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Article(id=1320436344141239274, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1320436284418544199, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202512003, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1764518400000, receivedDateStr=2025-12-01, revisedDate=1768147200000, revisedDateStr=2026-01-12, acceptedDate=null, acceptedDateStr=null, onlineDate=1792746156963, onlineDateStr=2026-10-23, pubDate=1772208000000, pubDateStr=2026-02-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792746156963, onlineIssueDateStr=2026-10-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792746156963, creator=13701087609, updateTime=1792746156963, updator=13701087609, issue=Issue{id=1320436284418544199, tenantId=1146029695717560320, journalId=1319373162502258839, year='2026', volume='48', issue='4', pageStart='387', pageEnd='522', issueExtLink='null', onlineDate='null', pubDate='1772208000000', pubDateStr='2026-02-28', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792746142725, creator='13701087609', updateTime=1792750115637, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1320452948077953743, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1320436284418544199, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1320452948077953744, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1320436284418544199, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=514, endPage=522, ext={EN=ArticleExt(id=1320436344346760171, articleId=1320436344141239274, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Toward pecision-based prevention: trends in the burden of adverse effects of medical treatment in China based on GBD data and identification of high-risk elderly male groups, columnId=1320434453051199700, journalTitle=Journal of Army Medical University, columnName=Think Tank for Public Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the status and trends of the burden of adverse effects of medical treatment (AEMT) in China from 1990 to 2023 using open data from the Global Burden of Disease (GBD) 2023.

Methods

Based on the GBD 2023 data, we extracted the number of incident cases, prevalent cases, disability-adjusted life years (DALYs), and deaths due to AEMT in China from 1990 to 2023. We also extracted age-standardized rates, including the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized DALYs rate (ASDR), and age-standardized mortality rate (ASMR). The annual percent change (APC), average annual percent change (AAPC), and their 95% confidence intervals (95% CI) for ASIR, ASPR, ASDR, and ASMR were calculated to analyze trends in the burden of AEMT in China. Epidemiological characteristics and differences in the AEMT burden among different age and sex groups in China were compared for the years 1990, 2020, and 2023.

Results

From 1990 to 2023, the number of incident cases, prevalent cases, DALYs, and deaths due to AEMT in China changed from 432 784 (95%UI:347 489 to 526 244), 33 087 (95%UI: 24 103 to 42 381), 686 404(95%UI:398 451 to 1 086 894), and 11 426(95%UI:7 233 to 17 456) to 342 349(95%UI: 279 429 to 423 443), 26 165(95%UI: 19 529 to 33 662), 121 245(95%UI: 90 707 to 155 623), and 3 337(95%UI: 2 494 to 4 212) in 2020, and further to 372 069 (95%UI: 303 152 to 464 618), 28 436 (95%UI: 21 029 to 36 643), 107 384(95%UI, 79 527 to 137 417), and 3 128 (95%UI: 2 305 to 3 985) in 2023. From 1990 to 2023, the AAPC values for ASIR, ASPR, ASDR, and ASMR were -0.994 8%(95%CI: -1.199 7% to -0.789 5%), -0.993 3%(95%CI: -1.202 2% to -0.783 9%), -5.968 4%(95%CI: -6.195 9% to -5.740 3%), and -5.432 2% (95%CI: -5.658 8% to -5.205 1%), respectively (P<0.05). In 1990, incidence and mortality rates were higher in younger age groups and among females compared to males, while rates were higher among older males compared to older females. In 2020 and 2023, incidence was higher among females than males in younger age groups and higher among older males than older females; the differences in incidence rates between males and females within the same age group and year narrowed compared to 1990, while mortality among older males remained higher than among females in the same periods.

Conclusion

From 1990 to 2023, key indicators of the AEMT burden in China-incidence, prevalence, DALYs, and mortality-showed an overall declining trend. Among the elderly population, AEMT incidence and mortality increased with age, and elderly males were more likely to die from AEMT than elderly women. Countermeasures　Enhancing investment in medical training and resources to improve the capability for diagnosing and treating AEMT, continuously strengthening AEMT prevention and control, and implementing tailored interventions for the elderly, particularly elderly males.

