中国先天性心脏病疾病负担三十年变化分析

目的：分析1990—2019年中国先天性心脏病（先心病）的疾病负担变化趋势。方法：采用2019年全球疾病负担（GBD）研究数据，分析中国1990—2019年先心病发病人数、标化发病率、死亡人数、标化死亡率、伤残调整生命年（DALY）、标化DALY率的变化趋势。采用Joinpoint回归模型对以上指标进行时间趋势分析；采用年龄-时期-队列模型进行先心病死亡率的年龄、时期和出生队列效应分析；采用Pearson相关性分析分析以上指标与人类发展指数（HDI）的相关性。结果：1990—2019年，中国先心病标化发病率、死亡率及DALY率年平均变化百分比（AAPC）分别为–0.1%（95%CI：–0.7%~0.4%）、–3.5%（95%CI：–3.7%~ –3.2%）及–3.5%（95%CI：–3.7%~–3.2%）。先心病发病主要集中在1岁之前：新生儿平均发病率为2497.9/10万；1岁以下儿童平均发病率为2626.6/10万。1995—2000年新生儿及1岁以下儿童的发病率呈指数级上升，随后呈平稳下降趋势，但2010—2013年与2014—2015年1岁以下儿童的发病率有两次呈指数级上升，随后呈指数级下降，在2019年下降至近三十年最低值。先心病死亡率随年龄增长呈下降趋势，5岁以下儿童先心病死亡率为101.67/10万人年，5岁及以上人群死亡率下降；但55~<60岁人群死亡率呈短暂上升。1995—2019年，先心病患者的相对死亡风险呈下降趋势，与1995—1999年比较，2015—2019年先心病患者死亡的率比（RR）下降了24%；1945年以后的出生队列相对死亡风险呈下降趋势，与1945—1949年出生队列比较，2015—2019年出生队列先心病患者RR值下降了75%。当HDI小于0.58时（1999年以前），先心病标化发病率与HDI呈正相关（r=0.74，P<0.05）；当HDI为0.58及以上时（1999年及以后），先心病标化发病率与HDI呈负相关（r=–0.76，P<0.01）。标化死亡率、标化DALY率与HDI均呈负相关（r=–0.95和 –0.93，均P<0.01）。结论：我国先心病1990—1999年标化发病率上升，与社会发展程度呈正相关；1999—2019年标化发病率下降，与社会发展程度呈负相关。先心病疾病负担下降，与社会经济发展程度呈负相关。先心病防控虽取得了一些进展，但低龄先心病患儿的疾病负担仍较重。

Trends in the disease burden of congenital heart disease in China over the past three decades

Objective: To investigate the disease burden of congenital heart disease (CHD) in China from 1990 to 2019. Methods: Using the data from Global Burden of Disease (GBD) study 2019, the incidence, age-standardized incidence rates, the mortality, age-standardized mortality rates, disability-adjusted life year (DALY) and age-standardized DALY rates of CHD were calculated. Time trend analysis of disease burden-related indicators was analyzed by Joinpoint regression model. Age-period-cohort model was used to describe age, period, and birth cohort effects in CHD mortality population. The relationship between age-standardized incidence, mortality, DALY rates of congenital heart disease and human development index (HDI) were analyzed by Pearson correlation. Results: From 1990 to 2019, the mean annual percentage change (AAPC) in age-standardized incidence rate, mortality rate and DALY rate of CHD in China were –0.1%(95%CI: –0.7%-0.4%)、–3.5%(95%CI: –3.7%-–3.2%) and -3.5%(95%CI: –3.7%-–3.2%), respectively. CHD usually occurred in the first year of life. The mean incidence rate at birth was 2497.9/100 000, and the mean incidence rate under 1?year of age was 2626.6/100 000. During the period of 1995—2000, the incidence rate in newborn and <1?year children showed an exponential upward trend, then it remained a steady downward trend. However, there was an exponential increase in <1?year children during 2010—2013 and 2014—2015, followed by an exponential decrease to the lowest value in the last three decades. The mortality of CHD tended to decrease with age, with mortality of 101.67/100 000 for children under 5?years of age and a decrease after 5?years of age. However, there was a transient increase in mortality in age group 55-<60. From 1995 to 2019, the relative risk of death of patients with CHD showed a downward trend. Compared with 1995—1999, the rate ratio of death decreased by 24% in 2015—2019. Such downward trend was also observed in the birth cohort after 1945. Compared with the 1945—1949 birth cohort, the rate ratio of death for patients with CHD decreased by 75% in the 2015—2019 birth cohort. When HDI<0.58 (before 1999), the age-standardized incidence of CHD was positively correlated with HDI ( r=0.74, P<0.05). When HDI≥0.58 (after 1999), the age-standardized incidence of CHD was negatively correlated with HDI (r=–0.76, P<0.01). The age-standardized mortality and DALY rates were negatively correlated with HDI (r=–0.95 and –0.93, both P<0.01).Conclusions: During 1990 to 1999, the incidence of CHD increases and is positively correlated with the social development. During 1999 to 2019, the incidence of CHD decreases and is negatively correlated with the social development. The disease burden of CHD decreases and is negatively correlated with the social development. Some progress has been made in the field of prevention and control of CHD, but the disease burden remains high among younger population in China.