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Article(id=1311349962500305573, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349919793905738, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202601177, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1768147200000, receivedDateStr=2026-01-12, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579794763, onlineDateStr=2026-09-28, pubDate=1782316800000, pubDateStr=2026-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579794763, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579794763, creator=13701087609, updateTime=1790579794763, updator=13701087609, issue=Issue{id=1311349919793905738, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='12', pageStart='2113', pageEnd='2304', issueExtLink='null', onlineDate='null', pubDate='1782316800000', pubDateStr='2026-06-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1790579784582, creator='13701087609', updateTime=1790588408144, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311386089701597565, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349919793905738, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311386089701597566, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349919793905738, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2285, endPage=2290, ext={EN=ArticleExt(id=1311349964245136038, articleId=1311349962500305573, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Temporal trends and comparison of the burden of musculoskeletal disorders attributable to high body mass index in China and globally, 1990-2021, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the temporal trends of the burden of musculoskeletal disorders (MSDs) attributable to high body mass index (BMI) in China and globally from 1990 to 2021.

Methods

This study utilized the publicly available database of the Global Burden of Disease Study 2021 (GBD 2021). The temporal trends of the burden of MSDs attributable to high BMI in China and globally were evaluated by calculating the annual estimated percentage change and joinpoint analysis. The Das Gupta decomposition method was used to quantify the contributions of population growth, aging, and epidemiological changes to the increase in disease burden.

Results

In 2021, the years lived with disability(YLDs)due to MSDs attributable to high BMI in China was 239 person-years, an increase of 353.92% compared to 1990, significantly higher than the global increase of 184.03% during the same period. The burden of MSDs attributable to high BMI in both China and globally showed an upward trend. The estimated average percentage change (EAPC) in China was 2.69%, and the average annual percentage change (AAPC) was 2.35%. The EAPC globally was 1.18%, and the AAPC was 1.11%. Compared with the global trend, the burden of MSDs attributable to high BMI in China increased at a faster rate and showed a phased fluctuating growth trend. The disease burden of MSDs was higher in females than in males in both China and globally. Decomposition analysis indicated that population aging and population growth were the main reasons for the increase in the prevalence of MSDs in the population.

Conclusion

The burden of MSDs attributable to high BMI in China increased at a faster rate than globally from 1990 to 2021. It is recommended that health departments focus on middle-aged and elderly women, and through strengthening weight management and early intervention, slow down the upward trend of the burden of MSDs.

, authors=Huan LI1, Tao CHEN1, Lei ZHAN1, Min LIU2, Xiao-bing PU1, 3, authorsList=Huan LI, Tao CHEN, Lei ZHAN, Min LIU, Xiao-bing PU, authorCompany=null, correspAuthors=Xiao-bing PU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1311349965042053803, articleId=1311349962500305573, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=1990—2021年中国和全球高体质指数归因的肌肉骨骼疾病负担的对比分析, columnId=1228016573844226129, journalTitle=现代预防医学, columnName=疾病预防控制, runingTitle=null, highlight=null, articleAbstract=
目的

分析1990—2021年，中国及全球归因于高体质指数（Body Mass Index, BMI）的肌肉骨骼疾病（Musculoskeletal disorders，MSDs）负担的时间趋势。

方法

本研究基于2021年全球疾病负担研究（GBD 2021）的公开数据库，通过计算年估计变化百分比和joinpoint分析，对中国及全球归因于高BMI的MSDs疾病负担的时间趋势进行了评估。利用Das Gupta分解法量化人口增长、老龄化及流行病学变化对疾病负担增长的贡献。

结果

2021年中国归因于高BMI的MSDs的伤残损失健康生命年为239.22万人年，较1990年增长了353.92%，显著高于全球同期增幅184.03%。中国及全球归因于高BMI的MSDs的疾病负担均呈上升趋势，中国EAPC为2.69%，AAPC为2.35%，全球EAPC为1.18%，AAPC为1.11%。与全球相比，中国归因于高BMI的MSDs负担上升速度更快，且呈阶段性波动增长趋势。中国以及全球的MSDs的疾病负担女性大于男性。分解分析表明，人口老龄化和人口增长是导致人群MSDs疾病患病人数上升的主要原因。

结论

1990—2021年中国归因于高BMI的MSDs疾病负担增长速度高于全球。建议卫生部门重点关注中老年女性群体，通过加强体重管理及早期健康干预，减缓MSDs负担的上升趋势。