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目的

基于全球疾病负担（Global Burden of Disease，GBD）2023年开放数据，分析1990—2023年我国医疗不良反应（adverse effects of medical treatment，AEMT）负担状况和变化趋势。

方法

本研究基于GBD 2023数据，提取1990—2023年我国AEMT的发病数、患病数、伤残调整生命年数（disability-adjusted life years，DALYs）及死亡数，同时提取年龄标化发病率（age-standardized incidence rate，ASIR）、年龄标化患病率（age-standardized prevalence rate，ASPR）、年龄标化伤残调整生命年率（age-standardized disability-adjusted life year rate，ASDR）和年龄标化死亡率（age-standardized mortality rate，ASMR）等数据。计算ASIR、ASPR、ASDR及ASMR的年度变化百分比（annual percent change，APC）、平均年度变化百分比（average annual percent change，AAPC）及其95% 可信区间（95% confidence interval，95%CI），以分析国内AEMT疾病负担趋势。比较 1990、2020 及 2023 年我国不同年龄与性别群体中AEMT疾病负担的流行病学特征与差异。

结果

1990—2023年，我国AEMT的发病、患病、DALYs 数和死亡数分别由432 784（95% UI：347 489~526 244）、33 087（95% UI：24 103~42 381）、686 404（95% UI：398 451~1 086 894）、11 426（95% UI： 7 233~17 456）变化至2020年的342 349（95% UI： 279 429~423 443）、26 165（95% UI：19 529~33 662）、121 245（95% UI：90 707~155 623）、3 337（95% UI：2 494~4 212），2023年的372 069（95% UI：303 152~464 618）、28 436（95% UI：21 029~36 643）、107 384（95% UI：79 527~137 417）、3 128（95% UI：2 305~3 985）。1990—2023年间，ASIR、ASPR、ASDR、ASMR 的AAPC值分别为-0.994 8% （95% CI：-1.199 7%~-0.789 5%）、-0.993 3%（95%CI：-1.202 2%~-0.783 9%）、-5.968 4% （95%CI：-6.195 9%~-5.740 3%）、-5.432 2 （95% CI ：-5.658 8%~-5.205 1%）（P<0.05）。1990年我国低年龄组的发病率、死亡率均较高，女性高于男性，高龄组男性高于女性。2020 年及2023年低年龄组女性发病率高于男性、高龄男性发病率高于女性，多数年龄段间同年份、同年龄段中男性和女性之间发病率的差值较1990年的有所缩小，高龄男性死亡率均高于同时期的女性。

结论

1990—2023年我国AEMT疾病负担指标发病、患病、DALYs和死亡情况整体呈现下降趋势。在老年群体中，AEMT发病率及死亡率随年龄增长而增加，而且老年男性更容易死于 AEMT。对策　加大医疗培训和资源投入，提升诊断、治疗AEMT能力，持续加强AEMT防控，针对老年人，尤其是老年男性实施精准干预。

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杨青梅，E-mail：
YANG Qingmei，E-mail：
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Demography， 2010， 47（3）： 555-578., articleTitle=Social， behavioral， and biological factors， and sex differences in mortality, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1320436345642800113, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, xref=1, ext=[AuthorCompanyExt(id=1320436345651188722, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, companyId=1320436345642800113, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Nephrology， Shanghai Public Health Clinical Center， Shanghai， China), AuthorCompanyExt(id=1320436345655383027, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, companyId=1320436345642800113, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1上海市公共卫生临床中心，肾内科，上海)]), AuthorCompany(id=1320436347295355892, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, xref=2, ext=[AuthorCompanyExt(id=1320436347307938805, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, companyId=1320436347295355892, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Tuberculosis， Shanghai Public Health Clinical Center， Shanghai， China), AuthorCompanyExt(id=1320436347316327414, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, companyId=1320436347295355892, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2上海市公共卫生临床中心，结核科，上海)])], figs=[ArticleFig(id=1320436348926939149, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, language=EN, label=Figure 1, caption=Trends in the burden of adverse effects of medical treatment in China from 1990 to 2023, figureFileSmall=yM4gi8HCOFdn/r/QXmS7vQ==, figureFileBig=kcxZjuGitodqQgwy3gdSgA==, tableContent=null), ArticleFig(id=1320436349002436622, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, language=CN, label=图1, caption=1990—2023年中国医疗不良反应负担趋势图, figureFileSmall=yM4gi8HCOFdn/r/QXmS7vQ==, figureFileBig=kcxZjuGitodqQgwy3gdSgA==, tableContent=null), ArticleFig(id=1320436349191180303, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, language=EN, label=Figure 2, caption=Disease burden of adverse effects of medical treatment among difterent ages and genders in China， 1990， 2020， and 2023, figureFileSmall=QT79ACGMM5Ez253wOyqR2Q==, figureFileBig=QitWYPCfUECV25ZVfivnBg==, tableContent=null), ArticleFig(id=1320436349262483472, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, language=CN, label=图2, caption=1990、2020、2023年我国不同年龄组、不同性别医疗不良反应的疾病负担, figureFileSmall=QT79ACGMM5Ez253wOyqR2Q==, figureFileBig=QitWYPCfUECV25ZVfivnBg==, tableContent=null), ArticleFig(id=1320436349337980945, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, language=EN, label=Table 1, caption=

