中国胃炎和十二指肠炎疾病负担的长期演变、效应解析与未来态势：基于 GBD 2023 的分析

Long-term evolution，effect analysis and future trend of the burden of gastritis and duodenitis in China ：An analysis based on GBD 2023

摘要

目的：探究1990—2023年中国胃炎和十二指肠炎（gastritis and duodenitis，GD）的疾病负担演变趋势，明确其负担变化的驱动要素，预测2024—2040年疾病负担态势，为 GD 防控策略的制定提供数据依据。方法：依托全球疾病负担研究2023的数据，运用 Joinpoint 回归模型剖析1990—2023年中国 GD 年龄标准化（简称标化）发病率、标化患病率、标化死亡率及标化伤残调整寿命年（disability-adjusted life year，DALY）率的平均年度百分比变化（ave-rage annual percent change，AAPC）；通过年龄-时期-队列模型探究年龄、时期、队列三效应对发病、患病及死亡风险的作用；分辨人口结构变化、流行病学变化、人口增长三类因素对疾病负担的驱动效应；运用自回归积分滑动平均（autoregressive integrated moving average，ARIMA）模型展望未来疾病负担。结果：1990—2023年，中国 GD 发病例数由 615.88 万上升至 935.45 万，患病例数由 877.06 万上升至 1314.59 万，死亡例数由 1.98 万降至 1.72 万，DALY数由90.24万人年微降至85.16万人年；标化发病率、标化患病率、标化死亡率及标化 DALY 率的 AAPC 分别为$-1.08\mathrm{\%}\mathrm{、}-1.18\mathrm{\%}\mathrm{、}-3.81\mathrm{\%}\mathrm{、}-2.89\mathrm{\%}$（均 P<0.001）。Joinpoint 回归分析表明，各标化率均呈分阶段下降趋势。年龄-时期-队列模型显示，发病与患病风险在 55∼59 岁达峰，死亡风险随年龄升高显著上升；发病与患病风险时期效应先升后降，死亡风险时期效应持续下降；队列风险均呈下降趋势。分解研究表明，人口增长与结构变化促使发病数、患病数增加（发病数总体贡献占比分别为 165.66%、167.00%），流行病学变化为其下降主因（发病数总体贡献占比- 232.66%）；流行病学变化是死亡数下降的核心因素（总体贡献占比 490.07%）。ARIMA 模型预测显示，至2040年发病数将升至1 108.61 万例，患病数升至1527.96万例，死亡率降至 0.48/10 万，DALY 率降至 26.18/10万。结论：1990—2023年中国 GD 标化疾病负担明显缓解，人口因素与流行病学变化协同推动负担变化；未来发病与患病数将上升，但死亡与伤残负担持续降低，需结合年龄、队列特征及驱动因素制定精准防控策略。

Abstract

Objective：To explore the evolutionary trends of the disease burden of gastritis and duode- nitis（GD）in China from 1990 to 2023，to clarify the driving factors of changes in this burden，to predict the disease burden situation from 2024 to 2040，and to provide data support for formulating GD preven- tion and control strategies. Methods：Based on the Global Burden of Disease Study（GBD） 2023 data， the Joinpoint regression model was applied to analyze the annual average percentage change（AAPC）of age-standardized incidence rate，age-standardized prevalence rate，age-standardized mortality rate，and age-standardized disability-adjusted life years（DALY）rate of GD in China from 1990 to 2023.The age- period-cohort model was used to investigate the effects of age，period，and cohort on incidence，preva- lence，and mortality risks.Three factors-population structure change，epidemiological change，and population growth-were identified to determine their driving effects on the disease burden.The auto- regressive integrated moving average（ARIMA）time series model was employed to forecast the future disease burden. Results：From 1990 to 2023，the number of GD incident cases in China increased from 6. 1588 million to 9.3545 million，the number of prevalent cases rose from 8.7706 million to 13.1459 million，the number of deaths decreased from 19800 to 17 200，and the number of DALY slightly de- clined from 902400 person-years to 851600 person-years.The AAPCs of age-standardized incidence rate，age-standardized prevalence rate，age-standardized mortality rate，and age-standardized DALY rate were -1.08%,-1.18%,-3.81% ，and -2.89% ，respectively（all P<0.001）.Joinpoint regres- sion analysis showed that all age-standardized rates presented a phased downward trend.Age-period- cohort model analysis revealed that the incidence and prevalence risks peaked in the 55-59 years age group，while the mortality risk increased significantly with age.The period effect of incidence and preva- lence risks first increased and then decreased，whereas the period effect of mortality risk showed a conti- nuous downward trend；the cohort risk exhibited a decreasing trend across all the groups.Decomposition analysis indicated that population growth and structural change promoted the increase in incident and prevalent cases（the overall contribution rates to the incident cases were 165.66% and 167.00% ，re- spectively），while epidemiological change was the main factor driving their decrease（with an overall contribution rate of -232.66% to the incident cases）.Additionally，epidemiological change was the core factor for the reduction in deaths（with an overall contribution rate of 490.07％）.The ARIMA time series model predicted that by 2040，the number of incident cases would rise to 11.0861 million，the number of prevalent cases to 15.2796 million，the mortality rate to 0.48 per 100000 population，and the DALY rate to 26.18 per 100000 population. Conclusion：From 1990 to 2023，the age-standardized disease burden of GD in China was significantly alleviated，with population factors and epidemiological changes jointly driving the burden changes.Although the number of incident and prevalent cases will in- crease in the future，the mortality and disability burden will continue to decrease.It is necessary to formu- late targeted prevention and control strategies based on age，cohort characteristics，and driving factors.

关键词

胃炎 / 十二指肠炎 / 全球疾病负担 / 中国

Key words

Gastritis / Duodenitis / Global burden of disease / China

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