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李欢（2000—），女，硕士在读，研究方向：老年保健与姑息医学

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蒲小兵，E-mail:
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李欢（2000—），女，硕士在读，研究方向：老年保健与姑息医学

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注：A女性，B男性。

, figureFileSmall=iRjUrjIA4DWRZAZ98qiC/g==, figureFileBig=df2sZSfNQRqpDrFQJNzYPw==, tableContent=null), ArticleFig(id=1311349969223774933, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349962500305573, language=EN, label=Fig.2, caption=The number and rate of YLDs attributed to high BMI for musculoskeletal disorders by sex and age group in China and globally, 2021, figureFileSmall=qplPInHR5KXvhaQO6BDeaw==, figureFileBig=NnSNmON5CrzVwWyEzNu1WQ==, tableContent=null), ArticleFig(id=1311349969295078102, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349962500305573, language=CN, label=图2, caption=2021年中国与全球不同性别、年龄组YLDs数量、YLDs率, figureFileSmall=qplPInHR5KXvhaQO6BDeaw==, figureFileBig=NnSNmON5CrzVwWyEzNu1WQ==, tableContent=null), ArticleFig(id=1311349969366381271, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349962500305573, language=EN, label=Table 1, caption=

The burden of musculoskeletal diseases attributable to high body mass index in 1990 and 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
分类性别20211990—2021 EAPC［%，（95%CI）］1990—2021 AAPC［%，（95%CI）］
YLDs数［（95%UI）］ASDR［1/10万，（95%UI）］
中国男性868 779（956 321 963 012）85（10~192）2.66（2.55~2.78）2.38（2.35~2.40）
女性1 523 399（64 567~3 587 812）141（6~332）2.68（2.54~2.83）2.31（2.28~2.34）
合计2 392 178（157 060~5 558 902）113（8~265）2.69（2.56~2.82）2.35（2.32~2.38）
全球男性4 918 211（506 104~10 488 662）118（12~252）1.33（1.31~1.36）1.25（1.23~1.26）
女性8 481 798（541 980~18 198 242）191（12~409）1.12（1.09~1.16）1.06（1.04~1.07）
合计13 400 009（1 048 084~28 718 885）155（12~332）1.18（1.15~1.21）1.11（1.09~1.13）
), ArticleFig(id=1311349969454461656, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349962500305573, language=CN, label=表1, caption=

1990年和2021年归因于高体重指数的肌肉骨骼疾病的疾病负担

, figureFileSmall=null, figureFileBig=null, tableContent=
分类性别20211990—2021 EAPC［%，（95%CI）］1990—2021 AAPC［%，（95%CI）］
YLDs数［（95%UI）］ASDR［1/10万，（95%UI）］
中国男性868 779（956 321 963 012）85（10~192）2.66（2.55~2.78）2.38（2.35~2.40）
女性1 523 399（64 567~3 587 812）141（6~332）2.68（2.54~2.83）2.31（2.28~2.34）
合计2 392 178（157 060~5 558 902）113（8~265）2.69（2.56~2.82）2.35（2.32~2.38）
全球男性4 918 211（506 104~10 488 662）118（12~252）1.33（1.31~1.36）1.25（1.23~1.26）
女性8 481 798（541 980~18 198 242）191（12~409）1.12（1.09~1.16）1.06（1.04~1.07）
合计13 400 009（1 048 084~28 718 885）155（12~332）1.18（1.15~1.21）1.11（1.09~1.13）
), ArticleFig(id=1311349969538347737, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349962500305573, language=EN, label=Table 2, caption=

Joinpoint analysis of the burden of musculoskeletal diseases attributable to high BMI by sex in China and globally

, figureFileSmall=null, figureFileBig=null, tableContent=
ASDR地区性别趋势 1趋势 2趋势 3
时间段APC（%）时间段APC（%）时间段APC（%）
中国男性1990—19940.31994—20001.92000—20053.8
女性1990—1994-0.71994—20002.02000—20053.6
合计1990—1994-0.31994—20001.92000—20053.7
全球男性1990—19940.81994—20001.32000—20091.5
女性1990—19940.51994—20000.92000—20061.2
合计1990—19920.51992—19950.71995—20001.1
ASDR地区性别趋势 4趋势 5趋势 6
时间段APC（%）时间段APC（%）时间段APC（%）
中国男性2005—20102.72010—20153.02015—20212.3
女性2005—20153.02015—20212.4NANA
合计2005—20153.02015—20212.4NANA
全球男性2009—20151.32015—20211.4NANA
女性2006—20171.32017—20211.1NANA
合计2000—20151.32015—20211.1NANA
), ArticleFig(id=1311349969613845210, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349962500305573, language=CN, label=表2, caption=