Disease burden of adverse effects of medical treatment in China in 1990， 2020 and 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
Measure199020202023
Number （95% UI）ASR（95%UI）/
per 100 000		Number
（95% UI）		ASR（95%UI）/
per 100 000		Number
（95% UI）		ASR（95%UI）/
per 100 000
Incidence432 784
（347 489~526 244）		36.93
（30.38~44.83）		342 349
（279 429~423 443）		24.54
（19.70~30.21）		372 069
（303 152~464 618）		26.70
（21.26~33.17）
Prevalence33 087
（24 103~42 381）		2.82
（2.09~3.61）		26 165
（19 529~33 662）		1.88
（1.37~2.45）		28 436
（21 029~36 643）		2.04
（1.49~2.67）
DALYs686 404
（398 451~1 086 894）		61.59
（36.31~97.22）		121 245
（90 707~155 623）		9.19
（6.74~11.96）		107 384
（79 527~137 417）		8.26
（5.94~10.70）
Deaths11 426
（7 233~17 456）		1.14
（0.75~1.71）		3 337
（2 494~4 212）		0.20
（0.15~0.26）		3 128
（2 305~3 985）		0.18
（0.13~0.23）
), ArticleFig(id=1320436349413478418, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, language=CN, label=表1, caption=

1990、2020及2023年我国医疗不良反应疾病负担情况

, figureFileSmall=null, figureFileBig=null, tableContent=
Measure199020202023
Number （95% UI）ASR（95%UI）/
per 100 000		Number
（95% UI）		ASR（95%UI）/
per 100 000		Number
（95% UI）		ASR（95%UI）/
per 100 000
Incidence432 784
（347 489~526 244）		36.93
（30.38~44.83）		342 349
（279 429~423 443）		24.54
（19.70~30.21）		372 069
（303 152~464 618）		26.70
（21.26~33.17）
Prevalence33 087
（24 103~42 381）		2.82
（2.09~3.61）		26 165
（19 529~33 662）		1.88
（1.37~2.45）		28 436
（21 029~36 643）		2.04
（1.49~2.67）
DALYs686 404
（398 451~1 086 894）		61.59
（36.31~97.22）		121 245
（90 707~155 623）		9.19
（6.74~11.96）		107 384
（79 527~137 417）		8.26
（5.94~10.70）
Deaths11 426
（7 233~17 456）		1.14
（0.75~1.71）		3 337
（2 494~4 212）		0.20
（0.15~0.26）		3 128
（2 305~3 985）		0.18
（0.13~0.23）
), ArticleFig(id=1320436349472198675, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, language=EN, label=Table 2, caption=

Total percentage change in the burden of adverse effects of medical treatment in China， 2020—2023 and 1990—2023

, figureFileSmall=null, figureFileBig=null, tableContent=
Measure2020—20231990—2023
Number（95%CI）Rate（95%CI）Number（95%CI）Rate（95%CI）
Incidence0.086 8（0.066 6~0.111 3）0.087 9（0.071 0~0.105 0）-0.140 3（-0.224 1~-0.035 8）-0.277 0（-0.320 9~-0.223 7）
Prevalence0.086 8（0.066 7~0.112 3）0.088 0（0.071 6~0.104 8）-0.140 6（-0.222 6~-0.039 6）-0.276 9（-0.320 9~-0.224 2）
DALYs-0.114 3（-0.219 6~0.022 7）-0.101 4（-0.208 7~0.050 6）-0.843 6（-0.915 8~-0.725 8）-0.865 9（-0.927 6~-0.765 0）
Deaths-0.062 8（-0.180 9~0.083 9）-0.109 4（-0.216 0~0.036 3）-0.726 3（-0.844 4~-0.556 7）-0.840 3（-0.909 6~-0.747 8）
), ArticleFig(id=1320436349539307540, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, language=CN, label=表2, caption=

2020—2023、1990—2023年中国医疗不良反应疾病负担总百分比变化

, figureFileSmall=null, figureFileBig=null, tableContent=
Measure2020—20231990—2023
Number（95%CI）Rate（95%CI）Number（95%CI）Rate（95%CI）
Incidence0.086 8（0.066 6~0.111 3）0.087 9（0.071 0~0.105 0）-0.140 3（-0.224 1~-0.035 8）-0.277 0（-0.320 9~-0.223 7）
Prevalence0.086 8（0.066 7~0.112 3）0.088 0（0.071 6~0.104 8）-0.140 6（-0.222 6~-0.039 6）-0.276 9（-0.320 9~-0.224 2）
DALYs-0.114 3（-0.219 6~0.022 7）-0.101 4（-0.208 7~0.050 6）-0.843 6（-0.915 8~-0.725 8）-0.865 9（-0.927 6~-0.765 0）
Deaths-0.062 8（-0.180 9~0.083 9）-0.109 4（-0.216 0~0.036 3）-0.726 3（-0.844 4~-0.556 7）-0.840 3（-0.909 6~-0.747 8）
), ArticleFig(id=1320436349602222101, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, language=EN, label=Table 3, caption=

