切换至 "中华医学电子期刊资源库"
高级检索
中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (06) : 708 -716. doi: 10.3877/cma.j.issn.1674-392X.2024.06.022

调查研究

基于GBD2021 数据库对中国与全球老年人疝疾病负担和健康不平等的分析比较
张晋伟1,2, 董永红1,2,†(), 王家璇3   
  1. 1.030012 太原，山西医科大学第五临床医学院
    2.030012 太原，山西省人民医院胃肠胰及疝与腹壁外科
    3.046000 山西，长治医学院第一临床医学院
  • 收稿日期:2024-07-27 出版日期:2024-12-18
  • 通信作者: 董永红

Analysis and comparison of disease burden and health inequality of hernias in elderly populations between China and global levels based on GBD2021 study

Jinwei Zhang1,2, Yonghong Dong1,2,†(), Jiaxuan Wang3   

  1. 1.The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan 030012, Shanxi Province, China
    2.The Department of Gastrointestinal, Pancreatic, Hernia and Abdominal Wall Surgery,Shanxi Provincial People's Hospital, Taiyuan 030012, Shanxi Province, China
    3.First Clinical Medical College of Changzhi Medical College, Changzhi 046000, Shanxi Province, China
  • Received:2024-07-27 Published:2024-12-18
  • Corresponding author: Yonghong Dong
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

张晋伟, 董永红, 王家璇. 基于GBD2021 数据库对中国与全球老年人疝疾病负担和健康不平等的分析比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 708-716.

Jinwei Zhang, Yonghong Dong, Jiaxuan Wang. Analysis and comparison of disease burden and health inequality of hernias in elderly populations between China and global levels based on GBD2021 study[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 708-716.

目的

分析1990—2021 年中国老年人疝疾病（包括腹股沟疝、股疝、脐疝、膈疝、其他腹部疝，不包括切口疝、造口旁疝和其他未指明的腹疝）负担、变化趋势和健康不平等，并与全球水平进行对比，为我国老年人疝防治相关措施的制定提供依据。

方法

利用2021 年全球疾病负担（GBD2021）研究评估中国老年人疝的疾病负担，采用Joinpoint 回归模型分别计算1990—2021年我国和全球老年人疝的各项标化率的平均年百分比变化（AAPC）；分解分析揭示老年人疝疾病负担的驱动因素；健康不平衡分析揭示不同社会人口指数（SDI）地区老年人疝疾病负担差距。

结果

1990—2021 年，中国老年人疝疾病的标化发病率、标化患病率和标化伤残调整寿命年（DALY）率均低于全球整体水平。2021 年中国老年人疝疾病的标化发病率、标化患病率和标化DALY 率分别为82.63/10 万、169.35/10 万、17.32/10 万，全球分别为134.87/10 万、330.86/10 万、76.23/10 万。1990—2021 年，中国与全球老年男性疝疾病负担均高于女性。1990—2021 年，中国老年人疝疾病的标化发病率呈上升趋势（AAPC=1.19%，P＜0.001），而标化患病率（AAPC=-0.64%，P＜0.001）和标化DALY 率（AAPC=-1.56%，P＜0.001）呈下降趋势，全球的标化发病率（AAPC=-1.12%，P＜0.001）、标化患病率（AAPC=-1.44%，P＜0.001）和标化DALY 率（AAPC=-1.64%，P＜0.001）均呈下降趋势。1990—2021 年，人口增长对中国和全球的疝疾病发病率、患病率和DALY 率的上升均呈主要贡献。全球健康不平等现象仍存在，DALY 率和患病率的健康不平等现象过度集中在低SDI 的国家，发病率的健康不平等现象过度集中在高SDI 的国家，中国的健康不平等现象继续加重。

结论

1990—2021 年，中国和全球老年人疝疾病负担整体呈下降趋势，中国负担低于全球水平，2019 年后疝疾病负担在逐渐增加，相关疝疾病综合防治仍需重视，男性人群应为防治主要人群，落后地区应为防治主要地区。

关键词: 疝,腹股沟, 股疝, 疾病负担, 老年人群, 分解分析, 健康不平等

Objective

To analyze the burden, trends, and health inequalities of hernia disease(including inguinal hernia, femoral hernia, umbilical hernia, diaphragmatic hernia, other abdominal hernia,not including incisional hernia, parostomy hernia and other unspecified abdominal hernia) in older adults in China from 1990 to 2021, and to compare these with global levels, providing a basis for formulating prevention and control measures for hernias in the elderly population in China.

