1990—2021年中国归因于烟草的慢性阻塞性肺疾病负担分析

doi:10.12183/j.scjpm.2026.0183

摘要/Abstract

摘要： 目的了解1990—2021年中国因烟草暴露致COPD的疾病负担变化情况,为行政部门制定COPD预防控制策略和控烟措施提供依据。方法从2021年全球疾病负担数据库（Global Burden of Disease Study 2021,GBD 2021）提取1990—2021年中国、亚洲、不同SDI地区和全球归因于烟草的COPD数据,采用标化死亡率、标化伤残调整寿命年（DALY）率等指标进行描述性分析,分析1990—2021年归因于烟草的COPD疾病负担指标年估计百分比变化（EAPC）,利用年龄-时期-队列（APC）模型分析年龄、时期和队列效应,采用贝叶斯年龄-时期-队列（BAPC）预测2022—2035年中国居民归因于烟草的COPD标化死亡率和标化DALY率。结果中国归因于烟草的标化死亡率和标化DALY率从1990年111.74/10万和1 884.73/10万降为2021年的35.46/10万和589.75/10万,中国与全球、亚洲和不同SDI地区相比,归因于烟草的COPD标化死亡率（EAPC=-4.20%,95% CI：-4.40%~-4.00%）和标化DALY率（EAPC=-4.20%,95% CI：-4.37%~-4.04%）下降幅度均为最大。1990—2021年中国归因于烟草的COPD标化死亡率和DALY率随着年龄的增加而增加,均在≥80岁年龄组达到最高,男性和女性归因于烟草的COPD标化死亡率（标化DALY率）1990年分别为193.55/10万（3 117.39/10万）和59.65/10万（967.21/10万）,2021年下降至70.91/10万（1 079.53/10万）和12.50/10万（225.11/10万）。1990—2021年中国归因于烟草的COPD标化死亡率随年龄增长呈上升趋势,时期效应和队列效应均呈现下降趋势。BAPC预测模型显示,2022—2035年中国归因于烟草的COPD造成的标化死亡率和标化DALY率呈缓慢下降趋势,2035年标化死亡率和标化DALY率分别降为29.43/10万和455.00/10万。结论 1990—2021年我国归因于烟草的COPD的负担显著下降,但相比其他国家和地区相比,我国负担仍然较为严重,尤其以男性最为明显,应继续尤其加强对男性人群烟草控制、推广健康生活方式、提高公众对COPD的认知和防治意识。

关键词: 烟草, 慢性阻塞性肺疾病, 疾病负担

Abstract: Objective To investigate the temporal trends in the disease burden of chronic obstructive pulmonary disease (COPD) attributable to tobacco exposure in China from 1990 to 2021, thereby providing an evidence base for public health authorities to formulate targeted prevention and control strategies and tobacco control policies. Methods Data on COPD attributable to tobacco in China, Asia, various Socio-Demographic Index (SDI) regions, and globally from 1990 to 2021 were extracted from the Global Burden of Disease Study 2021 (GBD 2021). A descriptive analysis was conducted using metrics such as age-standardized mortality rates and age-standardized Disability-Adjusted Life Year (DALY) rates. The Estimated Annual Percentage Change (EAPC) was calculated to quantify trends in the disease burden metrics. An Age-Period-Cohort (APC) model was employed to analyze the respective effects of age, period, and cohort. Furthermore, a Bayesian Age-Period-Cohort (BAPC) model was utilized to forecast the age-standardized mortality and DALY rates for tobacco-attributable COPD in the Chinese population from 2022 to 2035. Results In China, the age-standardized mortality rate and age-standardized DALY rate for tobacco-attributable COPD decreased from 111.74 and 1 884.73 per 100 000 in 1990 to 35.46 and 589.75 per 100 000 in 2021, respectively. Compared to global, Asian, and other SDI regional counterparts, China demonstrated the most substantial decline in both the age-standardized mortality rate (EAPC=-4.20%, 95% CI: -4.40% to -4.00%) and the age-standardized DALY rate (EAPC=-4.20%, 95% CI: -4.37% to -4.04%). Between 1990 and 2021, the age-standardized mortality and DALY rates for tobacco-attributable COPD in China increased with advancing age, peaking in the ≥80 years age group. The age-standardized mortality rate (and DALY rate) for males decreased from 193.55 (3 117.39) per 100 000 in 1990 to 70.91 (1 079.53) per 100 000 in 2021, while for females, the corresponding rates declined from 59.65 (967.21) per 100 000 to 12.50 (225.11) per 100 000. Over the study period, the age-standardized mortality rate exhibited a positive correlation with age, whereas both period and cohort effects demonstrated a declining trend. Projections from the BAPC model indicate a continued, gradual downward trend in age-standardized mortality and DALY rates from 2022 to 2035, with the rates anticipated to reach 29.43 and 455.00 per 100 000, respectively, by 2035. Conclusion Although the burden of COPD attributable to tobacco in China has decreased significantly from 1990 to 2021, it remains severe in comparison to other nations and regions, with a particularly pronounced burden among the male population. It is therefore imperative to intensify tobacco control interventions, especially targeting males, promote healthy lifestyles, and elevate public awareness regarding COPD prevention and management.

Key words: Tobacco, Chronic obstructive pulmonary disease, Disease burden

中图分类号:

R195.4

张盼, 程刚, 吴斗琼, 李志新. 1990—2021年中国归因于烟草的慢性阻塞性肺疾病负担分析[J]. 华南预防医学, 2026, 52(2): 183-188.

Zhang Pan, Cheng Gang, Wu Douqiong, Li Zhixin. Analysis of the disease burden of chronic obstructive pulmonary disease attributable to tobacco in China, 1990—2021[J]. South China Journal of Preventive Medicine, 2026, 52(2): 183-188.

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