Analysis of trend and age-period-cohort model on ischemic stroke incidence and mortality from 1990 to 2019 in China
-
摘要:
目的 分析1990—2019年中国缺血性脑卒中发病、死亡趋势,并探索年龄、时期和队列对缺血性脑卒中发病、死亡风险的影响。 方法 本研究中中国缺血性脑卒中发病和死因数据来源于全球疾病负担数据库,采用联结点回归模型和年龄-时期-队列(APC)模型分别分析缺血性脑卒中发病率和死亡率的趋势及影响缺血性脑卒中发病和死亡风险的年龄效应、时期效应和队列效应。采用的软件为Jointpoint软件和Stata软件。 结果 1990—2019年期间中国缺血性脑卒中的发病率和死亡率均呈现上升趋势,年平均变化百分比分别为3.5%(95% CI:3.5%~3.6%)和2.8%(95% CI:2.5%~3.1%)。APC模型提示缺血性脑卒中的发病和死亡风险均随年龄的增长而增加,随着年份的推移而增加,较晚出生的队列,其发病和死亡风险均低于之前出生的队列。 结论 1990—2019年中国缺血性脑卒中总体发病和死亡率呈逐年上升趋势,年龄大、生活时代越近、出生越早的人群缺血性脑卒中发病和死亡风险越高,应重点加强特殊人群的预防,降低该病的疾病负担。 -
关键词:
- 缺血性脑卒中 /
- 年龄-时期-队列模型 /
- 趋势分析
Abstract:Objective To analyze the incidence and mortality trend of ischemic stroke in China from 1990 to 2019, and explore the effects of age, period, and cohort on the incidence and mortality risk of ischemic stroke. Methods The incidence and mortality of ischemic stroke in China were collected from the Global Burden of Disease database. The joint regression model and age-period-cohort (APC) model were used to analyze the trend of incidence and mortality of ischemic stroke and the age, period, and cohort effects affecting the incidence and mortality of ischemic stroke, respectively. Jointpoint software and Stata software were used. Results The average annual percent change in incidence and mortality of ischemic stroke in China from 1990 to 2019 was 3.5% (95% CI: 3.5%-3.6%) and 2.8% (95% CI: 2.5%-3.1%), showing an increasing trend. The APC model suggested that the risk of ischemic stroke and death increased with age and year, with the later birth cohort having a lower risk of onset and death than the earlier birth cohort. Conclusion The overall incidence and mortality of ischemic stroke in China increased year by year from 1990 to 2019. The risk of ischemic stroke incidence and death is higher in people with older age, more recent lifetimes, and earlier birth. Prevention of ischemic stroke should be strengthened in special groups to reduce the disease burden. -
Key words:
- Ischemic stroke /
- Age-period-cohort model /
- Trend analysis
-
表 1 缺血性脑卒中发病率趋势的联结点回归分析
Table 1. Jointpoint regression analysis of trends in ischemic stroke incidence
变量 年份 APC(95% CI) AAPC(95% CI) 男性 3.7(3.6~3.7) 1990—1996 2.2(2.2~2.3) 1996—2003 2.9(2.8~2.9) 2003—2006 3.4(3.0~3.7) 2006—2010 5.0(4.8~5.2) 2010—2016 5.2(5.1~5.3) 2016—2019 4.0(3.8~4.2) 女性 3.4(3.3~3.4) 1990—1995 1.6(1.5~1.8) 1995—2000 2.9(2.7~3.0) 2000—2005 2.0(1.9~2.2) 2005—2010 5.7(5.5~5.8) 2010—2019 4.1(4.1~4.2) 合计 3.5(3.5~3.6) 1990—1995 1.9(1.8~2.0) 1995—2006 2.7(2.7~2.8) 2006—2009 5.9(5.4~6.4) 2009—2015 4.7(4.6~4.9) 2015—2019 4.1(3.9~4.3) 表 2 缺血性脑卒中死亡率趋势的联结点回归分析
Table 2. Jointpoint regression analysis of trends in ischemic stroke mortality