Methods

The Global Burden of Disease 2021 (GBD2021) study was used to assess the disease burden of hernias in Chinese older adults.The Joinpoint regression model was employed to calculate the average annual percentage change (AAPC) of standardized rates for hernias in older adults in China and globally from 1990 to 2021.Decomposition analysis was conducted to reveal the driving factors of hernia disease burden in the elderly,and health inequality analysis was performed to reveal disparities in hernia disease burden among older adults across regions with different socio-demographic index (SDI) levels.

Results

From 1990 to 2021,the age-standardized incidence, prevalence, and disability-adjusted life year (DALY) rates of hernia disease in Chinese older adults were all lower than the global level.In 2021, the age-standardized incidence,prevalence, and DALY rates for hernias in Chinese older adults were 82.63 per 100,000, 169.35 per 100,000, and 17.32 per 100,000, respectively, compared to the global rates of 134.87 per 100,000, 330.86 per 100,000, and 76.23 per 100,000.From 1990 to 2021, the hernia disease burden in older male adults was higher than that in females in both China and globally.During this period, the age-standardized incidence rate in China showed an upward trend (AAPC=1.19%, P＜0.001), while the age-standardized prevalence rate (AAPC=-0.64%, P＜0.001) and DALY rate (AAPC=-1.56%, P＜0.001) showed downward trends.Globally, the age-standardized incidence (AAPC=-1.12%, P＜0.001), prevalence (AAPC=-1.44%,P＜0.001), and DALY rates (AAPC=-1.64%, P＜0.001) all showed downward trends.Population growth contributed significantly to the increase in incidence, prevalence, and DALY rates of hernia disease both in China and globally from 1990 to 2021.Health inequalities persist globally, with DALY and prevalence inequalities excessively concentrated in low-SDI countries, and incidence inequalities excessively concentrated in high-SDI countries.Health inequalities in China continue to increase.

Conclusion

From 1990 to 2021, the overall hernia disease burden in older adults in China and globally showed a declining trend, and the hernia burden in China was lower than the global level.Since 2019, the burden of hernia diseases has gradually increased, highlighting the need for comprehensive prevention and control of related hernias, with a focus of prevention on the male population and underdeveloped regions.

