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Article(id=1241329580917707117, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202503148, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1741708800000, receivedDateStr=2025-03-12, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773885634879, onlineDateStr=2026-03-19, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773885634879, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773885634879, creator=13701087609, updateTime=1773885634879, updator=13701087609, issue=Issue{id=1241329570129956900, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='13', pageStart='2305', pageEnd='2496', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773885632307, creator=13701087609, updateTime=1773885763730, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241330121425080472, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241330121425080473, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2354, endPage=2360, ext={EN=ArticleExt(id=1241329584398979587, articleId=1241329580917707117, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Characteristics and prediction of respiratory tuberculosis deaths and disease burden in China and globally from 1990 to 2021, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To compare the characteristics of deaths and disease burden of respiratory tuberculosis in China and globally from 1990 to 2021 and predict future trends, providing evidence for formulating prevention and control policies.

Methods

Data from the Global Burden of Disease Study 2021 (GBD 2021) were used to describe deaths and disability-adjusted life years (DALYs) of respiratory tuberculosis in China and globally from 1990 to 2021. The average annual percentage change (AAPC) was used to assess trends. The Bayesian age-period-cohort (BAPC) model was employed for prediction.

Results

From 1990 to 2021,the number of respiratory tuberculosis deaths in China and globally was 37 300 and 1 162 800, respectively, with age-standardized mortality rates (ASMR) of 1.91/100 000 and 13.96/100 000, and AAPCs of -7.4 (95%CI: -7.8 to -7.1) and -3.3(95%CI: -3.5 to -3.2), respectively. DALYs were 1 375 500 person-years and 46 977 500 person-years, with age-standardized DALY rates (ASDR) of 76.22/100 000 and 580.26/100 000, and AAPCs of -7.0 (95% CI: -7.2 to -6.8) and -3.3 (95% CI: -3.4 to-3.2), respectively. The death and disease burden were higher in males than females. From 2022 to 2036, ASMR (China: males-55.30%, females -62.50%; global: males -36.72%, females -37.50%) and ASDR (China: males -46.50%, females -44.82%;global: males -31.87%, females -32.95%) are projected to decline.

Conclusion

From 1990 to 2021, the ASMR and ASDR of respiratory tuberculosis declined in both China and globally, with a significantly higher disease burden in males. Over the next 15 years, ASMR and ASDR are expected to continue decreasing. Relevant authorities should sustain and optimize prevention and control measures to further reduce the disease burden and achieve more comprehensive disease control.

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目的

对比1990—2021年中国与全球人群呼吸道结核病死亡和疾病负担特征，并预测趋势，为制定呼吸道结核病相关防治政策和措施提供依据。

方法

利用2021年全球疾病负担研究（GBD 2021）数据，描述1990—2021年中国与全球人群呼吸道结核病的死亡和伤残调整寿命年（DALYs）情况。采用平均年度变化百分比（AAPC）描述变化趋势。采用贝叶斯年龄-时期-队列（BAPC）模型进行预测。

结果

1990—2021年中国和全球人群呼吸道结核病死亡人数分别为3.73万、116.28万，标化死亡率分别为1.91/10万、13.96/10万，AAPC分别为-7.4%(95% CI: -7.8%～-7.18%)、-3.3%(95% CI: -3.58%～-3.28%)，DALYs分别为137.55万人年、4 697.75万人年，标化DALY率（ASDR）分别为76.22/10万、580.26/10万，AAPC分别为-7.0%(95% CI: -7.28%～-6.88%)、-3.3% (95% CI: -3.48%～-3.28%)。男性死亡和疾病负担高于女性。2022—2036年中国和全球人群呼吸道结核病的标化死亡率（中国男性下降55.30%，女性下降62.50%；全球男性下降36.72%，女性下降37.50%）和标化DALY率（中国男性下降46.50%，女性下降44.82%；全球男性下降31.87%，女性下降32.95%）预计呈下降趋势。

结论

1990—2021年中国和全球呼吸道结核病的标化死亡率和DALY率均呈下降趋势，在男性的疾病负担明显重于女性。未来15年中国和全球的呼吸道结核病标化死亡率和DALY率将呈现下降趋势，相关部门仍需持续制定和优化防控措施，以有效降低呼吸道结核病的疾病负担，实现更全面的疾病控制。

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刘冬，E-mail:
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辛雯艳（1983—），女，硕士，副主任医师，研究方向：呼吸系统疾病方向

