中国全科医学 ›› 2023, Vol. 26 ›› Issue (35): 4425-4432.DOI: 10.12114/j.issn.1007-9572.2023.0260

• 论著 • 上一篇    下一篇

1990—2019年中国周围动脉疾病患病性别差异情况研究

刘林波1, 廖智杰1, 杨文凡2, 白丹丹1, 王冬梅1, 施森2,*()   

  1. 1.621000 四川省绵阳市第三人民医院 四川省精神卫生中心血管外科
    2.646099 四川省泸州市,西南医科大学附属医院血管外科
  • 收稿日期:2023-03-28 修回日期:2023-07-06 出版日期:2023-12-15 发布日期:2023-07-27
  • 通讯作者: 施森

  • 作者贡献:刘林波、施森负责论文总体设计、审阅;刘林波、廖智杰、杨文凡负责资料分析、解释数据并负责文献查阅;杨文凡、白丹丹、王冬梅负责论文图片的绘制、整理和起草论文;施森负责论文修改和审校工作。所有作者共同确定了论文的最终版本。
  • 基金资助:
    四川省卫生健康委科研课题(18PJ488); 四川省医学会(恒瑞)科研基金专项科研课题(2021HR65)

Analysis of Gender Differences in Peripheral Arterial Disease Prevalence from 1990 to 2019 in China

LIU Linbo1, LIAO Zhijie1, YANG Wenfan2, BAI Dandan1, WANG Dongmei1, SHI Sen2,*()   

  1. 1. Department of Vascular Surgery, the Third Hospital of Mianyang/Sichuan Mental Health Center, Mianyang 621000, China
    2. Department of Vascular Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou 646099, China
  • Received:2023-03-28 Revised:2023-07-06 Published:2023-12-15 Online:2023-07-27
  • Contact: SHI Sen

摘要: 背景 周围动脉疾病(PAD)是心血管疾病中一种常见的、严重的疾病,易并发肢体缺血及心血管不良事件。PAD的患病有性别差异,而相关研究相对缺乏。充分认识中国PAD患病情况的性别差异对于公共卫生政策的制定至关重要。 目的 分析中国PAD患病情况中的性别差异及其原因,为制订有针对性的筛查和预防措施提供理论依据。 方法 通过2019年全球疾病负担(GBD)数据库提取中国男性和女性以及全球、日本、韩国和印度女性的PAD患病人数、患病率、年龄标化患病率、疾病负担可归因危险因素以及相应95%不确定区间(UI)。采用R语言进行本研究数据和可视化分析。采用Joinpoint软件分析1990—2019年中国男性和女性PAD患病率随时间变化的趋势,计算PAD患病率的年度变化百分比(APC)和平均年度变化百分比(AAPC)以及其95%可信区间(CI)。采用贝叶斯年龄-时期-队列(BAPC)模型预测2020—2035年PAD的患病人数和患病率。 结果 中国2019年PAD患病率例数男性为71.74×10万,女性为213.15×10万。与1990年比较,2019年PAD患病人数男性增加了154.22%,女性增加了181.27%。2019年日本、韩国、印度和全球女性PAD患病人数、患病率均较1990年升高,但年龄标化患病率均降低,1990年中国女性PAD年龄标化患病率分别为日本和韩国女性的57.80%和76.35%,2019年则分别为日本和韩国的1.10倍和1.33倍。中国男性PAD患病率1990年为462.40/10万,2019年为989.79/10万,增幅为114.05%,1990—2019年呈上升趋势。中国女性PAD的患病率1990年为1 321.44/10万,2019年为3 055.85/10万,增幅为131.25%,1990—2019年呈上升趋势。2019年中国女性PAD患病率是男性的3.09倍。中国男性PAD的年龄标化患病率1990年为731.02/10万,2019年为744.96/10万,增幅为1.91%,1990—1993年、1993—2005年呈上升趋势,2005—2019年呈下降趋势。中国女性PAD的年龄标化患病率1990年为1 839.43/10万,2019年为2 022.13/10万,增幅为9.93%,1990—2005年呈上升趋势(P<0.05),2005—2019年变化趋势不显著(P>0.05)。2019年中国女性PAD年龄标化患病率是男性的2.71倍。BAPC模型预测结果示,2035年中国男性PAD患病人数将达到101.30×10万,女性将达到319.24×10万。2035年中国女性PAD患病人数较2019年将增长49.77%。分年龄统计,2019年中国女性65~69岁PAD患病人数最多,为35.15×10万,2035年将是70~74岁患病人数最多,为55.89×10万。2035年40~44、45~49、50~54、55~59岁中国女性PAD患病人数将低于2019年,60~64、65~69、70~74、75~79、80~84、85~89、90~94、≥95岁患病人数将高于2019年。2035年中国男性PAD年龄标化患病率为712.09/10万,女性为1 945.97/10万,较2019年分别降低4.41%与3.77%。分年龄统计,2035年中国女性各年龄分层PAD患病率随年龄增大而增加,除≥95岁人群外,其他年龄段人群的患病率均较2019年下降。2019年中国PAD疾病负担可归因于6种危险因素,分别为高血压、吸烟、糖尿病、肾功能不全、高盐饮食和铅暴露。男性最主要危险因素为吸烟(44.32%),其次为高血压(18.97%)和糖尿病(16.11%)。女性最主要的危险因素为高血压(32.31%),其次为糖尿病(24.81%)和肾功能不全(17.27%)。 结论 中国女性PAD的患病人数、患病率及年龄标化患病率均明显高于男性,并且年龄标化患病率已经超过日本和韩国。在可预知的未来,中国女性PAD患病人数将进一步增加,且老年女性的患病人数增长越来越明显。因此应更加重视PAD在性别、年龄方面呈现出的变化,重视PAD患者危险因素的性别差异,采取必要的筛查和预防措施。