变量 年份 APC(95% CI) AAPC(95% CI) 男性 1990—1997 2.3(2.0~2.5) 3.2(3.0~3.4) 1997—2004 4.8(4.5~5.1) 2004—2007 0.4(-1.3~2.1) 2007—2011 5.3(4.4~6.2) 2011—2019 2.7(2.6~2.9) 女性 1990—1997 1.4(1.0~1.7) 2.5(2.0~2.9) 1997—2004 5.1(4.6~5.6) 2004—2007 -1.2(-4.0~1.6) 2007—2010 3.2(0.3~6.1) 2010—2015 1.3(0.3~2.2) 2015—2019 3.6(2.7~4.6) 合计 1990—1997 1.8(1.5~2.1) 2.8(2.5~3.1) 1997—2004 4.9(4.5~5.3) 2004—2007 -0.4(-2.5~1.7) 2007—2010 4.3(2.1~6.5) 2010—2019 2.6(2.4~2.8) -
[1] GRABER M, BAPTISTE L, MOHR S, et al. A review of psychosocial factors and stroke: a new public health problem[J]. Rev Neurol(Paris), 2019, 175(10): 686-692. doi: 10.1016/j.neurol.2019.02.001 [2] HU S, CUI B, MLYNASH M, et al. Stroke epidemiology and stroke policies in China from 1980 to 2017: a systematic review and meta-analysis[J]. Int J Stroke, 2020, 15(1): 18-28. doi: 10.1177/1747493019873562 [3] 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 [4] GBD 2016 Lifetime Risk of Stroke Collaborators, FEIGIN V L, NGUYEN G, et al. Global, regional, and country-specific lifetime risks of stroke, 1990 and 2016[J]. N Engl J Med, 2018, 379(25): 2429-2437. doi: 10.1056/NEJMoa1804492 [5] 何小双, 徐丽娜, 刘冬, 等. 基于年龄-时期-队列模型的2005—2016年中国老年人恶性肿瘤流行特征分析[J]. 中华肿瘤防治杂志, 2023, 30(11): 631-638. https://www.cnki.com.cn/Article/CJFDTOTAL-QLZL202311001.htmHE X S, XU L N, LIU D, et al. Epidemiological characteristics of malignant tumors in the elderly in China from 2005 to 2016 based on age period cohort model[J]. Chin J Cancer Prev Treat, 2023, 30(11): 631-638. https://www.cnki.com.cn/Article/CJFDTOTAL-QLZL202311001.htm [6] YANG Y, LAND F K C. A methodological comparison of age-period-cohort models: the intrinsic estimator and conventional generalized linear models[J]. Sociol Methodol, 2004, 34: 75-110. doi: 10.1111/j.0081-1750.2004.00148.x [7] 王陇德, 彭斌, 张鸿祺, 等. 《中国脑卒中防治报告2020》概要[J]. 中国脑血管病杂志, 2022, 19(2): 136-144. https://www.cnki.com.cn/Article/CJFDTOTAL-NXGB202202011.htmWANG L D, PENG B, ZHANG H Q, et al. Brief report on stroke prevention and treatment in China, 2020[J]. Chin J Cerebrovasc Dis, 2022, 19(2): 136-144. https://www.cnki.com.cn/Article/CJFDTOTAL-NXGB202202011.htm [8] 马丽媛, 王增武, 樊静, 等. 《中国心血管健康与疾病报告2021》要点解读[J]. 中国全科医学, 2022, 25(27): 3331-3346. doi: 10.12114/j.issn.1007-9572.2022.0506MA L Y, WANG Z W, FAN J, et al. An Essential Introduction to the Annual Report on Cardiovascular Health and Diseases in China (2021)[J]. Chinese General Practice, 2022, 25(27): 3331-3346. doi: 10.12114/j.issn.1007-9572.2022.0506 [9] 刘湘, 段振斌, 刘海楠, 等. 社区健康管理模式对缺血性脑卒中危险因素干预的研究进展[J]. 临床医学进展, 2023, 13(6): 10308-10313.LIU X, DUAN Z B, LIU H N, et al. Research Progress of Community Health Management Model Intervention on Ischem-ic Stroke Risk Factors[J]. Adv Clin Med, 2023, 13(6): 10308-10313. [10] 王娅, 周厚援, 罗志强, 等. 新预测模型AULTS评分对缺血性脑卒中的预测价值[J]. 中华全科医学, 2021, 19(10): 1666-1668, 1696. doi: 10.16766/j.cnki.issn.1674-4152.002137WANG Y, ZHOU H Y, LUO Z Q, et al. Predictive value of the new predictive model AULTS score for ischemic stroke[J]. Chinese Journal of General Practice, 2021, 19(10): 1666-1668, 1696. doi: 10.16766/j.cnki.issn.1674-4152.002137 [11] 黎健. 血管衰老干预的新策略[J]. 