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BMC Pulmonary Medicine,2024, 24(1): 476., articleTitle=The temporal trend of tuberculosis burden in an aging population in China: a secondary data analysis from the GBD 2019, refAbstract=null), Reference(id=1241329757825069117, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, doi=null, pmid=null, pmcid=null, year=2021, volume=2, issue=3, pageStart=289, pageEnd=293, url=null, language=null, rfNumber=[18], rfOrder=25, authorNames=姜游力, 张培泽, 邓国防, journalName=结核与肺部疾病杂志, refType=null, unstructuredReference=姜游力，张培泽，邓国防，等.结核病患者诊断延迟及其影响因素研究进展[J] .结核与肺部疾病杂志，2021，2（3）：289-293., articleTitle=结核病患者诊断延迟及其影响因素研究进展, refAbstract=null), Reference(id=1241329757929926723, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, doi=null, pmid=null, pmcid=null, year=2021, volume=2, issue=3, pageStart=289, pageEnd=293, url=null, language=null, rfNumber=[18], rfOrder=26, authorNames=Jiang YL, Zhang PZ, Deng GF, journalName=Journal of Tuberculosis and Lung Disease, refType=null, unstructuredReference=Jiang YL, Zhang PZ, Deng GF, et al. 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Journal of Tuberculosis and Lung Disease, 2021, 2(3): 289-293.(In Chinese), articleTitle=Research progress of delay in diagnosis of tuberculosis and its influencing factors, refAbstract=null), Reference(id=1241329758013812812, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, doi=null, pmid=null, pmcid=null, year=2021, volume=2, issue=3, pageStart=216, pageEnd=222, url=null, language=null, rfNumber=[19], rfOrder=27, authorNames=徐静, 罗萍, 贺晓新, journalName=结核与肺部疾病杂志, refType=null, unstructuredReference=徐静， 罗萍， 贺晓新.629例老年肺结核患者特征及诊断延迟情况分析[J] .结核与肺部疾病杂志，2021，2（3）：216-222., articleTitle=629例老年肺结核患者特征及诊断延迟情况分析, refAbstract=null), Reference(id=1241329758139641938, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, doi=null, pmid=null, pmcid=null, year=2021, volume=2, issue=3, pageStart=216, pageEnd=222, url=null, language=null, rfNumber=[19], rfOrder=28, authorNames=Xu J, Luo P, He XX, journalName=Journal of Tuberculosis and Lung Disease, refType=null, unstructuredReference=Xu J, Luo P, He XX. Analysis of characteristics and diagnosis delay of 629 elderly tuberculosis patients[J] . Journal of Tuberculosis and Lung Disease,2021, 2(3): 216-222.(In Chinese), articleTitle=Analysis of characteristics and diagnosis delay of 629 elderly tuberculosis patients, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241329750103355894, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, xref=null, ext=[AuthorCompanyExt(id=1241329750124327415, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, companyId=1241329750103355894, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang 832000, China), AuthorCompanyExt(id=1241329750132716024, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, companyId=1241329750103355894, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=石河子大学第一附属医院呼吸与危重症医学科，新疆 石河子 832000)])], figs=[ArticleFig(id=1241329753148420762, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=EN, label=Figure 1, caption=Changes in respiratory tuberculosis deaths in China and globally from 1990 to 2021, figureFileSmall=TEciXaZplMd7dHh0QVmhJQ==, figureFileBig=Q+24X8OoiGEkpENaFpM27g==, tableContent=null), ArticleFig(id=1241329753278444193, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=CN, label=图1, caption=1990—2021年中国和全球人群呼吸道结核病死亡变化情况

注：A为中国死亡例数；B为全球死亡例数；C为中国死亡率，D为全球死亡率。

, figureFileSmall=TEciXaZplMd7dHh0QVmhJQ==, figureFileBig=Q+24X8OoiGEkpENaFpM27g==, tableContent=null), ArticleFig(id=1241329753412661933, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=EN, label=Figure 2, caption=Changes in respiratory tuberculosis DALY in Chinese and global populations from 1990 to 2021, figureFileSmall=TdI4yNhEc0rn77nWV+WsIA==, figureFileBig=csyEXlkEXVpYzE9vSgm4TQ==, tableContent=null), ArticleFig(id=1241329753500742324, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=CN, label=图2, caption=1990—2021年中国和全球人群呼吸道结核病DALY变化情况

