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 Study 2021 (GBD2021). 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 the sixth largest 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% ~ 0.24%) and -0.58% (95%CI：-0.98% ~ -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: Second-hand smoke, Ischemic heart disease, Disease burden, Age-period-cohort model, Social-demographic index

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　分析1990—2021年中国与五类社会人口指数（SDI）地区归因于二手烟的IHD疾病负担及其变化趋势，为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研究2021（GBD2021），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　二手烟作为中国人群IHD的第六大危险因素，其死亡和DALYs的人群归因分值较五类SDI地区均处于较高水平，1990—2021年间分别下降了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：12.27/100 000；2021年：11.62/100 000）和年龄标准化DALYs率（1990年：284.58/100 000；2021年：239.26/100 000）整体上呈略微下降趋势，其AAPC分别为-0.20%（95%CI：-0.65%~0.24%）和-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，队列效应呈现先升后降的趋势；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: 二手烟, 缺血性心脏病, 疾病负担, 年龄 – 时期 – 队列模型, 社会人口指数