1990—2021年中国归因于二手烟的缺血性心脏病疾病负担分析

doi:10.12114/j.issn.1007-9572.2024.0320

摘要/Abstract

摘要： 背景缺血性心脏病（IHD）是中国第二大死因，二手烟暴露是导致IHD的一个重要危险因素。目的探索1990—2021年中国归因于二手烟的IHD疾病负担及其变化趋势，并与5类社会人口指数（SDI）地区对比分析，为我国降低归因于二手烟的IHD致病死亡风险提供科学参考。方法本文数据来源于全球疾病负担（GBD） 2021，通过人群归因分值评估二手烟对IHD疾病负担的影响；采用Joinpoint回归分析25~94岁人群的死亡和伤残调整寿命年（DALYs）的平均年度变化百分比（AAPC）；应用年龄-时期-队列模型分析死亡率和DALYs率的年龄、时期及队列效应。结果二手烟为中国人群IHD的危险因素，其死亡和DALYs的人群归因分值较5类SDI地区均处于较高水平，1990—2021年分别下降了0.66%和0.67%。中国人群归因于二手烟的IHD年龄标准化死亡率（1990年：12.27/10万，2021年：11.62/10万）和年龄标准化DALYs率（1990年：284.58/10万，2021年：239.26/10万）整体上呈波动变化，其AAPC分别为-0.20%（95%CI=-0.65%~0.24%）、-0.58%（95%CI=-0.98%~-0.19%）。总人群中，中国归因于二手烟的IHD死亡和DALYs的年龄效应风险随年龄而上升，在75岁之后上升速度显著增大，时期效应呈下降趋势，队列效应呈现先上升后下降的趋势；然而，男性的时期和队列效应均呈上升趋势。结论中国归因于二手烟的IHD疾病负担较重，总体下降趋势更多得益于女性负担率的降低。男性的二手烟风险控制及高龄人群的疾病状况应受到更多关注。

关键词: 缺血性心脏病, 二手烟, 疾病负担, 年龄-时期-队列模型, 社会人口指数

Abstract:

Background

Ischemic heart disease (IHD) is the second leading cause of death in China, and second-hand smoke is a major risk factor for IHD deaths.

Objective

To analyze the disease burden and its change trends of IHD attributable to second-hand smoke in China and five social demographic index (SDI) regions from 1990 to 2021, providing scientific reference for reducing the risk of death from IHD attributable to second-hand smoke.

Methods

The data was collected from the Global Burden of Disease (GBD) 2021. Population attribution fraction (PAF) was used to evaluate the impact of second-hand smoke on IHD deaths; The annual average percentage change (AAPC) of mortality and disability adjusted life years (DALYs) were calculated by Joinpoint regression among the population aged 25-94 years during 1990-2021. The age-period-cohort model was performed to analyze the age, period, and cohort effects of mortality and DALYs rates.

Results

Second-hand smoke was a risk factor for IHD in China, and the PAF for deaths and DALYs were higher compared to the five SDI regions, with a decrease of 0.66% and 0.67% from 1990-2021, respectively. The age-standardized mortality rate (1990: 12.27/100 000; 2021: 11.62/100 000) and age-standardized DALYs rate (1990: 284.58/100 000; 2021: 239.26/100 000) of IHD attributable to second-hand smoke presented a slight downward trend, with the AAPC values of -0.20% (95%CI=-0.65% to 0.24%) and -0.58% (95%CI=-0.98% to -0.19%), respectively. The age effects of IHD death and DALYs attributable to second-hand smoke increased with age in China, with a significant rise after the age of 75 years. The period effects showed a downward trend, while the cohort effects increased first and then decreased. However, both the period and cohort effects of IHD deaths and DALYs were on a rise trend among males.

Conclusion

The disease burden of IHD attributable to second-hand smoke is relatively heavy in China, and the overall downward trend may be explained by the decline in the disease burden of IHD among women. More attention should be paid to the control of second-hand smoke in men and the status of disease in the elderly.