Key words: Hernia, inguinal, Hernia, femoral, Disease burden, Elderly population, Decomposition analysis, Health inequality
表1 1990—2021 年中国与全球老年人疝疾病负担及其AAPC 变化情况比较
性别 国家或地区 年份 发病数(万例) 标化发病率(/10万) 患病数(万例) 标化患病率(/10万) DALY(万人年) 标化DALY率(/10万)
男性 中国 1990 5.58 110.18 18.50 384.34 1.94 50.62
2021 21.32 160.27 41.18 314.97 3.67 31.35
AAPC 1.21(1.14～1.27) -0.67(-0.72～-0.61) -1.57(-1.78～-1.36)
全球 1990 -80.53 359.72 193.41 891.13 36.38 185.88
2021 128.54 250.95 281.03 556.06 52.00 108.70
AAPC -1.17(-1.31～-1.02) -1.52(-1.56～-1.49) -1.73(-1.85～-1.60)
女性 中国 1990 0.48 9.33 2.62 50.45 0.49 11.01
2021 1.52 10.72 5.27 37.31 0.79 5.86
AAPC 0.43(0.35～0.52) -0.98(-1.07～-0.90) -2.04(-2.27～-1.80)
全球 1990 13.85 51.88 58.53 219.70 21.49 84.59
2021 19.56 33.35 80.60 137.58 29.13 49.46
AAPC -1.49(-1.53～-1.35) -1.51(-1.55～-1.46) -1.72(-1.84～-1.60)
合计 中国 1990 6.06 57.14 21.12 205.15 2.43 27.88
2021 22.84 82.63 46.45 169.35 4.46 17.32
AAPC 1.19(1.12～1.25) -0.64(-0.69～-0.60) -1.56(-1.81～-1.31)
全球 1990 94.38 190.28 251.95 516.42 57.87 127.62
2021 148.10 134.87 361.64 330.86 81.13 76.23
AAPC -1.12(-1.24～-0.99) -1.44(-1.48～-1.40) -1.64(-1.77～-1.51)
图1 1990—2021 年中国和全球老年人疝疾病的标化发病率、标化患病率、标化DALY 率的Joinpoint 回归分析 注：APC 年度变化百分比；AAPC 平均年百分比变化；DALY 伤残调整寿命年。1A、1C、1E 为中国的，1B、1D、1F 为全球的。
表2 1990—2021 年中国和全球老年人疝疾病的发病率、患病率、DALY 率的分解分析（%）
观察对象 发病率 患病率 DALY率
总变化 部分变化占比 总变化 部分变化占比 总变化 部分变化占比
老龄化 人口增长 流行病学变化 老龄化 人口增长 流行病学变化 老龄化 人口增长 流行病学变化
中国 男性 282.04 -1.05 204.07 79.01 122.53 2.13 154.59 -34.18 88.88 15.00 145.56 -71.66
女性 216.29 4.55 183.15 28.59 101.29 3.10 147.12 -48.93 63.13 19.62 137.07 -93.57
总计 276.82 -3.44 202.23 78.03 119.90 -0.06 153.21 -33.26 83.73 12.90 143.22 -72.40
全球 男性 59.61 -0.73 110.68 -50.34 45.30 0.79 106.81 -62.30 42.94 6.80 106.55 -70.41
女性 41.25 0.78 97.70 -57.21 37.71 0.67 96.83 -59.79 35.55 7.66 96.56 -68.66
总计 56.92 -1.29 105.50 -47.30 43.54 -0.07 101.92 -58.31 40.20 6.10 101.34 -67.24
图2 1990—2021 年全球老年人疝疾病的发病率、患病率和DALY 率的绝对健康不平等和相对健康不平等 注：2A、2C、2E 绝对健康不平等；2B、2D、2F 相对健康不平等。DALY 伤残调整寿命年；SDI 社会人口指数。
表3 1990—2021 年与SDI 相关的全球老年人疝疾病年龄标准化的发病率、患病率和DALY 的健康不平等
性别 年份 健康不平等 发病率(95%CI) 患病率(95%CI) DALY(95%CI)
男性 1990 集中指数 0.2(0.15～0.25) -0.1(-0.15～-0.06) -0.21(-0.26～-0.15)
2021 集中指数 0.07(0.03～0.11) -0.17(-0.21～-0.13) -0.28(-0.35～-0.21)
1990 斜度指数 367.7(290.5～444.8) -194.4(-349.7～-39.1) -141.1(-180.8～-101.4)
2021 斜度指数 124.6(94.8～154.3) -384.9(-464.9～-304.9) -151.1(-173.9～-128.3)
女性 1990 集中指数 0.22(0.17～0.27) -0.02(-0.08～0.04) -0.1(-0.16～-0.03)
2021 集中指数 0.03(-0.02～0.08) -0.18(-0.24～-0.13) -0.21(-0.27～-0.15)
1990 斜度指数 67.6(55.6～79.6) 51.6(1.4～101.8) -22.6(-47.7～2.5)
2021 斜度指数 28.6(22.6～34.5) -51.6(-79.2～-24) -54.4(-69.9～-38.8)
合计 1990 集中指数 0.17(0.13～0.22) -0.11(-0.16～-0.07) -0.18(-0.24～-0.12)
2021 集中指数 0.06(0.02～0.1) -0.18(-0.21～-0.14) -0.25(-0.32～-0.19)
1990 斜度指数 195.1(154.3～235.8) -100.3(-190.7～-9.8) -83.7(-114.6～-52.8)
2021 斜度指数 77(60.9～93.1) -203.2(-247.9～-158.6) -98.1(-116.2～-80)
[1]
李航宇, 顾岩, 王明刚, 等.老年腹股沟疝诊断和治疗中国专家共识(2019 版)[J].中国实用外科杂志, 2019, 39(8): 782-787.
[2]
Zendejas B, Ramirez T, Jones T, et al.Incidence of inguinal hernia repairs in Olmsted County, MN: a population-based study[J].Ann Surg, 2013, 257(3): 520-526.
[3]
Ma Q, Jing W, Liu X, et al.The global, regional, and national burden and its trends of inguinal, femoral, and abdominal hernia from 1990 to 2019: findings from the 2019 Global Burden of Disease Study - a cross-sectional study[J].Int J Surg, 2023, 109(3): 333-342.
[4]