中国与全球不同性别归因于高BMI的肌肉骨骼疾病负担的Joinpoint分析

, figureFileSmall=null, figureFileBig=null, tableContent=
ASDR地区性别趋势 1趋势 2趋势 3
时间段APC（%）时间段APC（%）时间段APC（%）
中国男性1990—19940.31994—20001.92000—20053.8
女性1990—1994-0.71994—20002.02000—20053.6
合计1990—1994-0.31994—20001.92000—20053.7
全球男性1990—19940.81994—20001.32000—20091.5
女性1990—19940.51994—20000.92000—20061.2
合计1990—19920.51992—19950.71995—20001.1
ASDR地区性别趋势 4趋势 5趋势 6
时间段APC（%）时间段APC（%）时间段APC（%）
中国男性2005—20102.72010—20153.02015—20212.3
女性2005—20153.02015—20212.4NANA
合计2005—20153.02015—20212.4NANA
全球男性2009—20151.32015—20211.4NANA
女性2006—20171.32017—20211.1NANA
合计2000—20151.32015—20211.1NANA
), ArticleFig(id=1311349969693536987, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349962500305573, language=EN, label=Table 3, caption=

Decomposition of changes in the number of prevalent cases of musculoskeletal disorders by regions from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
地区总变化（例）人口老龄化贡献（例）人口增长贡献（例）流行病学转变贡献（例）老龄化贡献占比（%）人口增长贡献占比（%）流行病学转变贡献（%）
全球809 571 302143 170 587625 195 32641 205 38817.6877.235.09
中国173 574 17572 356 93794 946 6696 270 56941.6954.703.61
), ArticleFig(id=1311349969769034460, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349962500305573, language=CN, label=表3, caption=

1990年至2021年各地区肌肉骨骼疾病患病人数变化的分解分析

, figureFileSmall=null, figureFileBig=null, tableContent=
地区总变化（例）人口老龄化贡献（例）人口增长贡献（例）流行病学转变贡献（例）老龄化贡献占比（%）人口增长贡献占比（%）流行病学转变贡献（%）
全球809 571 302143 170 587625 195 32641 205 38817.6877.235.09
中国173 574 17572 356 93794 946 6696 270 56941.6954.703.61
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1990—2021年中国和全球高体质指数归因的肌肉骨骼疾病负担的对比分析
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李欢 1 , 陈涛 1 , 詹蕾 1 , 刘敏 2 , 蒲小兵 1, 3
现代预防医学 | 疾病预防控制 2026,53(12): 2285-2290
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现代预防医学 |疾病预防控制 2026 , 53 (12) : 2285 -2290
1990—2021年中国和全球高体质指数归因的肌肉骨骼疾病负担的对比分析
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李欢（2000—），女，硕士在读，研究方向：老年保健与姑息医学

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李欢1, 陈涛1, 詹蕾1, 刘敏2, 蒲小兵1, 3
作者信息
  • 1.四川大学华西公共卫生学院/四川大学华西第四医院，四川 成都 610041
  • 2.四川大学华西医院骨科
  • 3.四川大学华西第四医院骨科
通讯作者:
蒲小兵，E-mail:
作者简介:

李欢（2000—），女，硕士在读，研究方向：老年保健与姑息医学

Temporal trends and comparison of the burden of musculoskeletal disorders attributable to high body mass index in China and globally, 1990-2021
Huan LI1, Tao CHEN1, Lei ZHAN1, Min LIU2, Xiao-bing PU1, 3
Affiliations
  • West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2026-06-25 doi: 10.20043/j.cnki.MPM.202601177
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摘要
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目的

分析1990—2021年，中国及全球归因于高体质指数（Body Mass Index, BMI）的肌肉骨骼疾病（Musculoskeletal disorders，MSDs）负担的时间趋势。