中国心血管杂志, 2021, 26(5): 425-427. doi: 10.3969/j.issn.1007-5410.2021.05.004LI J. New strategies for vascular aging intervention[J]. Chinese Journal of Cardiovascular Medicine, 2021, 26(5): 425-427. doi: 10.3969/j.issn.1007-5410.2021.05.004 [12] KE C, GUPTA R, SHAH B R, et al. Association of hypertension and diabetes with ischemic heart disease and stroke mortality in India: the million death study[J]. Global heart, 2021, 16(1): 69. doi: 10.5334/gh.1048 [13] VYAS M V, SILVER F L, AUSTIN P C, et al. Stroke incidence by sex across the lifespan[J]. Stroke, 2021, 52(2): 447-451. doi: 10.1161/STROKEAHA.120.032898 [14] 杨娟, 陈典支. 绝经后女性性激素水平与缺血性脑卒中相关性的系统评价[J]. 中国性科学, 2021, 30(1): 31-33. https://www.cnki.com.cn/Article/CJFDTOTAL-XKXZ202101013.htmYANG J, CHEN D Z. Systematic review on correlation of sex hormone levels with ischemic stroke in postmenopausal women[J]. Chin J Human Sexual, 2021, 30(1): 31-33. https://www.cnki.com.cn/Article/CJFDTOTAL-XKXZ202101013.htm [15] 饶克勤, 钱军程, 陈红敬. 人口老龄化对卫生系统的挑战及健康老龄化战略[J]. 中华健康管理学杂志, 2013, 7(3): 149-150.RAO K Q, QIAN J C, CHEN H J. Challenges of population aging to the health system and strategies for healthy aging[J]. Chin J Health Manage, 2013, 7(3): 149-150. [16] 张伟, 马骁, 程浩, 等. 高糖饮食与炎症性疾病研究进展[J]. 四川大学学报(医学版), 2022, 53(3): 538-542. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYK202203030.htmZHANG W, MA X, CHENG H, et al. Research Progress in High-Sugar Diet and Inflammatory Diseases[J]. J Sichuan Univ (Med Sci), 2022, 53(3): 538-542. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYK202203030.htm [17] 周璐, 吕素景, 王晓鸣, 等. 郑州地区城市和农村中老年人群脑卒中危险因素比较研究[J]. 华南预防医学, 2022, 48(6): 715-717. https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF202206016.htmZHOU L, LV S J, WANG X M, et al. Risk factors comparison of stroke between urban and rural middle-aged and elderly people in Zhengzhou[J]. South China J Prev Med, 2022, 48(6): 715-717. https://www.cnki.com.cn/Article/CJFDTOTAL-GDWF202206016.htm [18] 詹启敏, 杜建. 论医学科技与"国之重器"[J]. 北京大学学报(医学版), 2022, 54(5): 785-790. https://www.cnki.com.cn/Article/CJFDTOTAL-BYDB202205001.htmZHAN Q M, DU J. Medical Science and Technology and "National Key Instruments"[J]. J PEKING Univ (Health Sciences), 2022, 54(5): 785-790. https://www.cnki.com.cn/Article/CJFDTOTAL-BYDB202205001.htm [19] 甘勇, 杨婷婷, 杨宇迪, 等. 基于系统基模的慢性病主要危险因素分析及对策研究[J]. 中华全科医学, 2019, 17(12): 2046-2050, 2054. doi: 10.16766/j.cnki.issn.1674-4152.001124GAN Y, YANG T T, YANG Y D, et al. Analysis of main risk factors and countermeasures of chronic diseases based on systems archetypes[J]. Chinese Journal of General Practice, 2019, 17(12): 2046-2050, 2054. doi: 10.16766/j.cnki.issn.1674-4152.001124 [20] 孙环, 夏昱, 陈艳梅, 等. 脑卒中发病的危险因素分析[J]. 护理实践与研究, 2022, 19(15): 2243-2247. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ202215008.htmSUN H, XIA Y, CHEN YM, et al. Risk factors anslysis of stroke[J]. Nursing Prac Res, 2022, 19(15): 2243-2247. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ202215008.htm -