Abstract：Objective To analyze the disease burden of chronic obstructive pulmonary disease (COPD) and changes in its risk factors among residents in Zhejiang Province from 1990 to 2021, so as to identify key priorities for COPD prevention and control. Methods Data on COPD mortality and disability-adjusted life years (DALY) for residents in Zhejiang Province from 1990 to 2021 were collected from the Global Burden of Disease (GBD) 2021 database. Standardized mortality and standardized DALY rate were calculated using the GBD 2021 world population standard structure. Premature mortality was computed via the life table method. The average annual percent change (AAPC) was applied to analyze trends in COPD mortality, DALY rate, and premature mortality. Changes in deaths of COPD risk factors were evaluated using population attributable fraction (PAF). Results From 1990 to 2021, the standardized COPD mortality in Zhejiang Province decreased from 272.40/105 to 70.56/105 (AAPC=-4.395%), and the standardized DALY rate declined from 4 167.37/105 to 1 071.89/105 (AAPC=-4.396%). Similar downward trends were observed in both males (AAPC=-3.933%, -4.173%) and females (AAPC=-4.785%, -4.480%), all P<0.05. Crude mortality and DALY rates increased with age, and the crude mortality and DALY rates of various age groups in Zhejiang Province showed decreasing trends from 1990 to 2021 (all P<0.05). The premature mortality declined from 4.37% to 0.60% from 1990 to 2021 (AAPC=-6.206%), with consistent trends across males and females (AAPC=-6.144%, -6.379%, all P<0.05). From 1990 to 2021, particulate matter pollution showed the largest reduction in PAF (-56.76%), while ambient ozone pollution had the largest increase (103.07%) in Zhejiang Province. By 2021, smoking became the leading risk factor for deaths of COPD (PAF=43.32%). Conclusions The standardized mortality, standardized DALY rate, and premature mortality for COPD show consistent declining trends in Zhejiang Province from 1990 to 2021. However, risk factors such as smoking and ambient ozone pollution require intensified focus to further reduce disease burden of COPD.
周晓燕, 龚巍巍, 潘劲, 戴品远, 关云琦, 王浩, 李娜, 陆凤, 钟节鸣. 1990—2021年浙江省慢性阻塞性肺疾病疾病负担变化趋势[J]. 预防医学, 2025, 37(8): 757-761.
ZHOU Xiaoyan, GONG Weiwei, PAN Jin, DAI Pinyuan, GUAN Yunqi, WANG Hao, LI Na, LU Feng, ZHONG Jieming. Disease burden of chronic obstructive pulmonary disease in Zhejiang Province from 1990 to 2021. Preventive Medicine, 2025, 37(8): 757-761.
[1] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组,中国医师协会呼吸医师分会慢性阻塞性肺疾病工作委员会.慢性阻塞性肺疾病诊治指南(2021年修订版)[J].中华结核和呼吸杂志,2021,44(3):170-205. Chronic Obstructive Pulmonary Disease Group of Chinese Thoracic Society,Chronic Obstructive Pulmonary Disease Committee of Chinese Association of Chest Physician. Guidelines for diagnosis and treatment of chronic obstructive pulmonary disease(2021 revision)[J].Chin J Tuberc and Respir Dis,2021,44(3):170-205.(in Chinese) [2] 阴巧媛,范伟,沈腊梅,等.慢性阻塞性肺疾病高危人群相关知识认知及影响因素分析[J].预防医学,2024,36(12):1065-1069. YIN Q Y,FAN W,SHEN L M,et al.Awareness of relevant knowledge and influencing factors among high-risk populations for chronic obstructive pulmonary disease[J].China Prev Med J,2024,36(12):1065-1069.(in Chinese) [3] 沈敏,郁智慧,朱爱韬.1992—2021年中国慢性阻塞性肺疾病发病和死亡的年龄-时期-队列分析[J].预防医学,2025,37(2):113-117. SHEN M,YU Z H,ZHU A T.Age-period-cohort analysis of incidence and mortality of chronic obstructive pulmonary disease in China from 1992 to 2021[J].China Prev Med J,2025,37(2):113-117.(in Chinese) [4] BD 2021 Causes of Death Collaborators.Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations,1990-2021:a systematic analysis for the Global Burden of Disease Study 2021[J].Lancet,2024,403(10440):2100-2132. [5] 龙政,刘威,齐金蕾,等.1990—2019年中国慢性呼吸系统疾病死亡情况及变化趋势[J].