注：A为中国DALY例数；B为全球DALY例数；C为中国DALY率；D为全球DALY率。

, figureFileSmall=TdI4yNhEc0rn77nWV+WsIA==, figureFileBig=csyEXlkEXVpYzE9vSgm4TQ==, tableContent=null), ArticleFig(id=1241329753576239803, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=EN, label=Figure 3, caption=Prediction of standardized mortality rates for respiratory tuberculosis in China and the global population from 2022 to 2036, figureFileSmall=8M4XbTyzB9ByARLufLgvWA==, figureFileBig=/moJFoKZyVY9HhRgZ3ysUQ==, tableContent=null), ArticleFig(id=1241329753643348671, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=CN, label=图3, caption=2022—2036年中国和全球人群呼吸道结核病标化死亡率预测情况

注：A为针对中国男性标化死亡率的预测；B为针对中国女性标化死亡率的预测；C为针对全球男性标化死亡率的预测；D为针对全球女性标化死亡率的预测。

, figureFileSmall=8M4XbTyzB9ByARLufLgvWA==, figureFileBig=/moJFoKZyVY9HhRgZ3ysUQ==, tableContent=null), ArticleFig(id=1241329753735623368, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=EN, label=Figure 4, caption=Prediction of standardized DALY rates for respiratory tuberculosis in China and the global population from 2022 to 2036, figureFileSmall=IbWmHCSbK1qo+CWoCPAZlA==, figureFileBig=Nf7kHG+YiyCKw09e7jVTSw==, tableContent=null), ArticleFig(id=1241329753899201232, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=CN, label=图4, caption=2022—2036年中国和全球人群呼吸道结核病标化DALY率预测情况

注：A为针对中国男性标化DALY率的预测；B为针对中国女性标化DALY率的预测；C为针对全球男性标化DALY率的预测；D为针对全球女性标化DALY率的预测。

, figureFileSmall=IbWmHCSbK1qo+CWoCPAZlA==, figureFileBig=Nf7kHG+YiyCKw09e7jVTSw==, tableContent=null), ArticleFig(id=1241329754033418968, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=EN, label=Table 1, caption=

Respiratory tuberculosis deaths in China and globally in 1990 and 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
变量年份（年）死亡数粗死亡率标化死亡率
数值
（万例）		变化率
（%）		AAPC
（%，95%CI）		率值
（/10万）		变化率
（%）		AAPC
（%，95%CI）		率值
（/10万）		变化率
（%）		AAPC
（%，95%CI）
中国
男性199010.3717.1025.50
20212.70-74.00-4.4（-4.7～-4.1）3.71-78.30-4.9（-5.2～-4.7）2.90-88.62-6.9（-7.1～-6.7）
女性19906.7311.8215.50
20211.04-84.55-5.9（-6.5～-5.4）1.49-87.39-6.5（-7.0～-6.1）1.03-93.35-8.5（-8.7～-8.2）
总人群199017.1114.5420.10
20213.73-78.19-4.9（-5.3～-4.5）2.62-81.98-5.5（-5.8～-5.1）1.91-90.49-7.4（-7.8～-7.1）
全球
男性1990105.1739.1651.78
202172.54-31.02-1.2（-1.3～-1.1）18.32-53.21-2.4（-2.5～-2.3）18.19-64.87-3.3（-3.5～-3.1）
女性199072.7127.4630.49
202143.74-39.84-1.6（-1.8～-1.5）11.12-59.50-3.0（-3.1～-2.8）10.22-66.48-3.5（-3.6～-3.3）
总人群1990177.8833.3540.00
2021116.28-34.63-1.4（-1.5～-1.3）14.74-55.80-2.6（-2.7～-2.5）13.96-65.1-3.3（-3.5～-3.2）
), ArticleFig(id=1241329754142470880, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=CN, label=表1, caption=

1990和2021年中国和全球呼吸道结核病死亡情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量年份（年）死亡数粗死亡率标化死亡率
数值
（万例）		变化率
（%）		AAPC
（%，95%CI）		率值
（/10万）		变化率
（%）		AAPC
（%，95%CI）		率值
（/10万）		变化率
（%）		AAPC
（%，95%CI）
中国
男性199010.3717.1025.50
20212.70-74.00-4.4（-4.7～-4.1）3.71-78.30-4.9（-5.2～-4.7）2.90-88.62-6.9（-7.1～-6.7）
女性19906.7311.8215.50
20211.04-84.55-5.9（-6.5～-5.4）1.49-87.39-6.5（-7.0～-6.1）1.03-93.35-8.5（-8.7～-8.2）
总人群199017.1114.5420.10
20213.73-78.19-4.9（-5.3～-4.5）2.62-81.98-5.5（-5.8～-5.1）1.91-90.49-7.4（-7.8～-7.1）
全球
男性1990105.1739.1651.78
202172.54-31.02-1.2（-1.3～-1.1）18.32-53.21-2.4（-2.5～-2.3）18.19-64.87-3.3（-3.5～-3.1）
女性199072.7127.4630.49
202143.74-39.84-1.6（-1.8～-1.5）11.12-59.50-3.0（-3.1～-2.8）10.22-66.48-3.5（-3.6～-3.3）
总人群1990177.8833.3540.00
2021116.28-34.63-1.4（-1.5～-1.3）14.74-55.80-2.6（-2.7～-2.5）13.96-65.1-3.3（-3.5～-3.2）
), ArticleFig(id=1241329754238939881, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=EN, label=Table 2, caption=

