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Article(id=1324044554818683852, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202601351, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1769011200000, receivedDateStr=2026-01-22, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793606421427, onlineDateStr=2026-11-02, pubDate=1777046400000, pubDateStr=2026-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793606421427, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793606421427, creator=13701087609, updateTime=1793606421427, updator=13701087609, issue=Issue{id=1324044540067328424, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='8', pageStart='1345', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='1777046400000', pubDateStr='2026-04-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793606417910, creator='13701087609', updateTime=1793670137580, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311799788602160, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311799788602161, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1351, endPage=1357, ext={EN=ArticleExt(id=1324044555187782605, articleId=1324044554818683852, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Trends in the disease burden of Alzheimer's disease and related dementias attributable to smoking, China, 1990-2023, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the trends in disease burden of Alzheimer's disease and related dementias (ADRD) attributable to smoking in China from 1990 to 2023, and to provide evidence to inform prevention and control strategies for dementia.

Methods

Based on Global Burden of Disease (GBD) data from 1990-2023, trends were analyzed using Joinpoint regression, and age-period-cohort (APC) models were applied to decompose age, period, and cohort effects.

Results

Between 1990 and 2023, the number of deaths and DALYs of ADRD attributable to smoking in China increased by 269.002% and 223.932%, respectively. During the same period, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) showed a slight overall decline, with average annual changes of-0.135% and-0.040%, respectively. Age effect: Disease burden increased significantly with age, rising more slowly after 60 years but remaining at high levels. Period effect: Risk of disease burden continued to increase over time, peaking between 2020 and 2023. Cohort effect: A significant intergenerational decline was observed, more pronounced among females.

Conclusion

Although the age-standardized burden of ADRD attributable to smoking in China has gradually decreased, the absolute burden has increased, with males bearing a significantly higher burden than females. The cumulative effect of long-term smoking before age 60 has markedly increased disease burden, laying the foundation for a peak in older age, highlighting the importance of early-and mid-life interventions. Multi-level strategies, including policy measures, community support, and individual behavior interventions, should focus on middle-aged and older male smokers to reduce long-term disease burden.

, authors=Xiao-qing LV1, 2, Zhong-quan YANG1, 2, Zi-yun CHENG1, 2, Jian-zhong ZHENG1, 2, Yan TONG1, 2, authorsList=Xiao-qing LV, Zhong-quan YANG, Zi-yun CHENG, Jian-zhong ZHENG, Yan TONG, authorCompany=null, correspAuthors=Jian-zhong ZHENG, Yan TONG, 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=1324044558727775190, articleId=1324044554818683852, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=1990—2023年中国归因于吸烟行为的阿尔茨海默病及相关痴呆症疾病负担趋势分析, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

分析1990—2023年归因于吸烟的阿尔茨海默病及相关痴呆症（ADRD）疾病负担变化趋势，为开展痴呆症防治工作提供建议。

方法

基于全球疾病负担（GBD）1990—2023年数据，采用Joinpoint回归分析趋势，运用年龄-时期-队列模型分解效应。

结果

1990—2023年间，中国归因于吸烟行为的ADRD死亡数和DALYs分别增长269.002%和223.932%；同期ASMR和ASDR整体呈轻微下降趋势，年均变化率分别为-0.135%和-0.040%。年龄效应：疾病负担随年龄显著上升，60岁后增幅趋缓但始终维持在高水平；时期效应：疾病负担风险随时间持续上升，在2020—2023年达到峰值；队列效应：呈显著代际下降趋势，在女性中下降更为显著。

结论

我国归因于吸烟的阿尔茨海默病及其他痴呆的年龄标准化疾病负担虽持续下降，但绝对数上升，男性负担明显高于女性。60岁前长期吸烟累积效应已显著增加疾病负担，为老年阶段高峰奠定基础，提示早中年干预的重要性。应重点针对中老年男性吸烟者，通过政策、社区支持及个体行为干预多层面联合措施，降低长期疾病负担。

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吕晓晴（2001—），女，硕士在读，研究方向：慢病预防和管理研究