中华流行病学杂志,2022,43(1):14-21. LONG Z,LIU W,QI J L,et al.Mortality trend of chronic respiratory diseases in China,1990-2019[J].Chin J Epidemiol,2022,43(1):14-21.(in Chinese) [6] 曾新颖,李镒冲,刘世炜,等.1990—2015年中国四类慢性病早死概率与“健康中国2030”下降目标分析[J].中华预防医学杂志,2017,51(3):209-214. ZENG X Y,LI Y C,LIU S W,et al.Subnational analysis of probability of premature mortality caused by four main non-communicable diseases in China during 1990-2015 and“Health China 2030”reduction target[J].Chin J Prev Med,2017,51(3):209-214.(in Chinese) [7] 杨静,殷鹏,曾新颖,等.2006—2016年中国室外空气污染的归因死亡分析[J].中华流行病学杂志,2018,39(11):1449-1453. YANG J,YIN P,ZENG X Y,et al.Deaths attributed to ambient air pollution in China between 2006 and 2016[J].Chin J Epidemiol,2018,39(11):1449-1453.(in Chinese) [8] 陶庄,杨功焕.反事实和归因疾病负担研究[J].中华流行病学杂志,2010,31(4):466-468. TAO Z,YANG G H.Counterfactual and burden of disease attributable to risk factors[J].Chin J Epidemiol,2010,31(4):466-468.(in Chinese) [9] 李阳,任炼.1990—2021年中国、日本、韩国慢性阻塞性肺疾病负担与变化趋势分析[J].中国循证心血管医学杂志,2024,16(11):1289-1294. LI Y,REN L.Analysis of the burden and trends of chronic obstructive pulmonary disease in China,Japan and Korea,1990-2021[J].Chin J Evid Based Cardiovasc Med,2024,16(11):1289-1294.(in Chinese) [10] 康健,文富强.从医保数据分析中国慢性阻塞性肺疾病管理的不足[J].中华结核和呼吸杂志,2017,40(12): 884-886. KANG J,WEN F Q.Insufficient management of chronic obstructive pulmonary disease in China based on medical insurance data[J].Chin J Tuberc and Respir Dis,2017,40(12):884-886.(in Chinese) [11] 陶凤然,樊娜,蒋云雯,等.1997—2017年中国人群慢性阻塞性肺病疾病负担趋势分析[J].中国慢性病预防与控制,2020,28(1):3-9. TAO F R,FAN N,JIANG Y W,et al.Analysis on disease burden trend for chronic obstructive pulmonary disease in China from 1997 to 2017[J].Chin J Prev Control Chron Dis,2020,28(1):3-9.(in Chinese) [12] GBD 2019 Chronic Respiratory Diseases Collaborators. Global burden of chronic respiratory diseases and risk factors,1990-2019:an update from the Global Burden of Disease Study 2019[J/OL].EClinicalMedicine,2023,59[2025-07-15].https://doi.org/10.1016/j.eclinm.2023.101936. [13] BRANDSMA C A,VAN DEN BERGE M,HACKETT T L,et al.Recent advances in chronic obstructive pulmonary disease pathogenesis:from disease mechanisms to precision medicine[J].J Pathol,2020,250(5):624-635. [14] 杨汉丰,陈胜则,郑沛,等.永嘉县居民慢性阻塞性肺疾病患病率及危险因素调查[J].浙江预防医学,2016,28(6):570-573. YANG H F,CHEN S Z,ZHENG P,et al.An investigation on the prevalence of chronic obstructive pulmonary disease and its influencing factors among residents in Yongjia County[J].China Prev Med J,2016,28(6):570-573.(in Chinese) [15] KAPLAN A,THOMAS M.Screening for COPD:the gap between logic and evidence[J/OL].Eur Respir Rev,2017,26(143)[2025-07-15].https://doi.org/10.1183/16000617.0113-2016. [16] 廖清,陶玉坚.慢性阻塞性肺疾病流行病学及危险因素研究现状[J].中华临床医师杂志(电子版),2018,12(8):468-471. LIAO Q,TAO Y J.Research status on epidemiology of and risk factors for chronic obstructive pulmonary disease[J].Chin J Clin Electron Ed,2018,12(8):468-471.(in Chinese) [17] YIN P,CHEN R J,WANG L J,et al.Ambient ozone pollution and daily mortality:a nationwide study in 272 Chinese cities[J/OL].Environ Health Perspect,2017,125(11)[2025-07-15].https://doi.org/10.1289/EHP1849. [18] 徐越,胡秀静,陈赫妮,等.浙江省成人卷烟和电子烟使用现况调查[J].预防医学,2022,34(5):439-444. XU Y,HU X J,CHEN H N,et al.Current status of cigarette and electronic cigarette use among adults in Zhejiang Province[J].China Prev Med J,2022,34(5):439-444.(in Chinese) [19] 《中国吸烟危害健康报告2020》编写组.《中国吸烟危害健康报告2020》概要[J].中国循环杂志,2021,36(10)：937-952. The Writing Committee of 2020 Report on Health Hazards of Smoking in China.2020 Report on health hazards of smoking in China：an updated summary[J].Chin Circulat J,2021,36(10)：937-952.(in Chinese)