方法

本研究基于2021年全球疾病负担研究（GBD 2021）的公开数据库，通过计算年估计变化百分比和joinpoint分析，对中国及全球归因于高BMI的MSDs疾病负担的时间趋势进行了评估。利用Das Gupta分解法量化人口增长、老龄化及流行病学变化对疾病负担增长的贡献。

结果

2021年中国归因于高BMI的MSDs的伤残损失健康生命年为239.22万人年，较1990年增长了353.92%，显著高于全球同期增幅184.03%。中国及全球归因于高BMI的MSDs的疾病负担均呈上升趋势，中国EAPC为2.69%，AAPC为2.35%，全球EAPC为1.18%，AAPC为1.11%。与全球相比，中国归因于高BMI的MSDs负担上升速度更快，且呈阶段性波动增长趋势。中国以及全球的MSDs的疾病负担女性大于男性。分解分析表明，人口老龄化和人口增长是导致人群MSDs疾病患病人数上升的主要原因。

结论

1990—2021年中国归因于高BMI的MSDs疾病负担增长速度高于全球。建议卫生部门重点关注中老年女性群体，通过加强体重管理及早期健康干预，减缓MSDs负担的上升趋势。

肌肉骨骼疾病  /  高体质指数  /  时间趋势
Objective

To analyze the temporal trends of the burden of musculoskeletal disorders (MSDs) attributable to high body mass index (BMI) in China and globally from 1990 to 2021.

Methods

This study utilized the publicly available database of the Global Burden of Disease Study 2021 (GBD 2021). The temporal trends of the burden of MSDs attributable to high BMI in China and globally were evaluated by calculating the annual estimated percentage change and joinpoint analysis. The Das Gupta decomposition method was used to quantify the contributions of population growth, aging, and epidemiological changes to the increase in disease burden.

Results

In 2021, the years lived with disability(YLDs)due to MSDs attributable to high BMI in China was 239 person-years, an increase of 353.92% compared to 1990, significantly higher than the global increase of 184.03% during the same period. The burden of MSDs attributable to high BMI in both China and globally showed an upward trend. The estimated average percentage change (EAPC) in China was 2.69%, and the average annual percentage change (AAPC) was 2.35%. The EAPC globally was 1.18%, and the AAPC was 1.11%. Compared with the global trend, the burden of MSDs attributable to high BMI in China increased at a faster rate and showed a phased fluctuating growth trend. The disease burden of MSDs was higher in females than in males in both China and globally. Decomposition analysis indicated that population aging and population growth were the main reasons for the increase in the prevalence of MSDs in the population.

Conclusion

The burden of MSDs attributable to high BMI in China increased at a faster rate than globally from 1990 to 2021. It is recommended that health departments focus on middle-aged and elderly women, and through strengthening weight management and early intervention, slow down the upward trend of the burden of MSDs.

