AIDS in China from 2004 to 2018: Incidence and Mortality Trends and Age-period-cohort Effect Analysis

doi:10.12114/j.issn.1007-9572.2022.0617

Abstract

Abstract:

Background

AIDS is a very hazardous infectious disease. The analysis of AIDS incidence and mortality trends and the age-period-cohort influence on them, may provide insights into the formulation of AIDS related prevention and control policies.

Objective

To assess AIDS incidence and mortality trends, and the impact of age, period and cohort on the incidence and mortality of AIDS in China from 2004 to 2018.

Methods

In March 2022, from the online direct reporting system of the Data-center of China Health Science, number of AIDS patients, AIDS incidence, number of patients dying of AIDS, AIDS mortality in China during 2004—2018 were extracted from the overall information during the period. The Joinpoint regression model was used to estimate the trend of AIDS incidence and mortality, and to calculate the annual percent change (APC) and average annual percent change (AAPC) . The age-period-cohort model was used to assess the influence of age, period and cohort on the trend of AIDS incidence and mortality.

Results

During the period from 2004 to 2018, the incidence of AIDS in China increased from 0.248 9/100 000 to 4.956 9/100 000, and AIDS mortality increased from 0.060 5/100 000 to 1.431 2/100 000. Joinpoint regression analysis revealed that the incidence and mortality of AIDS in China had an average annual increase of 22.70%〔95%CI (20.70%, 24.80%) 〕and 18.80%〔95%CI (12.10%, 25.90%) 〕in the period, respectively (P<0.05) . The age-period-cohort analysis indicated that age, period and cohort all affected AIDS incidence and mortality (P<0.05) . The temporal trend in age-specific AIDS incidence or mortality showed a J-shaped curve of growth. The AIDS incidence increased from 0.000 4/100 000 in 5-9-year-olds to 2 828.828 5/100 000 in 75-79-year-olds, and the AIDS mortality increased from 0.000 4 in 5-9-year-olds to 740.297 4 in 75-79-year-olds. With the passage of time, the risk of AIDS incidence and mortality increased gradually: compared with the rate ratio of AIDS incidence and mortality (RR=1.000 0) in 2009—2013, the RR of AIDS incidence increased from 0.315 6〔95%CI (0.277 2, 0.359 4) 〕during 2004—2008 to 2.024 4〔95%CI (1.877 1, 2.183 2) 〕during 2014—2018. The RR of AIDS mortality increased from 0.329 1〔95%CI (0.291 7, 0.371 3) 〕in the period 2004—2008 to 1.522 6 in the period 2014—2018. The later the cohort was born, the greater the risk of AIDS incidence and mortality: compared with the relative risk of AIDS incidence and mortality (RR=1.000 0) in 1969—1973 cohort, the RR of AIDS incidence increased from 0.000 1〔95%CI (0, 0.000 4) 〕in the 1929—1933 cohort to 471.385 3〔95%CI (118.524 3, 1 874.755 6) 〕in the 2009—2013 cohort; the RR for mortality increased from 0.000 1 〔95%CI (0, 0.000 6) 〕in the 1929—1933 cohort to 93.634 5〔95%CI (21.168 0, 414.182 4) 〕in the 2009—2013 cohort.

Conclusion

AIDS incidence and mortality were on the rise in China during 2004—2018. AIDS incidence and mortality increased with age, and the period and cohort effects on the risk of incidence and mortality increased. More efforts need to be made to strengthen AIDS prevention and treatment in middle-aged and elderly people.

Key words: Acquired immuno-deficiency syndrome, Incidence, Mortality, Burden of illness, Trend analysis, Age-period-cohort model

