发病率（age-standardized incidence rate, ASIR）、年龄标准化死亡率（age-standardized death rate, ASDR）呈显著上升，累计分别上升55.0%〔95%置信区间（confidence interval, CI）：42.3%～69.8%，P<0.001〕、57.3%（95%CI：43.1%～73.5%，P<0.001）；年龄标准化患病率（age-standardized prevalence rate, ASPR）累计下降37.5%（95%CI：－45.2%～－28.8%，P<0.001）；年龄标准化伤残调整寿命年（age-standardized disability-adjusted life years, DALYs）率累计上升56.2%（95%CI：42.8%～71.5%，P<0.001）。国家和地区间负担差异显著，格陵兰ASPR上升幅度最大，英国ASPR降幅最大；爱沙尼亚ASIR增幅最高，爱尔兰ASIR降幅最大；美国ASDR上升最显著，马尔代夫ASDR下降最明显。东亚现患病例数最多，南亚新发病例与DALYs负担最重，低社会人口指数（socio-demographic index, SDI）地区上升更显著。未来十年（2022–2031年）预测显示，全球DKD ASPR年均上升0.45%（95%CI：0.21%～0.69%），ASIR年均下降0.23%（95%CI：－0.47%～－0.01%），年龄标准化DALYs率年均上升1.12%（95%CI：0.89%～1.35%），疾病总负担仍将持续加重。

结论全球DKD疾病负担日益加重，低SDI地区尤为显著，亟需在高负担区域采取精准防控措施，为公共卫生资源配置提供科学依据。

Abstract:

Objective Based on the Global Burden of Diseases (GBD) 2021 data, this study systematically analyzed the trends in the disease burden of diabetic kidney disease (DKD) and predicted its burden over the next decade in 204 countries and regions worldwide from 1990 to 2021.

Methods Data on DKD from the GBD study spanning 1990 to 2021 were analyzed for trends using age-standardized rates (ASRs) and average annual percentage change (AAPC). The Joinpoint Regression Model (JRM) was applied to identify turning points, and the Autoregressive Integrated Moving Average (ARIMA) model was used to forecast future trends. Statistical analysis was performed using R software.

Results The age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) of global DKD from 1990 to 2021 showed substantial increases, with cumulative rises of 55.0% (95% CI: 42.3% to 69.8%, P < 0.001) and 57.3% (95% CI: 43.1% to 73.5%, P < 0.001), respectively. The age-standardized prevalence rate (ASPR) declined by 37.5% (95% CI: －45.2% to －28.8%, P < 0.001), while the age-standardized disability-adjusted life years (DALYs) rate rose by 56.2% (95% CI: 42.8% to 71.5%, P < 0.001). Noticeable disparities in disease burden were observed among countries and regions. Greenland experienced the largest increase in ASPR, whereas the United Kingdom had the most substantial decrease. Estonia had the highest rise in ASIR, while Ireland saw the greatest decline. The United States had the most pronounced increase in ASDR, while the Maldives had the largest decrease. East Asia had the highest number of current cases, while South Asia bore the heaviest burden of new cases and DALYs. The increase was more prominent in regions with a low socio-demographic index (SDI). Projections for the next decade (2022–2031) indicate that the global ASPR of DKD will increase by an average of 0.45% per year (95% CI: 0.21% to 0.69%), the ASIR will decrease by an average of 0.23% per year (95% CI: －0.47% to －0.01%), and the age-standardized DALYs rate will increase by an average of 1.12% per year (95% CI: 0.89% to 1.35%). The overall burden of the disease is expected to continue growing.

Conclusion The global burden of DKD is steadily increasing, and it is especially severe in regions with low SDI. It is essential to implement targeted prevention and control measures in high-burden areas to provide a scientific basis for allocating public health resources.

1990–2021年糖尿病肾病的全球、区域及国家和地区负担分析

Burden of Diabetic Kidney Disease at Global, Regional, and National Levels From 1990 to 2021