Musculoskeletal disorders  /  High body mass index  /  Temporal trends
李欢, 陈涛, 詹蕾, 刘敏, 蒲小兵. 1990—2021年中国和全球高体质指数归因的肌肉骨骼疾病负担的对比分析. 现代预防医学, 2026 , 53 (12) : 2285 -2290 . DOI: 10.20043/j.cnki.MPM.202601177
Huan LI, Tao CHEN, Lei ZHAN, Min LIU, Xiao-bing PU. Temporal trends and comparison of the burden of musculoskeletal disorders attributable to high body mass index in China and globally, 1990-2021[J]. Modern Preventive Medicine, 2026 , 53 (12) : 2285 -2290 . DOI: 10.20043/j.cnki.MPM.202601177
正文
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肌肉骨骼疾病（Musculoskeletal disorders，MSDs）常常导致急性或慢性疼痛、活动受限以及生活质量下降。常见的MSDs包括类风湿性关节炎、骨关节炎、腰痛、颈部疼痛和痛风。肌肉骨骼健康受损通常会导致工作效率降低，并增加患精神疾病、心血管疾病及癌症等慢性病的风险［1-3］。2019年，MSDs在全球伤残损失健康生命年（Years Lived with Disability，YLDs）中位列首位，在伤残调整生命年（Disability-Adjusted Life Years，DALY）中位列第六［4］。随着全球人口老龄化进程加速，MSDs已对个体健康、社会医疗体系乃至国家经济发展构成了健康与财政的双重负担［3］。由于MSDs直接致死率较低，其严重性被视为低于致命性疾病，导致其实际造成的健康寿命损失和社会经济负担的被低估［5-6］。身体质量指数（Body Mass Index, BMI）是依据个体体重与身高的比例所构建的一项常用生理评估指标，该指标被广泛应用于公共卫生研究与临床实践中，作为评估人体营养状况及肥胖程度的重要参考参数。在人口老龄化进程加速及相关风险暴露持续增加的背景下，全球范围内归因于高体重指数的疾病负担呈显著上升趋势。2000年至2021年间，其相关伤残调整生命年以年均1.8%的速度增长（95%CI：1.6~1.9）［7］。2017年，中国由高体质指数所致的伤残调整生命年占比在全球位列第五［8］。据《2021年全球疾病负担研究》报告，高体质指数与患腰痛、骨关节炎和痛风的风险增加有关［7］。高体质指数是MSDs发生与发展的重要风险因素［9］。尽管已有研究分别揭示了全球或中国单一层面的肌肉骨骼疾病负担，但目前仍缺乏针对中国与全球在归因于高BMI的MSDs负担的增长模式、性别差异及驱动因素方面的对比［10-14］。例如，Chen［15］等人曾对全球192个国家和地区中归因于高BMI的肌肉骨骼疾病负担进行评估，但其研究重点主要集中在经济负担方面，并未进一步在性别层面和时间趋势对健康负担进行分析。因此，本研究利用GBD 2021数据，系统对比1990—2021年中国与全球归因于高BMI的MSDs疾病负担，并利用Das Gupta分解法量化人口结构变化与流行病学因素对疾病负担的影响，旨在为我国制定肌肉骨骼健康干预策略及优化医疗资源配置提供实证支持。
1　资料与方法
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1.1　资料获取
本研究数据来自全球疾病负担（Global Burden of Disease，GBD）2021数据库（https://vizhub.healthdata.org/gbd-results/）。本研究从GBD 2021提取与高BMI相关的中国及全球的MSDs不同性别、年龄人群的YLDs和年龄标准化伤残调整生命年率（the age-standardized disability-adjusted life year rate，ASDR）数据。高BMI的定义依据GBD 2021标准，即成年人（年龄≥20岁）的BMI ≥25 kg/m2［16］。国际疾病分类第十版（ICD-10）编码为骨关节炎（M16, M17, M18, M19），腰痛（M54.3, M54.4, M54.5），痛风（M10）。GBD 2021的详细建模流程与数据处理方法见已发表的文献［4,7］。
1.2　统计分析
