1990—2021年中国归因于饮食因素的缺血性心脏病疾病负担变化趋势及预测研究
rend and Prediction of Changes in the Disease Burden of Diet-related Ischemic Heart Disease in China，1990-2021
背景 缺血性心脏病（IHD）是导致中国居民疾病负担的第二大原因，饮食因素被认为是减少疾病负 担有效及可行的手段。目的 分析1990—2021年中国归因于饮食因素的IHD疾病负担变化及未来变化趋势，以期为中国IHD饮食防治提供参考依据。方法 提取2021年全球疾病负担（GBD2021）数据库中1990—2021年中国、全球、不同社会人口指数（SDI）地区的归因于饮食因素的IHD疾病负担相关数据，应用Joinpoint模型计算年度变化百分比（APC）及平均年度变化百分比（AAPC）分析1990—2021年中国、全球、不同SDI地区归因于饮食因素的IHD疾病负担，中国不同性别、年龄人群归因于饮食因素的IHD疾病负担以及归因于不同类型饮食因素的IHD疾病负担。利用贝叶斯年龄时期队列（BAPC）模型预测2022—2031年中国归因于饮食因素的IHD标化死亡率、标化DALY率变化趋势。结果 2021年中国归因于饮食因素的IHD标化死亡率为44.26/10万、标化DALY率为820.87/10万，与全球水平接近，高于高SDI地区，低于其余4类SDI地区。1990—2021年中国归因于饮食因素的IHD标化死亡率（AAPC=-0.17%，P<0.001）、标化DALY率（AAPC=-0.50%，P<0.001）与全球及五类SDI地区一致，均呈现下降趋势，全球下降幅度明显高于中国，高SDI地区下降速度最快。1990与2021年中国男性归因于饮食因素的IHD疾病负担均高于女性；1990—2021年中国男性归因于饮食因素的IHD标化死亡率（AAPC=0.25%，P<0.001）呈上升趋势，女性标化死亡率（AAPC=-0.71%，P<0.001）、标化DALY率（AAPC=-1.23%，P<0.001）均呈下降趋势。1990与2021年中国归因于饮食因素的IHD疾病负担随着年龄增长呈上升趋势，≥70岁人群的死亡率、DALY率最高；1990—2021年50~69岁人群死亡率、DALY率呈下降趋势，而15~49岁、≥70岁人群呈上升趋势（P<0.001）。1990年与2021年归因于13种饮食因素的IHD标化死亡率、标化DALY率排名前两位的饮食因素均是钠摄入过量、全谷物摄入不足；1990—2021年标化死亡率、标化DALY率上升趋势最明显的是含糖饮料摄入过量、加工肉摄入过量、红肉摄入过量。BAPC模型显示，未来10年中国归因于饮食因素的IHD标化死亡率，标化DALY率均呈下降趋势。结论 1990—2021年中国归因于饮食因素的IHD标化死亡率、标化DALY率均呈下降趋势，但下降速度与高SDI地区相比差距较大，男性和老年人群负担较重，因此仍需重视IHD的饮食防控策略，加强宣传健康的膳食模式，倡导大家增加全谷物的摄入，减少钠盐、含糖饮料、加工肉、红肉的摄入，采取针对性措施进行有效干预以减轻其疾病负担。
Background Ischemic heart diseaseIHDis the second leading cause of disease burden in the Chinese populationand dietary factors are considered as effective and feasible approaches to reduce the disease burden. Objective To analyze the trends in the disease burden of IHD attributable to dietary factors from 1990 to 2021 and future trends in China aiming to provide a reference basis for dietary prevention and treatment of IHD in China. Methods Data related to the disease burden of IHD attributable to dietary factors in Chinaworldwideand regions with varied socio-demographic indexSDI from 1990 to 2021 were extracted from the Global Burden of Disease 2021GBD 2021database. Using the Joinpoint model the annual percent changeAPCand average annual percent changeAAPCwere calculated to analyze the disease burden of IHD attributable to dietary factors in Chinaworldwideand regions with varied SDI. Furthermorethe model evaluated the diet-ralated disease burden by gender and age groups in Chinaas well as the burden of disease attributable to specific dietary factors within the Chinese population from 1990 to 2021. Additionallythe Bayesian age-period-cohortBAPCmodel was used to predict the standardized mortality rate and the standardized disability-adjusted life yearDALYrate of IHD attributable to dietary factors from 2022 to 2031. Results In 2021the standardized mortality rate and standardized DALY rate of IHD attributable to dietary factors in China were 44.26/100 000 and 820.87/100 000respectivelywhich were close to the global levelsbut higher than those of high SDI regions and lower than the remaining four categories of SDI regions. From 1990 to 2021 the standardized mortality rateAAPC=-0.17%P<0.001and the standardized DALY rateAAPC=-0.50%P<0.001of IHD attributable to dietary factors in China showed a decreased trendwhich were consistent with the global trend and those in the five categories of SDI regions. The global decrease was significantly higher than that in Chinawith the fastest decrease in the high SDI regions. Disease burden of IHD attributable to dietary factors was significantly higher in Chinese males than in females in 1990 and 2021. The standardized mortality rateAAPC=0.25%P<0.001of IHD attributable to dietary factors in Chinese males showed an increasing trend from 1990 to 2021. The standardized mortality rateAAPC=-0.71%P<0.001and standardized DALY rateAAPC=-1.23%P<0.001in Chinese females both showed a decreased trend. Disease burden of IHD attributable to dietary factors showed an increased trend with age in China in 1990 and 2021and the highest mortality and DALY rate were detected in people 70 years old. The mortality and DALY rate of IHD attributable to dietary factors for the residents aged 50- 69 years showed a decreased trend from 1990 to 2021while those in the 15-49 years and 70 years showed an increased trend P<0.001. Among the 13 dietary factors attributed to the standardized mortality and standardized DALY rate of IHD in 1990 and 2021the top were excessive sodium intake and insufficient intake of whole grains. Dietary factors attributed to the most significant increased trends in the standardized mortality and standardized DALY rate of IHD from 1990 to 2021 were excessive intake of sugar-sweetened beveragesexcessive intake of processed meatsand red meat intake. The BAPC model showed that the standardized mortality rate and standardized DALY rate of IHD attributable to dietary factors in China will decline over the next 10 years. Conclusion From 1990 to 2021the standardized mortality and standardized DALY rate of IHD attributable to dietary factors decreased in Chinabut the decline is slower compared to high SDI regions. Disease burden of IHD attributable to dietary factors is heavier among men and the elderly. Thereforeit is essential to focus on dietary prevention and control strategies for IHD. Efforts should be made to promote healthy dietary patternsincrease the intake of whole grainsand reduce the consumption of sodiumsugar-sweetened beveragesprocessed meatsand red meats. Targeted measures and effective interventions are needed to further reduce the disease burden.
吴霞、张译匀、熊文婧、赵湘铃、姚承志、让蔚清
10.12114/j.issn.1007-9572.2024.0253
预防医学内科学
心肌缺血缺血性心脏病全球疾病负担饮食因素趋势预测
吴霞,张译匀,熊文婧,赵湘铃,姚承志,让蔚清.1990—2021年中国归因于饮食因素的缺血性心脏病疾病负担变化趋势及预测研究[EB/OL].(2024-08-30)[2025-08-18].https://chinaxiv.org/abs/202408.00270.点此复制
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