1990—2021年中國(guó)胃食管反流病疾病負(fù)擔(dān)分析

背景：全球胃食管反流病（GERD）發(fā)病率持續(xù)上升，對(duì)患者生活質(zhì)量和公共衛(wèi)生產(chǎn)生嚴(yán)重影響。目的：評(píng)估1990—2021年中國(guó)GERD疾病負(fù)擔(dān)的動(dòng)態(tài)變化。方法：通過(guò)全球疾病負(fù)擔(dān)（GBD）2021數(shù)據(jù)庫(kù)獲取1990—2021年中國(guó)GERD患病、發(fā)病、傷殘損失壽命年（YLDs）等數(shù)據(jù)，使用年齡?時(shí)期?隊(duì)列（APC）模型分析年齡、時(shí)期和出生隊(duì)列因素對(duì)GERD疾病負(fù)擔(dān)的影響。結(jié)果：1990—2021年中國(guó)GERD現(xiàn)患、新發(fā)病例數(shù)和YLDs均呈上升趨勢(shì)，但2021年年齡標(biāo)化患病率、發(fā)病率和YLDs率分別為4 540.66/10萬(wàn)、1 844.31/10萬(wàn)和35.12/10萬(wàn)，較1990年分別下降0.48%、0.40%和0.43%。男、女性年齡標(biāo)化率變化趨勢(shì)與總體趨勢(shì)一致，且女性疾病負(fù)擔(dān)高于男性。按年齡分析顯示總體以及男、女性患病率、發(fā)病率和YLDs率整體隨年齡增長(zhǎng)而增加，峰值出現(xiàn)于老年階段。APC分析顯示，1990—2021年中國(guó)GERD患病率、發(fā)病率和YLDs率整體隨年齡增長(zhǎng)而增加，縱向年齡曲線(xiàn)呈先上升后下降趨勢(shì)；時(shí)期效應(yīng)顯示1992—2011年間風(fēng)險(xiǎn)呈下降趨勢(shì)，之后開(kāi)始上升；出生隊(duì)列效應(yīng)顯示總體風(fēng)險(xiǎn)表現(xiàn)為波動(dòng)下降，男、女性趨勢(shì)與總體趨勢(shì)相似。結(jié)論：盡管近年中國(guó)GERD年齡標(biāo)化患病率、發(fā)病率和YLDs率有所下降，但疾病負(fù)擔(dān)整體呈上升趨勢(shì)，特別是中老年人群疾病風(fēng)險(xiǎn)較高。中國(guó)GERD的防治工作仍面臨嚴(yán)峻挑戰(zhàn)。

關(guān)鍵詞 胃食管反流病； 疾病負(fù)擔(dān)； 患病率； 發(fā)病率； 傷殘損失壽命年； 年齡?時(shí)期?隊(duì)列模型

Burden of Gastroesophageal Reflux Disease in China from 1990 to 2021 LI Na， TANG Mingyu. Division of Gastroenterology and Hepatology， Renji Hospital， School of Medicine， Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease， Shanghai （200001）

Correspondence to： TANG Mingyu， Email： mingyu_tang@163.com

Background： Gastroesophageal reflux disease （GERD） is increasing in incidence worldwide， which has a significant impact on patients′ quality of life and public health. Aims： To assess the trend dynamics of disease burden of GERD in China between 1990 and 2021. Methods： The Global Burden of Disease （GBD） 2021 database was used to obtain the data on prevalence， incidence， and years lived with disability （YLDs） of GERD in China from 1990 to 2021. The age?period?cohort （APC） model was further used to quantitatively analyze the effects of age， period， and birth cohort on disease burden. Results： From 1990 to 2021， the prevalent cases， incident cases， and YLDs of GERD in China showed an increasing trend. However， the age?standardized prevalence， incidence， and YLDs rates in 2021 were 4 540.66/100 000， 1 844.31/100 000 and 35.12/100 000， respectively， which decreased by 0.48%， 0.40% and 0.43%， respectively compared with those in 1990. In analysis of sex groups， the age?standardized rates were basically consistent with the general trend， and the disease burden of women was higher than that of men. When stratified with ages， the prevalence， incidence， and YLDs rates increased with age in both general and sex groups， and reached the peak in elderly people." APC analysis demonstrated that from 1990 to 2021， the prevalence， incidence， and YLDs rates of GERD increased with age， and the longitudinal age curve showed a trend of first rising and then decreasing. The period effect showed a downward trend in rate ratio between 1992 and 2011， followed by an increase. The birth cohort effect showed a fluctuating decline in risk ratio generally， with roughly the same trend for men and women. Conclusions： Despite the decline in age?standardized rates of prevalence， incidence， and YLDs of GERD in China in recent years， the overall burden of disease is on the rise， especially among middle?aged and elderly people， who are at high risk of developing GERD. The prevention and treatment of GERD in China still faces serious challenges.

Key words Gastroesophageal Reflux Disease; Disease Burden; Prevalence; Incidence; Years Lived With Disability;

Age?Period?Cohort Model

胃食管反流病（gastroesophageal reflux disease， GERD）是指胃和十二指腸內(nèi)容物反流入食管，導(dǎo)致不適感受和（或）相關(guān)并發(fā)癥的一類(lèi)疾病，主要分為反流性食管炎和非糜爛性反流病[1]。胃酸持續(xù)反流至食管下部，可引起食管炎、狹窄、潰瘍、穿孔、Barrett食管甚至食管腺癌[2]。……