按不同性别及年龄组（每5岁为一个年龄段，由 20~84岁共13个组别）进行分层分析，更加全面了解中国及全球不同性别和年龄组归因于高BMI的MSDs负担中的差异特征。通过拟合回归模型计算 EAPC及其 95%置信区间。公式如下：y=α+βx+ε，EAPC=（exp（β）-1）×100%。在上述公式中，y表示年龄标准化率的自然对数，x表示日历年，ε为误差项，β表示年龄标准化率的回归系数如果 EAPC估计值及其95%置信区间均大于0，则可认为ASDR呈上升趋势；反之，如果EAPC估计值及其95%置信区间均小于0，则可认为呈下降趋势。否则，ASDR的趋势被认为无显著意义［17］。
通过Joinpoint回归模型连接点分析1990—2021年中国及全球高BMI归因的MSDs的年龄标准化伤残调整生命年率，以识别其时间变化阶段性特征。该模型采用连续线性函数将长期趋势线划分为若干段，并识别趋势上的潜在点［18］。线性模型提供了平均年度变化百分比（AAPC）、年度变化百分比（APC）及其95%可信区间（CI）。如果APC和AAPC估计值及其95%置信区间的下限均大于0，则表明在特定时期内呈上升趋势。相反，如果APC和AAPC估计值及其95%置信区间的上限均小于0，则表明呈下降趋势。否则，认为趋势无显著变化。相较于仅能反映整体平均趋势的EAPC，转折点回归的核心优势在于能够识别趋势发生显著变化的具体时点，并揭示被整体平均值所掩盖的阶段性加速、减速或逆转模式。
为量化人口结构变化与流行病学因素对疾病负担趋势的影响，采用Das Gupta分解法，将1990—2021年间全球归因于高BMI的MSDs患病例数变化，分解为人口增长、年龄结构变化以及流行病学转变三大因素的独立效应［19］。人口增长的效应指在年龄结构和年龄别患病率均保持在1990年水平的假设下，由于总人口规模扩大所导致的理论病例数增加。年龄结构变化的效应指在总人口规模和年龄别患病率均保持在1990年水平的假设下，由于人口年龄分布向老年组偏移（即老龄化）所导致的理论病例数变化。流行病学转变（年龄别患病率变化）的效应指在总人口规模和年龄结构均保持在1990年水平的假设下，单纯由于各年龄组患病风险本身的变化如肥胖流行加剧、诊疗水平提升等所导致的理论病例数变化。使用Stata（16.0版）与R软件（4.3.3版）进行所有统计分析及可视化。
2　结果
收起
2.1　1990—2021年中国与全球归因于高BMI的肌肉骨骼疾病负担及趋势分析
2021年，中国归因于高BMI的MSDs所致YLDs为239万人年，较1990年增长353.92%；同期全球YLDs为1 340万人年，增长184.03%。Joinpoint回归分析显示，1990—2021年中国归因于高BMI的MSDs疾病负担整体呈显著上升趋势，AAPC为2.35%（95%CI: 2.32%~2.38%），显著高于全球平均水平（AAPC=1.11%，95%CI: 1.09%~1.13%）。本研究同时计算了EAPC（中国：2.69%，全球：1.18%），两种模型结果方向一致，均证实中国相关疾病负担呈快速增长趋势。
Joinpoint回归分析进一步揭示了疾病负担变化的阶段特征，中国男性ASDR在1990—1994年呈缓慢增长（APC=0.30%），1994—2005年进入快速上升期，其中2000—2005年增长速率达到峰值（APC=3.80%），此后增速虽有所回落，但2015—2021年仍维持在2.30%。中国女性ASDR在1990—1994年曾出现短暂下降（APC=-0.70%），但1994年后迅速上升。与全球相比，中国ASDR上升速度更快且呈阶段性波动趋势，尤其在2000—2005年间，中国增速（APC=3.70%）显著高于同期全球水平（1.10%~1.30%）。近年来，中国与全球的疾病负担增速均呈放缓趋势，但中国仍维持在较高水平。（见表1，表2，图1）
2.2　2021年中国及全球不同性别及年龄组归因于高BMI的肌肉骨骼疾病负担
2021年，中国归因于高BMI的肌肉骨骼疾病负担在性别与年龄维度上呈现出显著的差异性。从绝对负担看，YLDs随年龄增长呈先升后降的倒“U”型分布，峰值集中在55~59岁年龄组。在该峰值区间，女性的YLDs数量显著高于男性。从疾病强度来看，YLDs率随年龄增长的趋势更为突出。45岁成为性别负担差异的分水岭：45岁前男女YLDs率基本持平；45岁后女性YLDs率呈陡坡式上升，并在65~69岁达到顶点（约500/10万），约为同龄男性的两倍。2021年全球归因于高BMI的肌肉骨骼疾病负担模式与中国既有共性亦存在显著区别。全球YLDs总量同样在55~59岁达到峰值。然而，在全球，女性负担高于男性的现象自青年时期（20~24岁）即已显现，并贯穿全生命周期。在疾病强度方面，全球峰值出现在70~74岁组，女性约700/10万，男性约430/10万明显高于中国同期水平。见图2。
2.3　分解分析
Das Gupta分解分析表明，1990年至2021年全球MSDs患病人数的上升，主要由人口增长与人口老龄化两大人口学因素共同驱动。值得注意的是，在年龄结构变化的贡献中，人口老龄化对中国负担增长的贡献率高达41.69%，显著高于全球平均水平（17.68%）。这提示，与其他地区相比，中国过去三十年间经历的快速人口结构转型，是推动其相关疾病负担增长的一个尤为突出的特异性因素。见表3。
3　讨论
收起