关键词: 周围动脉疾病, 患病率, 全球疾病负担, 贝叶斯年龄-时期-队列模型, 贝叶斯预测

Abstract:

Background

Peripheral artery disease (PAD) is a common and serious cardiovascular disease, which is prone to complications of limb ischemia and adverse cardiovascular events. There is a gender difference in the prevalence of PAD, which has been relatively poorly studied. A full understanding of gender differences in prevalence of PAD in China is essential for public health policy development.

Objective

To analyze the gender differences in the prevalence of PAD in China and their causes, providing a theoretical basis for targeted screening and preventive measures.

Methods

The number of PAD cases, prevalence, age-standardized prevalence, attributable risk factors for disease burden, and corresponding 95% uncertainty intervals (UI) were extracted from the 2019 Global Burden of Disease (GBD) database for males and females in China and females in Japan, Korea, India and globally. R language was used to analyze the data and visualize the analysis of this study. Joinpoint software was used to analyze the trend of PAD prevalence in males and females in China over time from 1990 to 2019, and the annual percentage change (APC) and average annual percentage change (AAPC) of PAD prevalence and their 95% confidence intervals (CI) were calculated. A Bayesian age-period-cohort (BAPC) model was used to predict the number and prevalence of PAD in 2020—2035.

Results

The estimated prevalence of PAD in China in 2019 was 71.74×100 000 for males and 213.15×100 000 for females. Compared with 1990, the number of PAD cases in 2019 increased by 154.22% in males and 181.27% in females. In 2019, the number of cases and prevalence of PAD among males in Japan, Korea, India and globally were all higher than those in 1990, but the age-standardized prevalence was lower. In 1990, the age-standardized prevalence of PAD among women in China was 57.80% and 76.35% of those in Japan and Korea, 1.10 times and 1.33 times of those in Japan and Korea in 2019. The prevalence of PAD in Chinese men was 462.40/100 000 in 1990 and 989.79/100 000 in 2019, with an increase of 114.05%, and showed an upward trend during 1990 to 2019. The prevalence of PAD in Chinese women was 1 321.44 per 100 000 in 1990 and 3 055.85/100 000 in 2019, with an increase of 131.25%, and showed an upward trend from 1990 to 2019. The prevalence of PAD in Chinese women was 3.09 times higher than that of men in 2019. The age-standardized prevalence of PAD in Chinese males was 731.02/100 000 in 1990 and 744.96/100 000 in 2019, with an increase of 1.91%, showed an increasing trend from 1990 to 1993 and from 1993 to 2005, and a decreasing trend from 2005 to 2019. The age-standardized prevalence of PAD in Chinese women was 1 839.43/100 000 in 1990 and 2 022.13/100 000 in 2019, with an increase of 9.93%, showing an increasing trend from 1990 to 2005 (P<0.05), and a non-significant trend from 2005 to 2009 and 2009 to 2019 (P>0.05). In 2019, the age-standardized prevalence of PAD in Chinese women was 2.71 times of men. BAPC model predicts that the number of PAD cases will reach 101.30×100, 000 in Chinese men and 319.24×100 000 in Chinese women by 2035. In 2035, the number of Chinese women with PAD will increase by 49.77% compared with 2019. In terms of age, the largest number of Chinese women aged 65-69 with PAD in 2019 will be 35.15×100 000, and the largest number of women aged 70-74 with PAD in 2035 will be 55.89×100 000. In 2035, the number of Chinese women aged 40 to 44, 45 to 49, 50 to 54 and 55 to 59 with PAD will be lower than that in 2019, and the number of Chinese women aged 60 to 64, 65 to 69, 70 to 74, 75 to 79, 80 to 84, 85 to 89, 90 to 94 and≥95 with PAD will be higher than that in 2019. In 2035, the age-standardized prevalence of PAD in Chinese men and women will be 712.09/100 000 and 1 945.97/100 000, respectively, decreasing by 4.41% and 3.77% compared with 2019. By age, the prevalence of PAD in Chinese women in 2035 will increase with age, and the prevalence of PAD in all age groups will be decreased compared with 2019 except for those aged≥95 years. The disease burden of PAD in China in 2019 can be attributed to six risk factors, including hypertension, smoking, diabetes, renal insufficiency, high-salt diet and lead exposure. The most important risk factor for men was smoking (44.32%), followed by hypertension (18.97%) and diabetes (16.11%). The most common risk factor for women was hypertension (32.31%), which was followed by diabetes (24.81%) and renal insufficiency (17.27%) .

Conclusion

The number of cases, prevalence and age-specific prevalence of PAD in Chinese women are significantly higher than those in men, and the age-standardized prevalence has already exceeded that of Japan and Korea. In the foreseeable future, the number of Chinese women suffering from PAD will further increase, and the number of elderly women suffering from PAD will increase more and more obviously. Therefore, more attention should be paid to the changes in gender and age, and gender differences in risk factors of PAD patients, and necessary screening and prevention measures should be taken.

Key words: Peripheral artery disease, Prevalence, Global burden of disease, Bayesian age-period-cohort, Bayesian forecast