1990-2019年204个国家和地区的慢性阻塞性肺疾病负担及其归因风险因素：2019年全球疾病负担研究结果

Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019

(BMJ, IF: 93.333)

Saeid Safiri, Kristin Carson-Chahhoud, Maryam Noori, Seyed Aria Nejadghaderi, Mark J M Sullman, Javad Ahmadian Heris, Khalil Ansarin, Mohammad Ali Mansournia, Gary S Collins, Ali-Asghar Kolahi, Jay S Kaufman

CORRESPONDENCE TO: a.kolahi@sbmu.ac.ir

Objective 目标

To report the global, regional, and national burden of chronic obstructive pulmonary disease (COPD) and its attributable risk factors between 1990 and 2019, by age, sex, and sociodemographic index.

按年龄、性别和社会人口统计指数，报告1990年至2019年间全球、地区和国家慢性阻塞性肺疾病（COPD）的负担及其归因风险因素。

Design 设计

Systematic analysis.

系统分析。

Data Source 数据源

Global Burden of Disease Study 2019.

2019年全球疾病负担研究。

Main Outcome Measures 主要观察指标

Data on the prevalence, deaths, and disability adjusted life years (DALYs) of COPD, and its attributable risk factors, were retrieved from the Global Burden of Disease 2019 project for 204 countries and territories, between 1990 and 2019. The counts and rates per 100000 population, along with 95% uncertainty intervals, were presented for each estimate.

1990年至2019年间，从204个国家和地区的2019年全球疾病负担项目中检索到了COPD的患病率、死亡和残疾调整生命年（DALY）及其归因风险因素的数据。每10万人口的计数和比率，以及95%的不确定性区间，均为各项的估计值。

Results 结果

In 2019, 212.3 million prevalent cases of COPD were reported globally, with COPD accounting for 3.3 million deaths and 74.4 million DALYs. The global age standardised point prevalence, death, and DALY rates for COPD were 2638.2 (95% uncertainty intervals 2492.2 to 2796.1), 42.5 (37.6 to 46.3), and 926.1 (848.8 to 997.7) per 100000 population, which were 8.7%, 41.7%, and 39.8% lower than in 1990, respectively. In 2019, Denmark (4299.5), Myanmar (3963.7), and Belgium (3927.7) had the highest age standardised point prevalence of COPD. Egypt (62.0%), Georgia (54.9%), and Nicaragua (51.6%) showed the largest increases in age standardised point prevalence across the study period. In 2019, Nepal (182.5) and Japan (7.4) had the highest and lowest age standardised death rates per 100000, respectively, and Nepal (3318.4) and Barbados (177.7) had the highest and lowest age standardised DALY rates per 100000, respectively. In men, the global DALY rate of COPD increased up to age 85-89 years and then decreased with advancing age, whereas for women the rate increased up to the oldest age group (≥95 years). Regionally, an overall reversed V shaped association was found between sociodemographic index and the age standardised DALY rate of COPD. Factors contributing most to the DALYs rates for COPD were smoking (46.0%), pollution from ambient particulate matter (20.7%), and occupational exposure to particulate matter, gases, and fumes (15.6%).

2019年，全球报告了2.123亿例COPD病例，其中COPD导致330万人死亡，7440万伤残调整生命年。COPD的全球年龄标准化点患病率、死亡率和DALY率为每10万人2638.2（95%不确定区间2492.2至2796.1）、42.5（37.6至46.3）和926.1（848.8至997.7），分别比1990年低8.7%、41.7%和39.8%。2019年，丹麦（4299.5）、缅甸（3963.7）和比利时（3927.7）的COPD年龄标准化点患病率最高。在整个研究期间，埃及（62.0%）、格鲁吉亚（54.9%）和尼加拉瓜（51.6%）的年龄标准化点患病率增幅最大。2019年，尼泊尔（182.5）和日本（7.4）的每10万人年龄标准化死亡率分别最高和最低，尼泊尔（3318.4）和巴巴多斯（177.7）的每10万人年龄标准化伤残调整生命年率分别最高和最低。在男性中，慢性阻塞性肺病的整体伤残调整生命年比率在85-89岁之前增加，然后随着年龄的增长而下降，而在女性中，该比率在最老年龄组之前增加(≥95年）。从地区来看，社会人口统计指数与COPD的年龄标准化DALY率之间存在整体倒V型关联。吸烟（46.0%）、环境颗粒物污染（20.7%）和职业性接触颗粒物、气体和烟雾（15.6%）是导致慢性阻塞性肺病伤残调整生命年发病率的主要因素。

Conclusions 结论

Despite the decreasing burden of COPD, this disease remains a major public health problem, especially in countries with a low sociodemographic index. Preventive programmes should focus on smoking cessation, improving air quality, and reducing occupational exposures to further reduce the burden of COPD.

尽管慢性阻塞性肺病的负担在减轻，但该疾病仍然是一个主要的公共卫生问题，尤其是在社会人口指数较低的国家。预防方案应侧重于戒烟、改善空气质量和减少职业暴露，以进一步减轻慢性阻塞性肺病的负担。

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