Average annual percent change values of ASIR， ASPR， ASDR， and ASMR for adverse effects of medical treatment in China from 1990 to 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
ASR/per 100 000AAPC
1990—20202020—20231990—2023
ASIR-1.315 5（-1.449 2~-1.181 6）a3.236 6（-0.367 1~6.970 6）-0.994 8（-1.199 7~-0.789 5）a
ASPR-1.343 1（-1.391 0~-1.295 1）a3.240 8（-0.342 8~6.953 4）-0.993 3（-1.202 2~-0.783 9）a
ASDR-6.202 8 （-6.479 1~-5.925 6）a-3.187 3 （-6.217 3~-0.059 5）a-5.968 4 （-6.195 9~-5.740 3）a
ASMR-5.636 4（-5.928 1~-5.343 7）a-3.352 7（-8.221 8~1.774 6 ）-5.432 2 （-5.658 8~-5.205 1）a
), ArticleFig(id=1320436349681913878, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1320436344141239274, language=CN, label=表3, caption=

1990—2023年我国医疗不良反应ASIR、ASPR、ASDR、ASMR的平均年度百分比变化 ［%（95%CI）］

, figureFileSmall=null, figureFileBig=null, tableContent=
ASR/per 100 000AAPC
1990—20202020—20231990—2023
ASIR-1.315 5（-1.449 2~-1.181 6）a3.236 6（-0.367 1~6.970 6）-0.994 8（-1.199 7~-0.789 5）a
ASPR-1.343 1（-1.391 0~-1.295 1）a3.240 8（-0.342 8~6.953 4）-0.993 3（-1.202 2~-0.783 9）a
ASDR-6.202 8 （-6.479 1~-5.925 6）a-3.187 3 （-6.217 3~-0.059 5）a-5.968 4 （-6.195 9~-5.740 3）a
ASMR-5.636 4（-5.928 1~-5.343 7）a-3.352 7（-8.221 8~1.774 6 ）-5.432 2 （-5.658 8~-5.205 1）a
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面向精准防控：基于GBD数据对中国医疗不良反应疾病负担趋势及老年男性高风险群体的识别
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李琼琼 1 , 叶丹 2 , 杨青梅 1
陆军军医大学学报 | 论著·公共卫生智库 2026,48(4): 514-522
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陆军军医大学学报 |论著·公共卫生智库 2026 , 48 (4) : 514 -522
面向精准防控：基于GBD数据对中国医疗不良反应疾病负担趋势及老年男性高风险群体的识别
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李琼琼1, 叶丹2, 杨青梅1
作者信息
  • 1上海市公共卫生临床中心，肾内科，上海
  • 2上海市公共卫生临床中心，结核科，上海
通讯作者:
杨青梅，E-mail：
YANG Qingmei，E-mail：
Toward pecision-based prevention: trends in the burden of adverse effects of medical treatment in China based on GBD data and identification of high-risk elderly male groups
Qiongqiong LI1, Dan YE2, Qingmei YANG1
Affiliations
  • 1Department of Nephrology， Shanghai Public Health Clinical Center， Shanghai， China
  • 2Department of Tuberculosis， Shanghai Public Health Clinical Center， Shanghai， China
出版时间: 2026-02-28 doi: 10.16016/j.2097-0927.202512003
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摘要
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目的

基于全球疾病负担（Global Burden of Disease，GBD）2023年开放数据，分析1990—2023年我国医疗不良反应（adverse effects of medical treatment，AEMT）负担状况和变化趋势。

方法

本研究基于GBD 2023数据，提取1990—2023年我国AEMT的发病数、患病数、伤残调整生命年数（disability-adjusted life years，DALYs）及死亡数，同时提取年龄标化发病率（age-standardized incidence rate，ASIR）、年龄标化患病率（age-standardized prevalence rate，ASPR）、年龄标化伤残调整生命年率（age-standardized disability-adjusted life year rate，ASDR）和年龄标化死亡率（age-standardized mortality rate，ASMR）等数据。计算ASIR、ASPR、ASDR及ASMR的年度变化百分比（annual percent change，APC）、平均年度变化百分比（average annual percent change，AAPC）及其95% 可信区间（95% confidence interval，95%CI），以分析国内AEMT疾病负担趋势。比较 1990、2020 及 2023 年我国不同年龄与性别群体中AEMT疾病负担的流行病学特征与差异。