Respiratory tuberculosis DALY in China and globally in 1990 and 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
变量年份（年）DALY数粗DALY率标化DALY率
数值
（万例）		变化率
（%）		AAPC
（%，95%CI）		率值
（/10万）		变化率
（%）		AAPC
（%，95%CI）		率值
（/10万）		变化率
（%）		AAPC
（%，95%CI）
中国
男性1990432.60712.87855.49
202199.12-77.09-4.7（4.9～-4.4）136.13-80.90-5.3（-5.5～-5.0）108.66-87.30-6.5（-6.7～-6.2）
女性1990299.97526.63592.86
202138.43-87.19-6.5（-6.7～-6.2）55.33-89.49-7.1（-7.3～-6.8）45.02-92.41-8.1（-8.4～-7.7）
总人群1990732.57622.69719.42
2021137.55-81.22-5.3（-5.5～-5.0）96.68-84.47-5.9（-6.1～-5.6）76.22-89.41-7.0（-7.2～-6.8）
全球
男性19904 554.741 695.901 912.54
20212 853.61-37.36-1.5（-1.5～-1.5）720.72-57.50-2.7（-2.8～-2.7）705.23-63.13-3.2（-3.3～-3.0）
女性19903 713.241 402.341 424.24
20211 844.13-50.33-2.2（-2.4～-2.1）469.01-66.56-3.5（-3.6～-3.3）463.18-67.48-3.6（-3.7～-3.4）
总人群19908 267.981 550.161 650.59
20214 697.75-43.19-1.8（-1.9～-1.8）595.30-61.60-3.1（-3.1～-3.0）580.26-64.85-3.3（-3.4～-3.2）
), ArticleFig(id=1241329754339603189, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=CN, label=表2, caption=

1990和2021年中国和全球呼吸道结核病DALY情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量年份（年）DALY数粗DALY率标化DALY率
数值
（万例）		变化率
（%）		AAPC
（%，95%CI）		率值
（/10万）		变化率
（%）		AAPC
（%，95%CI）		率值
（/10万）		变化率
（%）		AAPC
（%，95%CI）
中国
男性1990432.60712.87855.49
202199.12-77.09-4.7（4.9～-4.4）136.13-80.90-5.3（-5.5～-5.0）108.66-87.30-6.5（-6.7～-6.2）
女性1990299.97526.63592.86
202138.43-87.19-6.5（-6.7～-6.2）55.33-89.49-7.1（-7.3～-6.8）45.02-92.41-8.1（-8.4～-7.7）
总人群1990732.57622.69719.42
2021137.55-81.22-5.3（-5.5～-5.0）96.68-84.47-5.9（-6.1～-5.6）76.22-89.41-7.0（-7.2～-6.8）
全球
男性19904 554.741 695.901 912.54
20212 853.61-37.36-1.5（-1.5～-1.5）720.72-57.50-2.7（-2.8～-2.7）705.23-63.13-3.2（-3.3～-3.0）
女性19903 713.241 402.341 424.24
20211 844.13-50.33-2.2（-2.4～-2.1）469.01-66.56-3.5（-3.6～-3.3）463.18-67.48-3.6（-3.7～-3.4）
总人群19908 267.981 550.161 650.59
20214 697.75-43.19-1.8（-1.9～-1.8）595.30-61.60-3.1（-3.1～-3.0）580.26-64.85-3.3（-3.4～-3.2）
), ArticleFig(id=1241329754436072192, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=EN, label=Table 3, caption=

Model fitting of standardized mortality prediction for respiratory tuberculosis in China and the world from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
变量MAPE(%)拟合精度
中国男性0.01399.987
中国女性0.03199.968
全球男性0.00199.999
全球女性0.00299.998
), ArticleFig(id=1241329754536735498, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=CN, label=表3, caption=

1990—2021年中国和全球呼吸道结核病标化死亡率预测模型拟合

, figureFileSmall=null, figureFileBig=null, tableContent=
变量MAPE(%)拟合精度
中国男性0.01399.987
中国女性0.03199.968
全球男性0.00199.999
全球女性0.00299.998
), ArticleFig(id=1241329754679341844, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=EN, label=Table 4, caption=