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郑建中与佟岩为共同通信作者。郑建中，E-mail：
佟岩，E-mail：
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Archives of Internal Medicine, 2011, 171(4): 333-339., articleTitle=Heavy smoking in midlife and long-term risk of Alzheimer disease and vascular dementia, refAbstract=null)], funds=[Fund(id=1324044564377501709, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, awardId=72504167, language=CN, fundingSource=国家自然科学基金青年项目(72504167), fundOrder=null, country=null), Fund(id=1324044564448804878, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, awardId=202303021212136, language=CN, fundingSource=山西省基础研究计划（自由探索类）资助项目(202303021212136), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324044558962656215, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, xref=1., ext=[AuthorCompanyExt(id=1324044558971044824, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, companyId=1324044558962656215, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Grassroots Health Guidance Center, Shanxi Medical University Second Hospital, Taiyuan, Shanxi 030001, China), AuthorCompanyExt(id=1324044558983627737, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, companyId=1324044558962656215, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.山西医科大学公共卫生学院社会医学教研室，山西　太原　030001)]), AuthorCompany(id=1324044559042347994, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, xref=2., ext=[AuthorCompanyExt(id=1324044559050736603, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, companyId=1324044559042347994, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.社区健康与卫生发展研究中心)])], figs=[ArticleFig(id=1324044563333120002, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, language=EN, label=Fig. 1, caption=Trend in ASMR of smoking-attributable ADRD in China from 1990 to 2023, figureFileSmall=KpQfSEb2U7HpZEGwogCVfA==, figureFileBig=xMensc6RGqIoTcX9t/q7vQ==, tableContent=null), ArticleFig(id=1324044563417006083, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, language=CN, label=图1, caption=1990—2023年中国归因于吸烟行为的ADRD的ASMR的变化趋势, figureFileSmall=KpQfSEb2U7HpZEGwogCVfA==, figureFileBig=xMensc6RGqIoTcX9t/q7vQ==, tableContent=null), ArticleFig(id=1324044563647692804, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, language=EN, label=Fig. 2, caption=Trend in ASDR of smoking-attributable ADRD in China from 1990 to 2023, figureFileSmall=jwqvJOUQndabP76XpwPNKw==, figureFileBig=wRpNKer8gX/MIkfx+8xZZw==, tableContent=null), ArticleFig(id=1324044563710607365, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, language=CN, label=图2, caption=1990—2023年中国归因于吸烟行为的ADRD的ASDR的变化趋势, figureFileSmall=jwqvJOUQndabP76XpwPNKw==, figureFileBig=wRpNKer8gX/MIkfx+8xZZw==, tableContent=null), ArticleFig(id=1324044563786104838, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, language=EN, label=Fig. 3, caption=Age-period-cohort analysis of mortality attributable to smoking-related ADRD in China, 1990-2023, figureFileSmall=5FT7iv4XbteGbboczfLVMA==, figureFileBig=ksssSalP3C5qVn4PZA8tZw==, tableContent=null), ArticleFig(id=1324044563878379527, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, language=CN, label=图3, caption=1990—2023年中国归因于吸烟行为的ADRD的死亡率年龄-时期-队列模型分析, figureFileSmall=5FT7iv4XbteGbboczfLVMA==, figureFileBig=ksssSalP3C5qVn4PZA8tZw==, tableContent=null), ArticleFig(id=1324044563979042825, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, language=EN, label=Fig. 4, caption=Age-period-cohort analysis of DALY rates attributable to smoking-related ADRD in China, 1990-2023, figureFileSmall=7D/Em3+kPMeVoCTl3Z78Pg==, figureFileBig=fn2QIiNAhQcCtkKQ/D6LZg==, tableContent=null), ArticleFig(id=1324044564100677642, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, language=CN, label=图4, caption=1990—2023年中国归因于吸烟行为的ADRD的DALYs率年龄-时期-队列模型分析, figureFileSmall=7D/Em3+kPMeVoCTl3Z78Pg==, figureFileBig=fn2QIiNAhQcCtkKQ/D6LZg==, tableContent=null), ArticleFig(id=1324044564167786507, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, language=EN, label=Table 1, caption=