结果

1990—2023年，我国AEMT的发病、患病、DALYs 数和死亡数分别由432 784（95% UI：347 489~526 244）、33 087（95% UI：24 103~42 381）、686 404（95% UI：398 451~1 086 894）、11 426（95% UI： 7 233~17 456）变化至2020年的342 349（95% UI： 279 429~423 443）、26 165（95% UI：19 529~33 662）、121 245（95% UI：90 707~155 623）、3 337（95% UI：2 494~4 212），2023年的372 069（95% UI：303 152~464 618）、28 436（95% UI：21 029~36 643）、107 384（95% UI：79 527~137 417）、3 128（95% UI：2 305~3 985）。1990—2023年间，ASIR、ASPR、ASDR、ASMR 的AAPC值分别为-0.994 8% （95% CI：-1.199 7%~-0.789 5%）、-0.993 3%（95%CI：-1.202 2%~-0.783 9%）、-5.968 4% （95%CI：-6.195 9%~-5.740 3%）、-5.432 2 （95% CI ：-5.658 8%~-5.205 1%）（P<0.05）。1990年我国低年龄组的发病率、死亡率均较高，女性高于男性，高龄组男性高于女性。2020 年及2023年低年龄组女性发病率高于男性、高龄男性发病率高于女性，多数年龄段间同年份、同年龄段中男性和女性之间发病率的差值较1990年的有所缩小，高龄男性死亡率均高于同时期的女性。

结论

1990—2023年我国AEMT疾病负担指标发病、患病、DALYs和死亡情况整体呈现下降趋势。在老年群体中，AEMT发病率及死亡率随年龄增长而增加，而且老年男性更容易死于 AEMT。对策　加大医疗培训和资源投入，提升诊断、治疗AEMT能力，持续加强AEMT防控，针对老年人，尤其是老年男性实施精准干预。

医疗不良反应  /  老年人  /  疾病负担  /  流行病学特征
Objective

To analyze the status and trends of the burden of adverse effects of medical treatment (AEMT) in China from 1990 to 2023 using open data from the Global Burden of Disease (GBD) 2023.

Methods

Based on the GBD 2023 data, we extracted the number of incident cases, prevalent cases, disability-adjusted life years (DALYs), and deaths due to AEMT in China from 1990 to 2023. We also extracted age-standardized rates, including the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized DALYs rate (ASDR), and age-standardized mortality rate (ASMR). The annual percent change (APC), average annual percent change (AAPC), and their 95% confidence intervals (95% CI) for ASIR, ASPR, ASDR, and ASMR were calculated to analyze trends in the burden of AEMT in China. Epidemiological characteristics and differences in the AEMT burden among different age and sex groups in China were compared for the years 1990, 2020, and 2023.

Results

From 1990 to 2023, the number of incident cases, prevalent cases, DALYs, and deaths due to AEMT in China changed from 432 784 (95%UI:347 489 to 526 244), 33 087 (95%UI: 24 103 to 42 381), 686 404(95%UI:398 451 to 1 086 894), and 11 426(95%UI:7 233 to 17 456) to 342 349(95%UI: 279 429 to 423 443), 26 165(95%UI: 19 529 to 33 662), 121 245(95%UI: 90 707 to 155 623), and 3 337(95%UI: 2 494 to 4 212) in 2020, and further to 372 069 (95%UI: 303 152 to 464 618), 28 436 (95%UI: 21 029 to 36 643), 107 384(95%UI, 79 527 to 137 417), and 3 128 (95%UI: 2 305 to 3 985) in 2023. From 1990 to 2023, the AAPC values for ASIR, ASPR, ASDR, and ASMR were -0.994 8%(95%CI: -1.199 7% to -0.789 5%), -0.993 3%(95%CI: -1.202 2% to -0.783 9%), -5.968 4%(95%CI: -6.195 9% to -5.740 3%), and -5.432 2% (95%CI: -5.658 8% to -5.205 1%), respectively (P<0.05). In 1990, incidence and mortality rates were higher in younger age groups and among females compared to males, while rates were higher among older males compared to older females. In 2020 and 2023, incidence was higher among females than males in younger age groups and higher among older males than older females; the differences in incidence rates between males and females within the same age group and year narrowed compared to 1990, while mortality among older males remained higher than among females in the same periods.

Conclusion

From 1990 to 2023, key indicators of the AEMT burden in China-incidence, prevalence, DALYs, and mortality-showed an overall declining trend. Among the elderly population, AEMT incidence and mortality increased with age, and elderly males were more likely to die from AEMT than elderly women. Countermeasures　Enhancing investment in medical training and resources to improve the capability for diagnosing and treating AEMT, continuously strengthening AEMT prevention and control, and implementing tailored interventions for the elderly, particularly elderly males.