Model fitting of standardized DALY rate prediction for respiratory tuberculosis in China and the world from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
地区MAPE (%)拟合精度 (%)
中国男性0.000 399.999 7
中国女性0.000 799.999 3
全球男性3.121 399.999 9
全球女性3.828 999.999 9
), ArticleFig(id=1241329754809365284, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329580917707117, language=CN, label=表4, caption=

1990—2021年中国和全球呼吸道结核病标化DALY率预测模型拟合

, figureFileSmall=null, figureFileBig=null, tableContent=
地区MAPE (%)拟合精度 (%)
中国男性0.000 399.999 7
中国女性0.000 799.999 3
全球男性3.121 399.999 9
全球女性3.828 999.999 9
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1990—2021年中国与全球人群呼吸道结核病死亡、疾病负担特征及预测研究
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辛雯艳 , 何小双 , 王蓓 , 程丽 , 徐丽娜 , 刘冬
现代预防医学 | 流行病与统计方法 2025,52(13): 2354-2360
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现代预防医学 | 流行病与统计方法 2025, 52(13): 2354-2360
1990—2021年中国与全球人群呼吸道结核病死亡、疾病负担特征及预测研究
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辛雯艳, 何小双, 王蓓, 程丽, 徐丽娜, 刘冬
作者信息
  • 石河子大学第一附属医院呼吸与危重症医学科，新疆 石河子 832000

    • 辛雯艳（1983—），女，硕士，副主任医师，研究方向：呼吸系统疾病方向

通讯作者:

刘冬，E-mail:
Characteristics and prediction of respiratory tuberculosis deaths and disease burden in China and globally from 1990 to 2021
Wen-yan XIN, Xiao-shuang HE, Bei WANG, Li CHENG, Li-na XU, Dong LIU
Affiliations
  • Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang 832000, China
出版时间: 2025-07-10 doi: 10.20043/j.cnki.MPM.202503148
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摘要
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目的

对比1990—2021年中国与全球人群呼吸道结核病死亡和疾病负担特征，并预测趋势，为制定呼吸道结核病相关防治政策和措施提供依据。

方法

利用2021年全球疾病负担研究（GBD 2021）数据，描述1990—2021年中国与全球人群呼吸道结核病的死亡和伤残调整寿命年（DALYs）情况。采用平均年度变化百分比（AAPC）描述变化趋势。采用贝叶斯年龄-时期-队列（BAPC）模型进行预测。

结果

1990—2021年中国和全球人群呼吸道结核病死亡人数分别为3.73万、116.28万，标化死亡率分别为1.91/10万、13.96/10万，AAPC分别为-7.4%(95% CI: -7.8%～-7.18%)、-3.3%(95% CI: -3.58%～-3.28%)，DALYs分别为137.55万人年、4 697.75万人年，标化DALY率（ASDR）分别为76.22/10万、580.26/10万，AAPC分别为-7.0%(95% CI: -7.28%～-6.88%)、-3.3% (95% CI: -3.48%～-3.28%)。男性死亡和疾病负担高于女性。2022—2036年中国和全球人群呼吸道结核病的标化死亡率（中国男性下降55.30%，女性下降62.50%；全球男性下降36.72%，女性下降37.50%）和标化DALY率（中国男性下降46.50%，女性下降44.82%；全球男性下降31.87%，女性下降32.95%）预计呈下降趋势。

结论

1990—2021年中国和全球呼吸道结核病的标化死亡率和DALY率均呈下降趋势，在男性的疾病负担明显重于女性。未来15年中国和全球的呼吸道结核病标化死亡率和DALY率将呈现下降趋势，相关部门仍需持续制定和优化防控措施，以有效降低呼吸道结核病的疾病负担，实现更全面的疾病控制。

呼吸道结核病  /  死亡率  /  疾病负担  /  伤残调整寿命年  /  预测研究
Objective

To compare the characteristics of deaths and disease burden of respiratory tuberculosis in China and globally from 1990 to 2021 and predict future trends, providing evidence for formulating prevention and control policies.

Methods

Data from the Global Burden of Disease Study 2021 (GBD 2021) were used to describe deaths and disability-adjusted life years (DALYs) of respiratory tuberculosis in China and globally from 1990 to 2021. The average annual percentage change (AAPC) was used to assess trends. The Bayesian age-period-cohort (BAPC) model was employed for prediction.