Disease burden of ADRD attributable to smoking in China, 1990 and 2023

, figureFileSmall=null, figureFileBig=null, tableContent=
性别年份死亡
数量（人）ASMR（1/10万）
全人群19907 873.868（1 609.988~22 862.761）1.449（0.327~4.163）
202329 054.766（5 769.999~70 941.445）1.343（0.269~3.251）
男性19905 318.433（1 049.775~15 214.457）2.171（0.458~6.098）
202323 404.313（4 695.053~57 816.330）2.432（0.490~5.879）
女性19902 555.435（521.810~7 486.853）0.937（0.195~2.640）
20235 650.454（1 287.972~13 940.544）0.477（0.109~1.180）
性别年份DALYs
数量（人）ASDR（1/10万）
全人群1990213 581.728（88 243.849~498 180.234）31.800（13.190~74.789）
2023691 858.650（299 269.363~1 379 239.116）30.460（13.163~60.438）
男性1990158 628.688（67 776.658~379 850.336）49.722（20.890~116.746）
2023575 414.148（241 816.445~1 173 398.204）54.773（23.016~110.850）
女性199054 953.040（20 066.486~131 842.809）17.174（6.597~39.971）
2023116 444.502（45 734.023~229 745.060）9.632（3.789~19.120）
), ArticleFig(id=1324044564251672588, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044554818683852, language=CN, label=表1, caption=

1990、2023年中国归因于吸烟行为的ADRD疾病负担情况

, figureFileSmall=null, figureFileBig=null, tableContent=
性别年份死亡
数量（人）ASMR（1/10万）
全人群19907 873.868（1 609.988~22 862.761）1.449（0.327~4.163）
202329 054.766（5 769.999~70 941.445）1.343（0.269~3.251）
男性19905 318.433（1 049.775~15 214.457）2.171（0.458~6.098）
202323 404.313（4 695.053~57 816.330）2.432（0.490~5.879）
女性19902 555.435（521.810~7 486.853）0.937（0.195~2.640）
20235 650.454（1 287.972~13 940.544）0.477（0.109~1.180）
性别年份DALYs
数量（人）ASDR（1/10万）
全人群1990213 581.728（88 243.849~498 180.234）31.800（13.190~74.789）
2023691 858.650（299 269.363~1 379 239.116）30.460（13.163~60.438）
男性1990158 628.688（67 776.658~379 850.336）49.722（20.890~116.746）
2023575 414.148（241 816.445~1 173 398.204）54.773（23.016~110.850）
女性199054 953.040（20 066.486~131 842.809）17.174（6.597~39.971）
2023116 444.502（45 734.023~229 745.060）9.632（3.789~19.120）
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1990—2023年中国归因于吸烟行为的阿尔茨海默病及相关痴呆症疾病负担趋势分析
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吕晓晴 1, 2 , 杨忠泉 1, 2 , 程子云 1, 2 , 郑建中 1, 2 , 佟岩 1, 2
现代预防医学 | 流行病与统计方法 2026,53(8): 1351-1357
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现代预防医学 |流行病与统计方法 2026 , 53 (8) : 1351 -1357
1990—2023年中国归因于吸烟行为的阿尔茨海默病及相关痴呆症疾病负担趋势分析
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吕晓晴1, 2, 杨忠泉1, 2, 程子云1, 2, 郑建中1, 2 , 佟岩1, 2
作者信息
  • 1.山西医科大学公共卫生学院社会医学教研室，山西　太原　030001
  • 2.社区健康与卫生发展研究中心
通讯作者:
郑建中与佟岩为共同通信作者。郑建中，E-mail：
佟岩，E-mail：
作者简介:

吕晓晴（2001—），女，硕士在读，研究方向：慢病预防和管理研究

Trends in the disease burden of Alzheimer's disease and related dementias attributable to smoking, China, 1990-2023
Xiao-qing LV1, 2, Zhong-quan YANG1, 2, Zi-yun CHENG1, 2, Jian-zhong ZHENG1, 2 , Yan TONG1, 2
Affiliations
  • Department of Grassroots Health Guidance Center, Shanxi Medical University Second Hospital, Taiyuan, Shanxi 030001, China
出版时间: 2026-04-25 doi: 10.20043/j.cnki.MPM.202601351
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摘要
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目的

分析1990—2023年归因于吸烟的阿尔茨海默病及相关痴呆症（ADRD）疾病负担变化趋势，为开展痴呆症防治工作提供建议。

方法

基于全球疾病负担（GBD）1990—2023年数据，采用Joinpoint回归分析趋势，运用年龄-时期-队列模型分解效应。

结果

1990—2023年间，中国归因于吸烟行为的ADRD死亡数和DALYs分别增长269.002%和223.932%；同期ASMR和ASDR整体呈轻微下降趋势，年均变化率分别为-0.135%和-0.040%。年龄效应：疾病负担随年龄显著上升，60岁后增幅趋缓但始终维持在高水平；时期效应：疾病负担风险随时间持续上升，在2020—2023年达到峰值；队列效应：呈显著代际下降趋势，在女性中下降更为显著。

