中国老年人群归因于饮食因素的脑卒中疾病负担及其变化趋势分析

摘要/Abstract

摘要： 目的分析1990—2021年中国老年群体（年龄≥60岁）归因于饮食因素的脑卒中疾病负担及变化趋势,为脑卒中防治提供参考依据。方法利用全球疾病负担（global burden of disease,GBD）2021数据库,提取≥60岁老年人群归因于饮食因素的脑卒中疾病负担数据,采用死亡数、年龄标准化死亡率（age-standardized mortality rate,ASMR）、伤残调整寿命年（disability-adjusted life years,DALYs）、年龄标准化DALYs率、人群归因分数（population attributable fraction,PAF）描述疾病负担。以变化率（%）和年估计百分比变化（estimated annual percentage change,EAPC）分析归因于饮食因素的疾病负担变化趋势。采用贝叶斯年龄-时期-队列（bayesian age-period-cohort,BAPC）模型预测2022—2035年的变化趋势。结果 1990—2021年,中国老年人群归因饮食因素导致的脑卒中死亡数和DALYs总体呈上升趋势,但ASMR和年龄标准化DALYs率呈下降趋势。ASMR由1990年的311.49/10万降至2021年的149.45/10万,变化率为-52.02%,EAPC为-2.50%（P<0.01）;年龄标准化DALYs率由1990年的5 821.82/10万降至2021年的2 824.21/10万,变化率为-51.49%,EAPC为-2.47%（P<0.01）。性别分析显示,男性ASMR（EAPC：-2.02%,P<0.01）和标准化DALYs率（EAPC：-2.05%,P<0.01）高于女性,而女性ASMR（EAPC：-3.26%,P<0.001）和标准化DALYs率（EAPC：-3.17%,P<0.01）的下降幅度更大。年龄组分析显示,1990—2021期间随着年龄的增长,老年人群归因于饮食因素的脑卒中疾病负担呈上升趋势,90~94岁年龄组的ASMR和标准化DALYs率最高,与1990年相比,2021年变化率分别为-43.55%、-42.26%,EAPC分别为-1.94%（P<0.01）、-1.87%（P<0.01）。60~64岁区间ASMR、标化DALY率下降最为显著,ASMR、标化DALY 率分别下降了60.13%、57.11%,EAPC分别为-3.06%（P<0.01）、-2.82%（P<0.01）。各饮食因素PAF分析显示,钠摄入过多和水果摄入不足始终是导致脑卒中的前2位因素,而加工红肉和含糖饮料摄入过多呈上升趋势。基于BAPC模型的预测,至2035年,中国老年人群的脑卒中归因饮食因素的ASMR预计将下降至97.29/10万,标化DALY率降至1,883.17/10万。结论 1990—2021年,中国老年群体因饮食因素导致的脑卒中负担有所减轻,但总体疾病负担仍较为严峻。钠摄入过多和水果摄入不足始终是主要风险因素,而加工红肉和含糖饮料的消费趋势值得关注。未来防控策略应聚焦高风险饮食因素的干预,尤其是在男性和高危群体中,以进一步减少脑卒中负担。

关键词: 老年人群, 脑卒中, 饮食因素, 疾病负担, 预测

Abstract: Objective To analyze the burden of stroke attributable to dietary factors in the elderly population（age≥60） in China from 1990 to 2021 and the trends over time,providing a reference for stroke prevention and control. Methods Data on the burden of stroke attributable to dietary factors in the elderly population（≥ 60 years old） were extracted from the Global Burden of Disease （GBD） 2021 database. The disease burden was described using the number of deaths,age-standardized mortality rate（ASMR）,disability-adjusted life years（DALYs）,age-standardized DALY rate,and population attributable fraction（PAF）. The trend of change in the disease burden attributable to dietary factors was analyzed using the percentage change and estimated annual percentage change（EAPC）. A Bayesian Age-Period-Cohort（BAPC） model was used to predict the trend from 2022 to 2035. Results From 1990 to 2021,the number of deaths and DALYs attributable to dietary factors in the elderly population of China showed an overall increasing trend,but both the ASMR and age-standardized DALY rate showed a decreasing trend. The ASMR decreased from 311.49 per 100 000 in 1990 to 149.45 per 100 000 in 2021,with a change rate of -52.02% and an EAPC of -2.50%（P<0.01）. The age-standardized DALY rate decreased from 5 821.82 per 100 000 in 1990 to 2 824.21 per 100 000 in 2021,with a change rate of -51.49% and an EAPC of -2.47%（P<0.01）. Gender analysis revealed that male ASMR（EAPC：-2.02%,P< 0.01） and age-standardized DALY rate（EAPC：-2.05%,P<0.01） were higher than females,while the decline in ASMR（EAPC：-3.26%,P<0.01） and age-standardized DALY rate（EAPC：-3.17%,P<0.01） was more significant in females. Age group analysis showed an increasing trend in the burden of stroke attributable to dietary factors with age from 1990 to 2021. The ASMR and age-standardized DALY rate in the 90-94 age group were the highest,with change rates of -43.55% and -42.26%,respectively,and EAPC values of -1.94%（P<0.01） and -1.87%（P<0.01） in 2021 compared to 1990. The 60-64 age group had the most significant decrease in ASMR and age-standardized DALY rate,with a decrease of 60.13% and 57.11%,respectively,and EAPC values of -3.06%（P<0.01） and -2.82%（P<0.01）. PAF analysis of dietary factors showed that excessive sodium intake and insufficient fruit intake remained the top two factors contributing to stroke,while the consumption of processed red meat and sugary drinks showed an increasing trend. Based on the BAPC model,the ASMR attributable to dietary factors in the elderly population of China was expected to decrease to 97.29 per 100 000,and the age-standardized DALY rate was expected to decrease to 1 883.17 per 100 000 by 2035. Conclusion From 1990 to 2021,the burden of stroke attributable to dietary factors among the elderly population in China has decreased,but the overall disease burden remains significant. Excessive sodium intake and insufficient fruit consumption have consistently been the primary risk factors,while the consumption trends of processed red meat and sugar-sweetened beverages warrants attention. Future prevention and control strategies should focus on interventions for high-risk dietary factors,particularly among men and high-risk groups,to further reduce the stroke burden.

Key words: Elderly population, Stroke, Dietary factors, Disease burden, Prediction

中图分类号:

R181.3⁺7

穆涛涛, 宋士娜, 李晓峰. 中国老年人群归因于饮食因素的脑卒中疾病负担及其变化趋势分析. [J]职业与健康, 2025, 41(16): 2256-2262.

MU Taotao, SONG Shina, LI Xiaofeng. Analysis of stroke burden attributed to dietary factors and its changing trend in the elderly population of China. [J]OCCUPATION AND HEALTH, 2025, 41(16): 2256-2262.

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