摘要： 背景艾滋病作为一种极具危害性的传染病，分析其发病率与死亡率变化趋势并探讨年龄、时期、队列3个因素对艾滋病发病率与死亡率的影响能够为艾滋病防控政策的制定提供一定的参考价值。目的分析2004—2018年中国艾滋病发病率与死亡率变化趋势，探究年龄、时期及队列因素对艾滋病发病率与死亡率的影响。方法于2022年3月，以中国公共卫生科学数据中心2004—2018年的网络直报系统数据作为数据来源，提取2004—2018年中国艾滋病各年龄组发病人数、发病率、死亡人数及死亡率数据。运用Joinpoint回归模型分析2004—2018年中国艾滋病发病率与死亡率的变化趋势，并计算年度变化百分比（APC）与平均年度变化百分比（AAPC）；借助年龄-时期-队列模型分析年龄、时期及队列因素对中国艾滋病发病率与死亡率的影响。结果 2004—2018年中国艾滋病发病率从0.248 9/105升至4.956 9/105，死亡率从0.060 5/105升至1.431 2/105。Joinpoint回归模型结果显示，2004—2018年中国艾滋病发病率与死亡率分别年均上升22.70%[95%CI(20.70%,24.80%)]和18.80%[95%CI(12.10%,25.90%)]。年龄-时期-队列模型结果显示：年龄、时期及队列因素均对中国艾滋病发病率与死亡率有影响；2004—2018年中国艾滋病发病率与死亡率的纵向年龄曲线均呈“J”字形上升趋势，年龄别发病率从5～9岁组的0.000 4/105上升至75～79岁组的2 828.828 5/105，年龄别死亡率从5～9岁组的0.000 4/105上升至75～79岁组的740.297 4/105；随着时期的推移，艾滋病发病与死亡风险均逐渐增加，以2009—2013年时期组为对照组[时期率比（RR）值=1.000 0]，发病风险RR值由2004—2008年时期组的0.315 6[95%CI(0.277 2,0.359 4)]上升至2014—2018年时期组的2.024 4[95%CI(1.877 1,2.183 2)]，死亡风险RR值由2004—2008年时期组的0.329 1[95%CI(0.291 7,0.371 3)上升至2014—2018年时期组的1.522 6[95%CI(1.412 8,1.640 9)]；与较早出生的队列相比，较晚出生的队列艾滋病发病与死亡风险更高，以1969—1973年出生队列组为对照组（出生队列RR值=1.000 0），发病风险RR值由1929—1933年出生队列组的0.000 1[95%CI(0,0.000 4)]上升至2009—2013年出生队列组的471.385 3[95%CI(118.524 3,1 874.755 6)]，死亡风险RR值由1929—1933年出生队列组的0.000 1[95%CI(0,0.000 6)]上升至2009—2013年出生队列组的93.634 5[95%CI(21.168 0,414.182 4)]。结论 2004—2018年中国艾滋病发病率与死亡率均呈上升趋势。艾滋病发病率与死亡率随年龄增长而升高，艾滋病发病与死亡风险的时期、队列效应均呈上升趋势。需重点加强对中老年群体的艾滋病防治工作。

关键词: 获得性免疫缺陷综合征, 发病率, 死亡率, 疾病负担, 趋势分析, 年龄-时期-队列模型

ZHAO Honglin,LI Qiaomei,LI Tingting, et al. AIDS in China from 2004 to 2018: Incidence and Mortality Trends and Age-period-cohort Effect Analysis[J]. Chinese General Practice, 2023, 26(04): 409-416. DOI: 10.12114/j.issn.1007-9572.2022.0617.
赵虹琳,李巧梅,李婷婷等. 2004—2018年中国艾滋病发病与死亡趋势及其年龄-时期-队列模型分析[J]. 中国全科医学, 2023, 26(04): 409-416. DOI: 10.12114/j.issn.1007-9572.2022.0617.

Figures/Tables 8

Figure 1 Trends of AIDS incidence and mortality in China，2004—2018

Table 1 Age-period-cohort effects on AIDS incidence and mortality in China from 2004 to 2018

零假设	发病率		死亡率
零假设	χ²值	P值	χ²值	P值
净变化=0	722.144 6	<0.001	527.809 5	<0.001
总年龄偏差=0	151.984 6	<0.001	192.045 4	<0.001
总时期偏差=0	28.872 8	<0.001	78.815 2	<0.001
总队列偏差=0	51.706 2	<0.001	84.309 3	<0.001
全时期RR值=1	810.462 4	<0.001	530.511 9	<0.001
全队列RR值=1	923.387 6	<0.001	760.560 1	<0.001
所有局部变化=净变化	49.848 1	<0.001	83.318 8	<0.001

Figure 2 Temporal trend curve of age-specific AIDS incidence in China，2004—2018

Figure 3 Temporal trend curve of age-specific AIDS mortality in China，2004—2018

Figure 4 Period effects on AIDS incidence in China，2004—2018

Figure 5 Period effects on AIDS mortality in China，2004—2018

Figure 6 Birth cohort effect on AIDS incidence in China，2004—2018

Figure 7 Birth cohort effect on AIDS mortality in China，2004—2018

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