GBD 2019 Diseases and Injuries Collaborators.Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J].Lancet, 2020, 396(10258): 1204-1222.
[5]
GBD 2021 Demographics Collaborators.Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021[J].Lancet,2024, 403(10440): 1989-2056.
[6]
Wang F, Ma B, Ma Q, et al.Global, regional, and national burden of inguinal, femoral, and abdominal hernias: a systematic analysis of prevalence, incidence, deaths, and DALYs with projections to 2030[J].Int J Surg, 2024, 110(4): 1951-1967.
[7]
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators.Global, regional, and national incidence, prevalence,and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016[J].Lancet, 2017, 390(10100): 1211-1259.
[8]
周小龙, 赵洋, 耿叶, 等.1990—2019 年中国70 岁及以上人群结直肠癌疾病负担分析[J].中国慢性病预防与控制, 2022, 30(6):442-446.
[9]
GBD 2019 Demographics Collaborators.Global age-sex-specific fertility, mortality, healthy life expectancy(HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019[J].Lancet, 2020, 396(10258): 1160-1203.
[10]
Xie Y, Bowe B, Mokdad A H, et al.Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016[J].Kidney Int, 2018, 94(3): 567-581.
[11]
Li Y, Wang H, Guan Z, et al.Persistence of severe global inequalities in the burden of blindness and vision loss from 1990 to 2019:findings from the Global Burden of Disease Study 2019[J].Br J Ophthalmol, 2024, 108(2): 301-309.
[12]
Stewart BT, Wong E, Gupta S, et al.Surgical need in an aging population: A cluster-based household survey in Nepal[J].Surgery,2015, 157(5): 857-864.
[13]
Perez AJ, Campbell S.Inguinal Hernia Repair in Older Persons[J].J Am Med Dir Assoc, 2022, 23(4): 563-567.
[14]
Pina-Vaz J, Glauser P, Hoffmann H, et al.Inguinal and femoral hernia repair in octogenarians and nonagenarians-A populationbased analysis[J].IJAWHS, 2020, 3(4): 128.
[15]
Rosen A, Nathan H, Luciansky E, et al.The inguinal region:anatomic differences in men and women with reference to hernia formation[J].Acta Anat(Basel), 1989, 136(4): 306-310.
[16]
Pelly T, Hwang R, Nirmalan P, et al.Inguinal and femoral hernias[J].BMJ, 2024, 386: e079531.
[17]
Wei J, Attaar M, Shi Z, et al.Identification of fifty-seven novel loci for abdominal wall hernia development and their biological and clinical implications: results from the UK Biobank[J].Hernia, 2022,26(1): 335-348.
[18]
Itani KMF, Fitzgibbons R.Approach to Groin Hernias[J].JAMA surgery, 2019, 154(6): 551-552.
[19]
HerniaSurge Group.International guidelines for groin hernia management[J].Hernia, 2018, 22(1): 1-165.
[20]
Tunder K, Novitsky Y.Open transversus abdominis release[J].IJAWHS, 2022, 5(1): 26.
[21]
徐杨荣, 杨毅, 王凤飞, 等.腹腔镜增强视野完全腹膜外疝修补术和腹腔镜腹膜内补片修补术在腹壁疝修补中的安全性及临床疗效[J/OL].中华疝和腹壁外科杂志(电子版), 2024, 18(3):296-301.
[22]
Gandhi J, Banker A, Bansal V.Assessment of the quality of life after hernia repair in India: does the HERQL questionnaire need amendment?[J].Hernia, 2022, 26(3): 969-970.
[23]
Estridge P, Sanders DL, Kingsnorth AN.Worldwide hernia repair:variations in the treatment of primary unilateral inguinal hernias in adults in the United Kingdom and in low- and middle-income countries[J].Hernia, 2019, 23(3): 503-507.
[24]
Chiari D.Hernia surgery in the COVID-19 era: does it require special attention?[J].Minerva Chir, 2020, 75(6): 466.
[25]
Cohen SL, Liu G, Abrao M, et al.Perspectives on Surgery in the Time of COVID-19: Safety First[J].J Minim Invasive Gynecol,2020, 27(4): 792-793.
[26]