adverse effects of medical treatment  /  aged  /  disease burden  /  epidemiological characteristics
李琼琼, 叶丹, 杨青梅. 面向精准防控：基于GBD数据对中国医疗不良反应疾病负担趋势及老年男性高风险群体的识别. 陆军军医大学学报, 2026 , 48 (4) : 514 -522 . DOI: 10.16016/j.2097-0927.202512003
Qiongqiong LI, Dan YE, Qingmei YANG. Toward pecision-based prevention: trends in the burden of adverse effects of medical treatment in China based on GBD data and identification of high-risk elderly male groups[J]. Journal of Army Medical University, 2026 , 48 (4) : 514 -522 . DOI: 10.16016/j.2097-0927.202512003
正文
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医疗不良反应（adverse effects of medical treatment， AEMT）是指由外科手术操作、用药失误、医疗相关感染/过敏反应，或护理疏忽、护理服务不达标等因素引发的患者伤害［1］，此类伤害不仅加重患者的身心痛苦与疾病负担，严重时还可能导致患者发生不可逆伤残甚至死亡［2］。AEMT在临床实践中并不罕见［3］，1990年至2019年，全球人口增长了44.6%，而 AEMT 发病率增长了59.3%［4］。据估计，在低收入至中等收入国家中，每年因医疗安全疏忽导致的不良事件高达1.34亿起，造成240万人死亡［5］。医疗错误也被认为是仅次于癌症和心脏病导致死亡的的第三大病因 ［6］。此外，AEMT还带来了沉重的社会医疗经济负担，仅美国医疗体系，每年因AEMT产生的经济损失达200亿美元［7］。AEMT已成为一个重大公共卫生问题，全球越来越多的国家和地区正加强其防治工作［8-9］。我国作为人口大国，庞大的人口基数与逐渐加深的老龄化，使国内医疗服务需求及费用持续增长［10］，减少AEMT发生、降低其影响，具有重要的意义。为此，本研究拟对我国1990—2023年的AEMT数据进行系统性分析，探究国内AEMT发病情况、发展趋势及流行特点，以期为制定防治AEMT防治策略提供理论依据。
1　资料与方法
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1.1　数据来源
本研究基于权威、开放数据库GBD 2023（https://vizhub.healthdata.org/gbd-results/）［11］ 提取1990—2023年我国AEMT的相关数据。具体筛选参数设置如下：在“Measure”下选择“Incidence”、 “Prevalence”、 “DALYs”和“Deaths”； 在“Metric”下选择“Number”和“Rate”；在“Location”下选择“China”； 在“Age”下选择“<5 years”，“5~9 years”，“10~14 years”，“15~19 years”，“20~24 years”，“25~29 years”，“30~34 years”，“35~39 years”，“40~44 years”，“45~49 years”， “50~54 years”，“55~59 years”，“60~64 years”，“65~69 years”，“70~74 years”，“75~79 years”，“80~84 years”，“85~89 years”，“90~94 years”，“95+ years”，“All ages” and “Age-standardized”； 在“Sex”下选择“Female”、“Male”和“Both”； 在“Year”下选择1990—2023年的全部年份，对筛选出的数据下载保存。
1.2　统计学分析
采用R Studio 4.2.2对上述提取数据进行整理和分析。以表格形式（Excel）呈现我国1990—2023年AEMT的疾病负担指标。使用Joinpoint 5.4.0软件分析年龄标化率（age-standardized rate，ASR）的时间变化趋势，并计算年度变化百分比（annual percent change，APC）、平均年度变化百分比（average annual percent change，AAPC）及其95% 可信区间（95% confidence interval，95%CI）［12］。当AAPC > 0 时说明指标呈上升趋势，AAPC<0时则呈下降趋势。如AAPC的95%CI 包括0，则判定趋势变化无统计学意义（P>0.05）［13］。P<0.05为差异具有统计学意义。
2　结果
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2.1　总体趋势变化