Key words: Ischemic heart disease, Second-hand smoke, Disease burden, Age-period-cohort model, Social-demographic index

中图分类号:

R 542.2

张泽宇,李春晖. 1990—2021年中国归因于二手烟的缺血性心脏病疾病负担分析[J]. 中国全科医学, 2026, 29(20): 2903-2912. DOI: 10.12114/j.issn.1007-9572.2024.0320.
ZHANG Zeyu,LI Chunhui. Ischemic Heart Disease Burden Attributable to Second-hand Smoke in China from 1990 to 2021[J]. Chinese General Practice, 2026, 29(20): 2903-2912. DOI: 10.12114/j.issn.1007-9572.2024.0320.

图/表 8

图1 1990—2021年中国与5类SDI地区IHD二手烟危险因素PAF对比分析注：A为死亡的PAF，B为DALYs的PAF；IHD=缺血性心脏病，PAF=人群归因分值，DALYs=伤残调整寿命年，SDI=社会人口指数。

Figure 1 Population attributable fraction of second-hand smoke risk factor that related to IHD in China and five types of SDI regions from 1990 to 2021

表1 2021年中国IHD前十大危险因素归因分值

Table 1 Population attribution fraction for the top 10 risk factors of IHD in China in 2021

危险因素	死亡PAF（%）	DALYs PAF（%）
颗粒物污染	34.75	34.48
吸烟	17.45	22.66
高钠饮食	12.25	14.00
全谷物含量低的饮食	11.23	13.41
饮食中多不饱和脂肪酸含量低	8.10	9.25
二手烟	7.45	8.09
铅暴露	7.67	7.15
低温	7.18	6.92
饮食中坚果和种子含量低	5.82	6.58
饮食富含红肉	3.87	4.62

图2 1990—2021年中国和5类SDI地区归因于二手烟的IHD疾病负担趋势变化注：A为中国分性别的年龄标准化死亡率，B为中国分性别的年龄标准化DALYs率，共用性别图例；C为不同地区的年龄标准化死亡率，D为不同地区的年龄标准化DALYs率，共用地区图例。

Figure 2 Trends in the IHD disease burden attributable to second-hand smoke in China and five SDI regions from 1990 to 2021

表2 归因于二手烟的IHD疾病负担平均年度变化百分比

Table 2 Changes in the IHD disease burden attributable to second-hand smoke

项目	地区	AAPC（%）	95%CI	t值	P值
ASMR	中国	-0.20	-0.65~0.24	-0.90	0.370
	高SDI	-4.04	-4.16~-3.92	-65.22	<0.001
	中高SDI	-1.71	-2.02~-1.40	-10.75	<0.001
	中SDI	-0.90	-1.12~-0.68	-7.89	<0.001
	中低SDI	-0.67	-0.84~-0.51	-8.15	<0.001
	低SDI	-0.69	-0.95~-0.44	-5.39	<0.001
ASDR	中国	-0.58	-0.98~-0.19	-2.90	0.004
	高SDI	-3.79	-3.92~-3.66	-55.23	<0.001
	中高SDI	-1.81	-2.11~-1.50	-11.43	<0.001
	中SDI	-1.06	-1.21~ -0.91	-13.82	<0.001
	中低SDI	-0.69	-0.80~-0.58	-11.74	<0.001
	低SDI	-0.78	-1.00~-0.56	-6.95	<0.001

图3 1990—2021年中国归因于二手烟的IHD死亡率APC模型分析注：A为局部漂移，B为纵向年龄曲线，C为队列相对比率，D为时期相对比率。

Figure 3 APC model analysis results of the IHD mortality attributable to second-hand smoke in China from 1990 to 2021

图4 1990—2021年中国归因于二手烟的IHD的DALYs率APC模型分析注：A为局部漂移，B为纵向年龄曲线，C为队列相对比率，D为时期相对比率。

Figure 4 APC model analysis results of DALYs rate of the IHD attributable to second-hand smoke in China from 1990 to 2021

图5 中国与5类SDI地区归因于二手烟的IHD死亡率趋势比较注：A为局部漂移，B为纵向年龄曲线，C为队列相对比率，D为时期相对比率。

Figure 5 Comparison of trends in the IHD mortality attributable to second-hand smoke in China and five SDI regions

图6 中国与5类SDI地区归因于二手烟的IHD的DALYs率变化趋势比较注：A为局部漂移，B为纵向年龄曲线，C为队列相对比率，D为时期相对比率。

Figure 6 Comparison of trends in the IHD DALYs rate attributable to second-hand smoke in China and the five SDI

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