本研究揭示了1990—2021年中国及全球归因于高BMI的MSDs负担的流行病学特征与差异。我们的研究显示，2021年中国归因于高BMI的MSDs的ASDR为113/10万，全球为155/10万。中国及全球的ASDR的年均百分比变化均呈上升趋势，中国增长速度是全球的2倍。在Joinpoint回归分析中，我们发现由于高BMI导致的MSDs的YLDs和年龄标准化 YLDs率在2005年后呈上升趋势。这与之前的研究结果一致［20］，可能归因于人口老龄化和全球肥胖症的流行。中国人口老龄化占比（41.7%）显著高于全球（17.7%），而流行病学占比（3.6%）低于全球（5.1%）。这一发现揭示了中国MSDs负担增长的特征，一方面，人口老龄化是主导因素，另一方面，肥胖流行的独立作用被老龄化和人口增长的效应所稀释。这提示，中国归因于高BMI相关MSDs防控，必须在应对老龄化的同时，警惕肥胖流行的滞后影响。过去三十年间，中国的肥胖症患病率从1980年的0.6%上升到2015年的5.3%［21］。这一上升趋势导致了与肥胖相关疾病的发病率大幅增加。学者们发现，体重的增加通过多种机制损伤肌肉骨骼系统，椎间盘受压导致腰椎承受过大的轴向负荷，诱发或加重腰痛［22］。肥大的脂肪细胞在关节内积聚，引发局部炎症，促使骨关节炎的发展［23］。此外，肥胖会增加尿酸钠的生成，同时减少尿酸的肾排泄，从而导致高尿酸血症［24］。
中国以及全球归因于高BMI的MSDs负担存在性别、年龄分布差异，中国及全球女性YLDs值与ASDR值皆高于男性，这与生理结构、行为因素密切相关［25］。在中国，女性YLDs率在45岁后出现“陡坡式”增长，并在65-69岁达到峰值。女性进入围绝经期后雌激素水平下降，导致骨密度降低和关节软骨发生退变，增加了对肥胖诱发的机械压力的敏感性［26］；与此同时，女性相对较小的骨骼构架与较低的肌肉密度，构成了其运动系统较男性脆弱的生理基础，使其在应对高BMI带来的力学负荷时，较男性更易发生退行性病变［27］。行为因素方面，中国中老年女性由于缺乏规律的体育锻炼及饮食结构不均衡，肥胖患病率持续攀升，进一步加剧了肌肉骨骼系统的慢性损伤。在一项中国人饮食结构与肥胖指标关系的横断面研究发现，中国女性对高能量、高脂肪的西式饮食（如快餐、含糖饮料等）的摄入偏好显著高于男性［28］。而西式饮食模式已被验证是诱发肥胖的危险因素［29］。全球疾病负担的性别差异自青年期（20~24岁）即已显现，提示全球肥胖年轻化趋势对MSDs的早期侵害不容忽视。MSDs会导致劳动生产力和社会财富的损失［30］。有研究表明，MSDs在青年人群中负担加重，可能会导致劳动力短缺，并阻碍个人为社会的发展做出贡献，尤其是在社会人口发展水平较低和中等的国家［31］。全球YLDs率峰值（70~74岁）较中国（65~69岁）更晚，且在高龄阶段（>75岁）仍维持高水平。这种差异可能与不同地区的医疗干预可及性、人群预期寿命以及饮食模式有关。
综上，中国应将45-69岁的女性作为MSDs的首要干预目标人群，通过社区健康教育提升其对体重管理与关节保护的认知。借鉴全球疾病流行病学特征，中国在公共卫生政策中应前瞻性地关注青少年及青年群体的BMI监测，防止肥胖相关的肌肉骨骼损伤风险在生命早期累积。随着中国人口老龄化加剧，尽管目前高龄组负担有所下降，但随着生活方式改变，未来高龄人群的YLDs率可能向全球高水平靠拢，需建立覆盖老年人的肥胖综合防治体系。
本研究存在一定的局限性：首先，由于医疗资源分布不均，发展中国家的疾病负担可能被低估。其次，GBD 2021的数据在收集和分析时严重依赖统计建模方法，这可能会影响结果的准确性。第三，由于年龄、性别和种族等因素导致个体间存在差异，仅靠体质指数无法全面反映健康风险的程度。因此，我们可能低估了与高BMI相关的肌肉骨骼疾病的潜在负担。未来研究应纳入更多维度的个体健康指标，如体脂分布、腰臀比、代谢综合征相关生物标志物等，更全面地评估归因于肥胖的肌肉骨骼疾病负担。

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2026年第53卷第12期
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doi: 10.20043/j.cnki.MPM.202601177
  • 接收时间：2026-01-12
  • 首发时间：2026-09-28
  • 出版时间：2026-06-25
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  • 收稿日期：2026-01-12
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    1.四川大学华西公共卫生学院/四川大学华西第四医院，四川 成都 610041
    2.四川大学华西医院骨科
    3.四川大学华西第四医院骨科

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