结论

我国归因于吸烟的阿尔茨海默病及其他痴呆的年龄标准化疾病负担虽持续下降，但绝对数上升，男性负担明显高于女性。60岁前长期吸烟累积效应已显著增加疾病负担，为老年阶段高峰奠定基础，提示早中年干预的重要性。应重点针对中老年男性吸烟者，通过政策、社区支持及个体行为干预多层面联合措施，降低长期疾病负担。

阿尔茨海默病  /  吸烟  /  疾病负担  /  年龄-时期-队列模型
Objective

To analyze the trends in disease burden of Alzheimer's disease and related dementias (ADRD) attributable to smoking in China from 1990 to 2023, and to provide evidence to inform prevention and control strategies for dementia.

Methods

Based on Global Burden of Disease (GBD) data from 1990-2023, trends were analyzed using Joinpoint regression, and age-period-cohort (APC) models were applied to decompose age, period, and cohort effects.

Results

Between 1990 and 2023, the number of deaths and DALYs of ADRD attributable to smoking in China increased by 269.002% and 223.932%, respectively. During the same period, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) showed a slight overall decline, with average annual changes of-0.135% and-0.040%, respectively. Age effect: Disease burden increased significantly with age, rising more slowly after 60 years but remaining at high levels. Period effect: Risk of disease burden continued to increase over time, peaking between 2020 and 2023. Cohort effect: A significant intergenerational decline was observed, more pronounced among females.

Conclusion

Although the age-standardized burden of ADRD attributable to smoking in China has gradually decreased, the absolute burden has increased, with males bearing a significantly higher burden than females. The cumulative effect of long-term smoking before age 60 has markedly increased disease burden, laying the foundation for a peak in older age, highlighting the importance of early-and mid-life interventions. Multi-level strategies, including policy measures, community support, and individual behavior interventions, should focus on middle-aged and older male smokers to reduce long-term disease burden.