Results

From 1990 to 2021,the number of respiratory tuberculosis deaths in China and globally was 37 300 and 1 162 800, respectively, with age-standardized mortality rates (ASMR) of 1.91/100 000 and 13.96/100 000, and AAPCs of -7.4 (95%CI: -7.8 to -7.1) and -3.3(95%CI: -3.5 to -3.2), respectively. DALYs were 1 375 500 person-years and 46 977 500 person-years, with age-standardized DALY rates (ASDR) of 76.22/100 000 and 580.26/100 000, and AAPCs of -7.0 (95% CI: -7.2 to -6.8) and -3.3 (95% CI: -3.4 to-3.2), respectively. The death and disease burden were higher in males than females. From 2022 to 2036, ASMR (China: males-55.30%, females -62.50%; global: males -36.72%, females -37.50%) and ASDR (China: males -46.50%, females -44.82%;global: males -31.87%, females -32.95%) are projected to decline.

Conclusion

From 1990 to 2021, the ASMR and ASDR of respiratory tuberculosis declined in both China and globally, with a significantly higher disease burden in males. Over the next 15 years, ASMR and ASDR are expected to continue decreasing. Relevant authorities should sustain and optimize prevention and control measures to further reduce the disease burden and achieve more comprehensive disease control.

Respiratory tuberculosis  /  Mortality  /  Disease burden  /  Disability-adjusted life years  /  Prediction study
辛雯艳, 何小双, 王蓓, 程丽, 徐丽娜, 刘冬. 1990—2021年中国与全球人群呼吸道结核病死亡、疾病负担特征及预测研究. 现代预防医学, 2025 , 52 (13) : 2354 -2360 . DOI: 10.20043/j.cnki.MPM.202503148
Wen-yan XIN, Xiao-shuang HE, Bei WANG, Li CHENG, Li-na XU, Dong LIU. Characteristics and prediction of respiratory tuberculosis deaths and disease burden in China and globally from 1990 to 2021[J]. Modern Preventive Medicine, 2025 , 52 (13) : 2354 -2360 . DOI: 10.20043/j.cnki.MPM.202503148
正文
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呼吸道结核病是一种由结核分枝杆菌引起的慢性传染性疾病，主要通过空气传播，尤其在拥挤、通风不良的环境中易于扩散，对全球和中国构成重大公共卫生威胁。全球范围内呼吸道结核病造成的死亡人数几乎是艾滋病毒/艾滋病的两倍，每年仍有超过1 000万人感染呼吸道结核病[1]；中国作为全球30个呼吸道结核病高负担国家之一，尽管近年来呼吸道结核病发病率呈现缓慢下降趋势，但未达预期目标[2]。耐药呼吸道结核病的出现进一步加剧了治疗难度和病死率，而呼吸道结核病与艾滋病、糖尿病等疾病的共患现象也增加了疾病管理的复杂性[3-5]。
为了应对呼吸道结核病的挑战，世界卫生组织（World Health Organization，WHO）于2014年提出了终结呼吸道结核病战略，旨在到2035年实现呼吸道结核病死亡人数95%的减少，发病数降低90%[6]。然而全球呼吸道结核病控制目标进展缓慢，与WHO设定的目标仍有较大差距。本研究基于2021年全球疾病负担研究（GBD 2021），对1990—2021年中国和全球呼吸道结核病的死亡、疾病负担及其变化趋势进行比较分析，并对未来15年的疾病负担进行预测，为呼吸道结核病防治政策的制定提供科学依据，助力实现终结呼吸道结核病的全球目标。