1990年我国AEMT的发病、患病数分别为432 784例（95%UI：347 489~526 244）、33 087例（95%UI：24 103~42 381），2020年AEMT的发病、患病数变为342 349 例（95% UI：279 429~423 443）、26 165 例（95% UI：19 529~33 662），2023年变为372 069 例（95% UI：303 152~464 618）、28 436 例（95% UI：21 029~36 643）。发病与患病数变化趋势一致，2020年较1990年AEMT负担下降，但2023年呈小幅回升态势，1990—2023年总降幅分别为0.140 3%（95%UI：-0.224 1%~-0.035 8%）和0.140 6%（95%UI： -0.222 6%~-0.039 6%），见表1、2。
1990年我国AEMT的DALYs和死亡数分别为686 404（95%UI：398 451~1 086 894）和11 426（95%UI：7 233~17 456），到2020年分别变化为121 245（95%UI：90 707~155 623）和3 337（95%UI：2 494~4 212），到2023年分别为107 384（95%UI：79 527~137 417）和3 128例（95%UI：2 305~3 985），呈现持续下降趋势，1990—2023 年总降幅分别达0.843 6%（95% UI：-0.915 8%~-0.725 8%）和0.726 3%（95% UI：-0.844 4%~-0.556 7%），见表1、2。同期ASIR、ASPR、ASDR、ASMR 值变化趋势相似（表3）。
2.2　消除人群年龄结构差异后疾病变化趋势
ASIR与ASPR趋势一致：1990—2015年呈持续下降趋势，2015—2023年显著回升。1990—2000年、2000—2005年、2005—2010年、2010—2015年 ASIR的APC值分别为-1.18%、-4.22%、-0.46%、-3.15%，ASPR的APC值分别-1.18%、-4.22%、-0.46%、-3.16%，2015—2023年ASIR及ASPR的APC 分别为 2.37%、2.38%（P均<0.05，图1A、B）。ASDR在1990—2023年持续下降，1990—2001年、2001—2007年、2007—2012年、2012—2020年、2020—2023年 APC值分别为-4.78%、-9.21%、-7.54%、-5.13%、-3.26%（P均<0.05，图1C）。ASMR 在1990—2023 年呈下降趋势，1990—2002年、2002—2007年、2007—2012年、2012—2023年APC值分别为-4.63%、-9.18%、-6.99%、-3.84%（图1D）。各指标的AAPC值见表2。
2.3　1990年、2020年及2023年我国不同性别、不同年龄AEMT的负担情况
1990年我国低年龄组的发病率、死亡率均较高，5~89岁年龄段间女性发病率高于男性，而更高龄的男性发病率高于女性，高龄男性死亡率高于女性。2020年及2023年数据显示，低年龄组女性发病率高于男性、高年龄组男性发病率高于女性。2020年、2023年，多数年龄段间男性及女性患者的发病率、死亡率变化波动相对平缓，而且，同年份、同年龄段中男性和女性之间发病率的差值相较1990年有所缩小，但整体仍存在一定区别。此外，2020 年、2023年，多数年龄段间同年份、同年龄段中男性和女性之间死亡率的差值较小，高龄男性死亡率高于同时期的女性（图2）。
3　讨论
收起
AEMT是由医疗管理/医疗行为的不当、疏漏或失误直接导致，而非患者潜在基础疾病的自然病程进展 ［14］。AEMT不仅加剧患者身心痛苦、延长住院时间，严重时可导致残疾或死亡，更给患者家庭及社会带来显著的劳动力损失［15］与经济负担［7，15-16］。全球不同国家及地区均需要采取措施进一步降低AEMT 的疾病负担［17］。本研究基于GBD 2023最新数据，整合中国1990—2023年（含新型冠状病毒感染疫情防控期）的AEMT资料，系统分析其疾病负担变化趋势，并重点评估年龄与性别的差异化影响。
3.1　1990—2023年AEMT疾病负担整体减轻
1990—2023年我国AEMT年龄标化发病及患病率呈现阶段性变化的特征，1990—2015 年呈逐年下降态势，2015—2023年则转为持续上升，这一趋势的转变并非单纯反映 AEMT实际发生风险的增加，而与多重因素共同作用有关。首先，自2016年我国颁布“医疗质量管理办法”，要求必须执行“不良事件上报制度”，我国医疗质量安全管理体系的逐步完善与落地实施推动了各级医院AEMT上报的规范化和全面化 ［18-19］，有效改善了既往AEMT漏报、迟报的问题，使得AEMT的表观发病率及患病率呈现上升趋势。其次，2020—2022年新型冠状病毒感染疫情防控的持续影响成为推动AEMT年龄标化发病率及患病率上升的重要诱因，我国自2019年12月报告首例新型冠状病毒感染病例后［20-21］，2020年1月将其纳入“乙类甲管”传染病，直至2022年12月才被调整为“乙类乙管”［22］。新型冠状病毒感染疫情防控期间，人群机体健康状态受到新型冠状病毒的影响，同时新型疫苗、中药、抗生素等各类药物的使用量大幅增加，甚至出现临床不合理用药与药品滥用现象［23-24］，药物联用的相互作用、抗生素滥用引发的机体微生态失衡等问题，均潜在增加了AEMT的发生风险，进一步推高了 AEMT 的发病及患病率；而新型冠状病毒感染疫情防控期间的严格管控虽降低了常规医疗服务量［25］，但并未削弱 AEMT 的上报与监测力度，也使得这一影响得以在指标中体现。