Alzheimer's disease  /  Smoking  /  Disease burden  /  Age-period-cohort model
吕晓晴, 杨忠泉, 程子云, 郑建中, 佟岩. 1990—2023年中国归因于吸烟行为的阿尔茨海默病及相关痴呆症疾病负担趋势分析. 现代预防医学, 2026 , 53 (8) : 1351 -1357 . DOI: 10.20043/j.cnki.MPM.202601351
Xiao-qing LV, Zhong-quan YANG, Zi-yun CHENG, Jian-zhong ZHENG, Yan TONG. Trends in the disease burden of Alzheimer's disease and related dementias attributable to smoking, China, 1990-2023[J]. Modern Preventive Medicine, 2026 , 53 (8) : 1351 -1357 . DOI: 10.20043/j.cnki.MPM.202601351
正文
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阿尔茨海默病及相关痴呆症（Alzheimer's disease and related dementia，ADRD）是一类以进行性认知功能减退为主要特征的中枢神经系统退行性疾病[1]。该疾病具有发病率高、致残率高、病程长及照护依赖重等特点，已成为全球范围内影响老年群体生活质量和社会经济发展的重大公共卫生问题[2]。痴呆目前是全球第七大死亡原因，同时也是导致失能和生活质量下降的主要原因之一[3]。我国目前已进入深度老龄化阶段，2025年65岁及以上人口占总人口的15.9%，预计到2050年该比例将超过30%[4]。受此影响，ADRD的疾病负担在我国持续上升，不仅是我国居民主要死亡原因之一，同时也是造成老年人失能的重要因素[5]。
痴呆的发生发展除了与不可控的年龄、遗传背景等因素密切相关外，吸烟是导致痴呆症发病和死亡最主要的行为危险因素之一[6-8]。由于吸烟行为具有一定的可控性与可逆性，识别并分析其对ADRD疾病负担的长期影响，对于优化资源配置、推动早期预防与健康促进策略具有重要意义。尽管国内外已有关于ADRD疾病负担的研究[9-12]，但专门针对归因于吸烟行为的ADRD疾病负担长期趋势分析仍相对缺乏。同时，不同年龄组、出生队列和历史时期可能对吸烟相关ADRD负担产生复杂作用。因此，本研究旨在应用年龄-时期-队列（Age-Period-Cohort，APC）分析方法，对1990—2023年中国归因于吸烟行为的ADRD疾病负担的变化趋势进行探讨，为优化痴呆症预防与延缓策略提供科学依据。
1　材料与方法
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1.1　数据来源
资料来源于全球疾病负担（Global Burden of Disease Study，GBD）研究2023数据库。GBD 2023量化了204个国家和地区的371种疾病和损伤以及对应的88种风险因素所导致的负担进行全面估算[13]。中国的疾病负担数据主要来源于人口普查、中国疾病监测点、妇幼监测系统和中国疾病控制中心。本研究以《精神障碍诊断与统计手册》及国际疾病分类（ICD）的病例定义为参考。阿尔茨海默病及相关痴呆作为研究中的疾病集合概念，涵盖阿尔茨海默病及其他类型的痴呆[14]。研究选取了1990—2023年期间中国归因于吸烟行为的ADRD疾病负担的死亡和DALYs绝对数与标准化率，并对人群进行年龄分组，每5岁一个年龄组，共分为12个组别（从40~95岁以上），性别分为男性和女性。
1.2　指标选择
本研究从GBD 2023数据库中提取1990—2023年中国ADRD的相关数据。在数据选取时，疾病选择“Alzheimer's disease and other dementias”，疾病负担相关的指标选择死亡数和死亡率；伤残调整生命年（Disability-Adjusted Life Years，DALYs）；年龄标准化死亡率（age-standardized mortality rate，ASMR）；年龄标准化伤残调整生命年率（age-standardized disability-adjustedlife year rate，ASDR）。
1.3　统计方法
本研究采用Joinpoint回归分析ADRD的ASMR和ASDR的时间变化趋势，计算年度变化百分比（Annual Percent Change，APC）和平均年度变化百分比（Average Annual Percent Change，AAPC）。采用Stata 16.0MP构建年龄-时期-队列模型，评估年龄效应、时期效应及出生队列效应对归因于吸烟的ADRD疾病负担的影响。利用内生因子算法（intrinsic estimator，IE）进行年龄-时期-队列模型的系数估计，求解得到的系数大于0则说明发生或死亡风险增加，小于0则表示发生或死亡风险降低。系数值越大，说明该年龄段、时期或出生队列对疾病负担的贡献越大，值越小则表示影响越小。
2　结果
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2.1　1990—2023年中国归因于吸烟行为的ADRD疾病负担及变化趋势
2.1.1　ASMR变化趋势