1　资料与方法
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1.1　资料来源
呼吸道结核病疾病负担相关数据来自于华盛顿大学健康测量与评价研究中心公布的GBD 2021数据库，该数据库提供了来自204个国家或地区、371种疾病和88个可归因危险因素的流行病学数据[7-8]。本研究根据《国际疾病分类》（第10版）编码原则，从GBD 2021中提取1990—2021年中国和全球呼吸道结核病（ICD-10编码为A14、A15-A19.9、B90-B90.9、K67.3、K93.0、M49.0、N74.1、P37.0和U84.3）死亡数和伤残调整寿命年（disability adjusted life years，DALYs）及其相应的粗率进行研究。
1.2　统计分析
使用世界标准人口结构对中国和全球呼吸道结核病的死亡率以及DALY率进行标化，使用Joinpoint 5.0.2软件计算各指标的平均年度变化百分比（average annual percent change，AAPC），用于分析疾病负担的变化趋势。最后使用R 4.3.2进行疾病负担的预测和可视化。
1.2.1　Joinpoint回归模型
Joinpoint回归模型是以时间（年份）为自变量，疾病死亡或DALY率为因变量的对数线性模型[9]。该模型通过拼接不同对数线段的连接点，来描述疾病死亡或DALY率随时间的变化趋势[10]。利用joinpoint模型对疾病负担指标进行回归分析，可以计算1990—2021年的平均年度变化百分比（AAPC）及其95%可信区间（CI）。模型公式如下：
当AAPC及其95%CI均大于0时，表示相应疾病指标呈现上升趋势；当均小于0时，表示呈现下降趋势；当包含0时，则表示疾病指标保持平稳。
1.2.2　贝叶斯年龄-时期-队列模型（Bayesian age-period-cohort，BAPC）
使用BAPC，分性别对2022—2036年呼吸道结核病的标化死亡率和标化DALY率进行预测，未来标准化人口采用2017年GBD数据库预测的人群数[11]。BAPC模型能够将样本信息和未知参数的先验信息综合估计后得出的后验分布，然后推断未知参数[12]。该预测过程通过R语言的BAPC包和INLA包实现。为验证模型的预测性能，本研究采用2010—2021年的中国和呼吸道结核病疾病负担数据作为测试集，选取平均绝对百分比误差(mean absolute percentage errors，MAPE)和拟合精度来评价模型预测效果。MAPE值大小与预测精度成反比关系，当MAPE<10.00%时提示预测精度较好[12]。
2　结果
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2.1　1990—2021年中国与全球人群呼吸道结核病死亡情况
与1990年相比，2021年全球人群呼吸道结核病死亡数从177.88万减少到116.28万，呈下降趋势，年均变化百分比（AAPC）为-1.4%（95%CI: -1.5%～-1.3%）；全球死亡率和标化死亡率分别从33.35/10万、40.00/10万下降到14.74/10万、13.96/10万，变化幅度分别为-55.80%、-65.1%，呈下降趋势，AAPC分别为-2.6%、-3.3%（P<0.001）。见表1。
中国呼吸道结核病死亡人数从17.11万例下降到3.73万例，降幅（-78.19%）及下降趋势（AAPC=-4.9%，P<0.001）均低于全球水平；死亡率和标化死亡率分别从1990年的14.54/10万、20.10/10万下降到2021年的2.62/10万、1.91/10万，均始终低于同期全球水平，且其降幅（-81.98%和-90.49%）低于全球水平，AAPC（-5.5%和-7.4%，P<0.001）同样均低于全球水平。见表1。
无论是中国还是全球，男性的死亡数、死亡率和标化死亡率及相应的变化率和AAPC均高于女性。中国和全球的死亡数都随着年龄的增长而显著增加；死亡率最低的年龄组均为<20岁，最高的年龄组是≥80岁。见图1。
2.2　1990—2021年中国与全球人群呼吸道结核病DALY情况
与1990年相比，2021年全球人群呼吸道结核病DALYs从8 267.98万减少到4 697.75万，呈下降趋势，AAPC为-1.8%（95%CI：-1.9%～-1.8%）；全球DALY率和标化DALY率分别从1 550.16/10万、1 650.59/10万下降595.30/10万、580.26/10万，变化幅度分别为-61.60%和-64.85%，呈下降趋势，AAPC分别为-3.1%，-3.3%，P<0.001。见表2。
中国呼吸道结核病所致DALYs从732.57万人年下降到137.55万人年，变化率（-81.22%）呈下降趋势，年均变化百分比（AAPC=-5.3%，P<0.001）均低于全球水平；DALY率和标化DALY率分别从1990年的622.69/10万、719.42/10万下降到2021年的96.68/10万、76.22/10万，均始终低于同期全球水平，且其变化率（-84.47%和-89.41%）和AAPC（-5.9%和-7.0%，P<0.001）同样均低于全球水平。见表2。
无论是中国还是全球，男性的死亡数、死亡率和标化死亡率及相应的变化率和AAPC均高于女性。中国和全球的DALYs都随着年龄的增长而显著增加；死亡率最低的年龄组均为<20岁，最高的年龄组是≥80岁。见图2。