1990—2023年，我国AEMT年龄标化DALYs及死亡率呈持续下降趋势，即便在2020—2022年新型冠状病毒感染疫情防控期间，该下降趋势虽有所放缓，但并未出现逆转，反映出我国1990—2023年间因AEMT导致的劳动力损伤及死亡情况有持续性改善，也充分反映了我国医疗质量安全水平的持续性提升，以及针对AEMT的临床治疗、综合防控体系的逐步完善。此外，也印证了我国医疗质量安全体系与公共卫生应急体系的协同韧性——即使在应对突发、重大公共卫生事件时，我国整体医疗水平和公共卫生能力也能有效控制AEMT导致的劳动力损伤与死亡风险。
3.2　年龄与性别差异
1990年我国AEMT的发病与死亡率呈现“高低龄双高”的特征。低年龄组发病率及死亡率高，这与该群体身体发育尚未成熟、免疫系统功能不够完善，对外界致病因素及医疗不良反应的抵抗力薄弱有关［26］；高年龄组同样表现出高发病率与高死亡率的特征，并且随年龄增长呈持续攀升趋势，这与老年人群身体机能自然衰退、对医疗不良反应的易感性和敏感性显著升高有关［27］。2020年与2023年，我国多数年龄段间男女性AEMT的发病率、死亡率变化波动相对平缓，死亡病例集中于高年龄组，且该群体死亡率随年龄增长持续升高。这一现象反映出我国国内积极重视低龄群体医疗安全、显著改善低年龄组 AEMT 疾病负担的成果。
1990—2019年全球AEMT研究数据显示女性发病率高于男性［6］。我国1990年≤89岁人群也呈现一致特征，同年龄组女性AEMT发病率高于男性，且两性别之间这种差异较为明显。2020年及2023年，我国多数年龄段内同年龄组男女AEMT发病率的差值较1990年有所缩小，这一变化与我国社会经济水平持续提升、女性社会地位与健康素养不断提高、以及女性整体身体机能改善等综合因素相关。与发病率的性别差异演变趋势不同，1990、2020、2023 年我国高龄男性的AEMT死亡率相较于同龄女性，均表现为随年龄增长快速升高的特点，尤其在2020、2023年新型冠状病毒感染的影响下，高龄男性AEMT死亡率的上升趋势更为陡峭。这一特征与国际研究结论相印证，美国1990—2019年老年人群AEMT疾病负担的研究亦发现，老年男性更易因AEMT死亡［28］。究其原因，男女性在疾病的流行病学特征、病理生理学机制、临床表现、心理影响、疾病进展及治疗应答等方面存在固有差异。老年群体中，性别差异是影响机体疾病应答、进而决定健康结局的重要因素［29］。同时已有研究证实，男性在多种影响预期寿命的疾病中患病率均高于女性［30］，且女性的年龄标化死亡率整体低于男性［31］，这也为高龄男性 AEMT 死亡率更高、增长更快的特征提供了流行病学与生理学层面的依据。上述年龄性别差异提示，在加强卫生政策与健康教育的同时，需重点关注AEMT对人口老龄化（尤其是男性群体）的负面影响。
3.3　政策建议
基于我国AEMT负担研究结果，可从以下方面加强AEMT监管：①继续加大各级医疗机构（尤其是基层）医疗培训和资源投入，以增强对AEMT的认识及识别能力，提升应急救治及管理能力，完善应急防控预案，持续提升医疗质量安全水平，将发生的AEMT事件对病人的伤害降到最小；②继续鼓励、要求各级医疗机构对AEMT事件及时、如实上报，持续更新完善AEMT监测、防控体系，能对多发/频发AEMT的医疗干预及时预警，定期开展政策效果评估，动态调整防控策略，以减少AEMT发生；③重点人群精准防控，强化老年群体、尤其是老年男性群体基础病协同管理，严格、规范执行高风险人群的医疗干预，切实完成医疗干预前、后的安全性评估及后续随访。国内各级医院应积极响应国家政策，对AEMT做到“早发现、快上报、多反思、勤总结”，加强临床治疗与综合防控等，进一步减少AEMT负担。
本研究仍存在一定的局限性。首先，GBD 数据库运用各种数学模型来估算疾病负担及其变动趋势，其呈现的数据并不一定会与实际情况相符。其次，GBD 数据库中未对各省份、各地区之间的差异进行分析，不能更深一步地了解我国国内不同地区AEMT疾病负担情况。另外，GBD 数据库提及AEMT，但未对其产生原因进行详细说明，亦未对其所造成不良后果进行严重程度的分级。
综上所述，本研究分析了我国1990—2023年AEMT疾病负担情况，探究了AEMT在年龄和性别方面的差异，提醒应继续加强对我国AEMT疾病负担的认识、监控及防治，尽可能减少AEMT的发生，同时，对于老年群体，尤其是老年男性群体，应适当分配更多的医疗资源。

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doi: 10.16016/j.2097-0927.202512003
  • 接收时间：2025-12-01
  • 首发时间：2026-10-23
  • 出版时间：2026-02-28
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  • 收稿日期：2025-12-01
  • 修回日期：2026-01-12
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    1上海市公共卫生临床中心，肾内科，上海
    2上海市公共卫生临床中心，结核科，上海

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