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

doi:10.3877/cma.j.issn.1674-392X.2024.06.022

Abstract

Abstract:

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

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]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 708-716.

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References 36

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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)

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)

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
		总变化	老龄化	人口增长	流行病学变化	总变化	老龄化	人口增长	流行病学变化	总变化	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

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
		总变化	老龄化	人口增长	流行病学变化	总变化	老龄化	人口增长	流行病学变化	总变化	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

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)

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