2.3　2022—2036年中国与全球人群呼吸道结核病标化死亡率的预测情况
预测模型的MAPE值均小于10%且拟合精度均达99%以上,表示模型预测效果较好。预计在2022—2036年，全球标化死亡率呈下降趋势，男性和女性标化死亡率分别从2022年的17.81/10万、8.80/10万变化至2036年的11.27/10万、5.50/10万，下降幅度分别为36.72%和37.50%；中国人群标化死亡率呈下降趋势，男性和女性标化死亡率分别从2022年的4.43/10万、0.96/10万下降至2036年的1.98/10万、0.36/10万，下降幅度分别为55.30%和62.50%。见表3、图3。
2.4　2022—2036年中国与全球人群呼吸道结核病标化DALY率的预测情况
预测模型的MAPE值均小于10%且拟合精度均达99%以上，表示模型预测效果较好。预计在2022—2036年，全球标化DALY率呈下降趋势，男性和女性标化DALY率分别从2022年的717.04/10万、427.12/10万变化至2036年的488.55/10万、286.37/10万，下降幅度分别为31.87%和32.95%；中国人群标化DALY率呈下降趋势，男性和女性标化DALY率分别从2022年的149.52/10万、40.45/10万下降至2036年79.99/10万、22.32/10万，下降幅度分别为46.50%和44.82%。见表4、图4。
3　讨论
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本研究利用GBD 2021数据库，揭示了过去30年中国和全球呼吸道结核病死亡和DALYs的变化情况。研究发现，这一现象凸显了中国在呼吸道结核病防治方面取得的实质性进展。这一成就的背后，首先是政府的高度重视与政策支持，为呼吸道结核病防治工作提供了坚实的保障。通过广泛接种卡介苗、大规模主动发现患者以及全面推行化学治疗等有效措施，成功提高了人群的免疫力，降低了呼吸道结核病的发病率和死亡率[12]。此外，技术创新也在这一过程中发挥了关键作用，中国积极探索新的防治措施和模式，研发并推广耐药诊断新技术，全面开展耐药呼吸道结核病防治工作，有效减少了耐药呼吸道结核病的传播和发病[13]。这些综合措施的实施，共同推动了中国呼吸道结核病死亡率和DALY率的快速下降，为全球呼吸道结核病防治提供了经验和借鉴。
本研究发现，男性呼吸道结核病死亡和DALY率下降幅度低于女性，男性的死亡和DALY水平仍高于女，这与与WHO《全球呼吸道结核报告2024》的结论相吻合[1]。这种差异主要由职业暴露和生活方式差异所致，男性更倾向于从事矿工、农牧民等高风险职业，增加了与结核分枝杆菌的接触机会[14]，吸烟和饮酒等不良生活方式也削弱了他们的免疫系统[12,15]。因此，应针对男性群体加大呼吸道结核病筛查力度，确保早期发现、早期治疗，同时积极倡导健康生活方式，鼓励男性戒烟戒酒，从源头上减少呼吸道结核病的发病诱因，以有效降低呼吸道结核病在男性中的死亡率和DALY率，实现性别间的健康公平。
本研究发现，中国及全球范围内呼吸道结核病的负担程度均随年龄增长而加重。这一现象可归因于多个因素：一方面，随着年龄的增长，人体免疫系统功能逐渐衰退，对结核分枝杆菌的抵抗力随之减弱，使老年人更易感染呼吸道结核病[16]。另一方面，老年人可能在早年已接触过结核分枝杆菌，虽未即时发病，但可能形成了潜伏感染，随着年龄增长，这些潜伏感染有可能被重新激活，导致呼吸道结核病发病[17]。此外，老年人对疾病的感知和反应往往较慢，加之可能存在的医疗资源获取障碍，这些因素共同作用可能导致呼吸道结核病的诊断和治疗延迟，进而增加病情恶化和死亡的风险[18-19]。在中国人口老龄化日益严峻的背景下，加强呼吸道结核病筛查、提高医疗资源可及性及优化诊断治疗流程显得尤为重要。
预测结果显示，未来15年内中国和全球的呼吸道结核病标化死亡率和DALY率均将呈现下降趋势。然而，与2015年相比，2035年中国和全球呼吸道结核病死亡数的下降幅度均未能达到95%。表明尽管呼吸道结核病疾病负担有所改善，但呼吸道结核病仍将是中国和全球的重要公共卫生问题。因此，为了进一步降低呼吸道结核病的疾病负担，中国和全球需持续加大对呼吸道结核病的重视程度，强化一级和二级预防措施，并不断提升呼吸道结核病的诊治水平。
本研究具有一定局限性。本研究依托于GBD数据，输入数据的质量、完整性以及所采用的建模技术和假设，均可能对最终结果的准确性造成影响。
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2025年第52卷第13期
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doi: 10.20043/j.cnki.MPM.202503148
  • 接收时间：2025-03-12
  • 首发时间：2026-03-19
  • 出版时间：2025-07-10
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    石河子大学第一附属医院呼吸与危重症医学科，新疆 石河子 832000

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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