Tian S, Hu N, Lou J, et al.Characteristics of COVID-19 infection in Beijing[J].J Infect, 2020, 80(4): 401-406.
[27]
Shi S, Nie B, Chen X, et al.Clinical and laboratory characteristics of severe and non-severe patients with COVID-19: A retrospective cohort study in China[J].J Clin Lab Anal, 2021, 35(1): e23692.
[28]
Yamada S, Noda T, Okabe K, et al.SARS-CoV-2 induces barrier damage and inflammatory responses in the human iPSC-derived intestinal epithelium[J].J Pharmacol Sci, 2022, 149(3): 139-146.
[29]
Chen C, Haupert S R, Zimmermann L, et al.Global Prevalence of Post-Coronavirus Disease 2019(COVID-19) Condition or Long COVID: A Meta-Analysis and Systematic Review[J].J Infect Dis,2022, 226(9): 1593-1607.
[30]
项鑫, 王乙.中国人口老龄化现状、特点、原因及对策[J].中国老年学杂志, 2021, 41(18): 4149-4152.
[31]
Williams ML, Hutchinson AG, Oh DD, et al.Trends in Australian inguinal hernia repair rates: a 15-year population study[J].ANZ J Surg, 2020, 90(11): 2242-2247.
[32]
陈双.腹股沟疝的病理生理[J/OL].中华疝和腹壁外科杂志(电子版), 2010, 4(3): 232-235.
[33]
Lau H, Fang C, Yuen W K, et al.Risk factors for inguinal hernia in adult males: a case-control study[J].Surgery, 2007, 141(2): 262-266.
[34]
de Goede B, Timmermans L, van Kempen BJH, et al.Risk factors for inguinal hernia in middle-aged and elderly men: results from the Rotterdam Study[J].Surgery, 2015, 157(3): 540-546.
[35]
Berndsen MR, Gudbjartsson T, Berndsen FH.[Inguinal hernia -review][J].Laeknabladid, 2019, 105(9): 385-391.
[36]
Chen S, Chen X, Hou X, et al.Temporal trends and disparities of population attributable fractions of modifiable risk factors for dementia in China: a time-series study of the China health and retirement longitudinal study(2011-2018)[J].Lancet Reg Health West Pac, 2024, 47: 101106.
[1] 张霄峰, 王军. 腹股沟疝与股疝的超声征象及鉴别诊断价值分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 615-618.
[2] 吴新兰, 余静. 彩色多普勒超声在腹股沟斜疝和直疝与股疝鉴别诊断中的应用价值[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 611-614.
[3] 屠义梅, 陈嘉, 戚腾. 腹腔镜经腹腹膜前疝修补术治疗嵌顿性股疝的临床研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(04): 427-431.
[4] 王振国, 谢正宇, 圣磊, 田径. 彩色多普勒超声联合多层螺旋CT诊断腹股沟斜疝、直疝及股疝的价值[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(03): 330-333.
[5] 凌振华, 张斌. 彩色多普勒血流显像及高频超声在腹股沟斜疝、直疝及股疝鉴别诊断中的应用价值[J/OL]. 中华疝和腹壁外科杂志(电子版), 2023, 17(03): 326-329.
[6] 谢海亮, 郑国富, 郭仪, 刘云强, 刘小春, 谢元才. 急诊和择期股疝临床特点及其修补后早期临床效果的回顾性队列研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2022, 16(06): 668-671.
[7] 周成明, 陈少科, 王风清, 吴雪影, 曹峻. 腹腔镜经腹腹膜前疝修补术与开放式腹膜前疝修补术治疗股疝的疗效比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2022, 16(05): 552-556.
[8] 王成昊, 赵强, 潘吉祥, 陈震. 高频超声结合彩色多普勒超声在腹股沟斜疝和股疝中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2022, 16(02): 224-226.
[9] 余静, 丁迎春. 高频彩色多普勒超声在老年腹股沟斜疝、直疝及股疝中的诊断与鉴别[J/OL]. 中华疝和腹壁外科杂志(电子版), 2022, 16(02): 165-168.
[10] 张万宇, 孙海燕, 黎东伟, 陈展辉, 卢强, 唐世龙, 李君久. 经腹直肌腹膜前无张力修补手术治疗嵌顿性股疝24例[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(05): 509-511.
[11] 章家强, 蔡亲磊, 詹兴云. 腹股沟斜疝、直疝及股疝的多排螺旋CT影像学特征及鉴别诊断价值[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(03): 243-247.
[12] 王伊帆, 陈燕, 彭劲民, 杜斌, 翁利. 中国脓毒症流行病学的研究进展[J/OL]. 中华重症医学电子杂志, 2023, 09(01): 89-94.
[13] 何妍, 檀丽冰, 周雯, 魏敏, 连军松. 老年男性人群幽门螺杆菌感染与血脂谱的关联研究[J/OL]. 中华胃肠内镜电子杂志, 2024, 11(03): 171-175.
[14] 罗峥, 张蔚, 徐晓云, 史楠, 张燕, 赵梅珍, 刘康永, 李小攀. 1990—2019年我国75岁及以上居民高收缩压所致脑卒中疾病负担及趋势分析[J/OL]. 中华老年病研究电子杂志, 2024, 11(01): 24-29.
[15] 晏美娟, 邵礼晖. 高水平脂蛋白（a）与无“三高”老年人群小动脉硬化型脑小血管病的相关性研究[J/OL]. 中华脑血管病杂志(电子版), 2023, 17(05): 458-463.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号