华中科技大学谢敏研究组对1990-2017年慢性呼吸系统疾病死亡率和伤残调整生命年的趋势和危险因素进行了分析。2020年2月19日，国际知名学术期刊《英国医学杂志》发表了这一成果。

研究组使用2017年全球疾病负担研究中的数据，对全球1990-2017年间按年龄和性别分列，对慢性呼吸系统疾病引起的死亡率和伤残调整生命年（DALYs）的时空趋势进行了系统分析。

1990-2017年间，慢性呼吸道疾病致死总数增加了18.0%，从1990年的332万增加至2017年的391万。慢性呼吸道疾病的年龄标准化死亡率平均每年下降2.41％。在过去的27年中，慢性阻塞性肺疾病（COPD）和尘肺病的死亡率每年缓慢下降，而间质性肺病和肺结节病的死亡率有所增加。哮喘和尘肺病的DALYs有所减少，但COPD、间质性肺病和肺结节病引起的DALYs有所增加。

在195个国家中，因慢性呼吸道疾病引起的死亡率和死亡率年度变化差异很大。对导致27年间死亡率和DALYs区域差异，以及改善不均衡的因素进行分析，结果发现人口统计学指标与COPD、尘肺和哮喘的死亡率呈负相关。

社会人口指数低的地区死亡率和DALYs最高。吸烟仍然是导致COPD和哮喘死亡的主要危险因素。在社会人口指数较低的地区，颗粒物造成的污染是COPD死亡的主要原因。自2013年以来，高体重指数已成为哮喘的主要危险因素。

总之，社会人口统计学指标低的地区疾病负担最大。吸烟、环境污染和高体重指数是死亡和DALYs的危险因素，应努力采取措施减少相应暴露。

附：英文原文

Title: Trends and risk factors of mortality and disability adjusted life years for chronic respiratory diseases from 1990 to 2017: systematic analysis for the Global Burden of Disease Study 2017

Author: Xiaochen Li, Xiaopei Cao, Mingzhou Guo, Min Xie, Xiansheng Liu

Issue&Volume: 2020/02/19

Abstract: AbstractObjective To describe the temporal and spatial trends of mortality and disability adjusted life years (DALYs) due to chronic respiratory diseases, by age and sex, across the world during 1990-2017 using data from the Global Burden of Disease Study 2017.Design Systematic analysis.Data source The Global Burden of Diseases, Injuries, and Risk Factors Study 2017.Methods Mortality and DALYs from chronic respiratory diseases were estimated from the Global Burden of Disease Study 2017 using DisMod-MR 2.1, a Bayesian meta-regression tool. The estimated annual percentage change of the age standardised mortality rate was calculated using a generalised linear model with a Gaussian distribution. Mortality and DALYs were stratified according to the Socio-demographic index. The strength and direction of the association between the Socio-demographic index and mortality rate were measured using the Spearman rank order correlation. Risk factors for chronic respiratory diseases were analysed from exposure data.Results Between 1990 and 2017, the total number of deaths due to chronic respiratorydiseases increased by 18.0%, from 3.32 (95% uncertainty interval 3.01 to 3.43) million in 1990 to 3.91 (3.79 to 4.04) million in 2017. The age standardised mortality rate of chronic respiratory diseases decreased by an average of 2.41% (2.28% to 2.55%) annually. During the 27 years, the annual decline in mortality rates of chronic obstructive pulmonary disease (COPD; 2.36%, uncertainty interval 2.21% to 2.50%) and pneumoconiosis (2.56%, 2.44% to 2.68%) has been slow, whereas the mortality rate for interstitial lung disease and pulmonary sarcoidosis (0.97%, 0.92% to 1.03%) has increased. Reductions in DALYs for asthma and pneumoconiosis have been seen, but DALYs due to COPD, and interstitial lung disease and pulmonary sarcoidosis have increased. Mortality and the annual change in mortality rate due to chronic respiratory diseases varied considerably across 195 countries. Assessment of the factors responsible for regional variations in mortality and DALYs and the unequal distribution of improvements during the 27 years showed negative correlations between the Socio-demographic index and the mortality rates of COPD, pneumoconiosis, and asthma. Regions with a low Socio-demographic index had the highest mortality and DALYs. Smoking remained the major risk factor for mortality due to COPD and asthma. Pollution from particulate matter was the major contributor to deaths from COPD in regions with a low Socio-demographic index. Since 2013, a high body mass index has become the principal risk factor for asthma.Conclusions Regions with a low Socio-demographic index had the greatest burden of disease. The estimated contribution of risk factors (such as smoking, environmental pollution, and a high body mass index) to mortality and DALYs supports the need for urgent efforts to reduce exposure to them.

DOI: 10.1136/bmj.m234

Source: https://www.bmj.com/content/368/bmj.m234