1990—2023年，中国因吸烟行为导致的ADRD死亡人数由7 874例增加至29 055例，男性明显高于女性，性别比2.08:1。全人群ASMR由1990年的1.449/10万降至2023年的1.343/10万（AAPC=-0.135%，95%CI：-0.261%~-0.028%）。分阶段分析表明：1990—1996年下降，1996—2004年上升，2004—2023年再次下降。性别分析显示，男性ASMR总体呈上升趋势但各阶段波动明显，女性ASMR总体下降，早期略有波动，随后长期下降，男性ASMR高于女性。见表1、图1。
2.1.2　ASDR变化趋势
归因于吸烟行为的ADRD伤残调整生命年由21.36万年增加至69.19万年，男性占比高于女性，性别比2.89∶1。全人群ASDR由1990年的31.800/10万下降至2023年的30.460/10万（AAPC=-0.040%，95%CI：-0.122%~-0.035%）；分阶段分析表明1990—1998年下降，1998—2004年上升，2004—2023年下降。性别分析显示，男性ASDR整体略升且波动不大，女性ASDR整体呈下降趋势，早期略有波动，随后长期下降，男性ASDR高于女性，见表1、图1。
2.2　1990—2023年中国归因于吸烟行为的ADRD疾病负担的年龄-时期-队列模型分析
2.2.1　年龄效应
在全人群中，归因于吸烟行为的ADRD疾病负担均随年龄增长呈持续上升趋势。死亡风险系数在40~44岁达到最低值-5.569，随后随年龄增加逐步升高，并在85~89岁达到最高值2.511，95岁及以上人群略有下降；DALYs风险系数同样在40~44岁最低（-4.151），在85~89岁达到最高值（1.725），高龄阶段略有回落。总体来看，两项风险系数在60岁以前上升较快，60岁以后增幅趋于平缓。男性和女性的死亡及DALYs风险系数均随年龄增加而升高，且在高龄阶段女性风险系数整体高于男性。
2.2.2　时期效应
在全人群中，归因于吸烟的ADRD疾病负担均随时期推移呈持续上升趋势。死亡风险系数在1990—1994年处于最低值-0.871，并在2020—2023年达到最高值0.441；DALYs风险系数亦在1990—1994年最低值-0.558，在2020—2023年达到最高值0.441。性别分层结果显示，男性在多数时期的死亡和DALYs风险系数整体高于女性。女性风险系数随时期推移呈持续但较为平缓的上升趋势。与死亡风险系数相比，DALYs风险系数随时期变化的波动幅度相对较小，但总体变化方向一致。
2.2.3　队列效应
在全人群中，归因于吸烟的ADRD疾病负担均随出生队列推移呈显著下降趋势。死亡风险系数在最早出生队列中最高，为2.242，随后逐代降低，并在1978—1981年出生队列达到最低值-1.428；DALYs风险系数同样随出生队列逐代下降，早期出生队列下降幅度较大，20世纪中叶以后下降趋势逐渐趋缓。男性和女性在死亡及DALYs风险系数上均呈现随出生年代推移而下降的趋势，且女性在不同出生队列间的风险下降幅度略大于男性。
3　讨论
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本研究基于GBD 2023数据库，分析了1990—2023年中国归因于吸烟的ADRD疾病负担及变化趋势。吸烟作为ADRD的重要可干预危险因素，其负担动态不仅反映我国控烟政策和慢病防控成效，也为制定针对性防治策略、延缓认知衰退提供流行病学依据。结果显示，我国归因于吸烟的ADRD死亡数和DALYs绝对值显著上升，而年龄标准化死亡率和DALYs率呈缓慢下降趋势，与全球趋势基本一致[15]；同期全球因吸烟导致的ADRD死亡数和DALYs约上升一倍，年龄标准化死亡率和DALYs率下降约20%[16]。这些发现可能源于两个主要因素：一方面，人口增长与老龄化加剧了加剧了ADRD的疾病负担；另一方面，全球控烟措施推进，包括价格与税收管制、公共场所禁烟、公众烟草危害认知提升及《世卫组织烟草控制框架公约》的实施，对减轻疾病负担发挥积极作用[13,17-19]。此外，吸烟导致ADRD负担上升还可能与其多重生物学机制相关。吸烟可引发全身慢性低度炎症并促进中枢神经系统神经炎症，烟草有害物质可破坏血脑屏障并激活脑内小胶质细胞，释放促炎细胞因子，加剧神经元损伤[20]；烟雾中的一氧化碳、重金属等还可干扰线粒体电子传递链，导致活性氧（ROS）积累，引发脂质和蛋白氧化损伤，并进一步促进神经元凋亡[21]。这些机制为吸烟推动ADRD长期负担上升提供了病理学基础。值得注意的是，自2019年起，中国归因吸烟的ADRD疾病负担出现阶段性反弹，可能与新冠疫情相关[22]。疫情期间，医疗资源向急性疫情防控倾斜，慢病管理和戒烟干预服务覆盖受到影响。调查显示，2020年疫情下，约7.7%的吸烟者吸烟量增加[23]。
我国归因于吸烟行为的ADRD疾病负担存在显著性别差异，男性负担明显高于女性，且下降趋势不及女性显著。虽然总体上ADRD在女性中更为常见，其患病率和发病率通常高于男性，这主要与女性平均寿命更长及早期教育水平较低等因素相关，但在吸烟相关负担方面，男性疾病负担仍显著高于女性。有研究表明，吸烟相关的ADRD对男性的影响约为女性的2-3倍[24]，这主要源于男性吸烟率远高于女性，40岁及以上男性约52%，女性仅2.5%[25]。从生物机制层面看，性激素和性染色体也被认为与ADRD的发病机制相关。有研究指出，性激素的变化与炎症、代谢和自噬等多种病理过程有交互作用，这可能导致男女在认知衰退和神经退行性病变上的不同表现[26]。此外，相比于男性，女性也对医疗保健和疾病预防表现出更大的关注。因此，为进一步降低吸烟相关ADRD负担，应重点针对男性群体制定和实施更具针对性的控烟政策及干预措施，同时兼顾性别差异的多维驱动机制。
本研究发现，随着年龄增加，归因于吸烟的ADRD疾病负担显著上升，85-89岁及以上人群风险最高，提示老龄阶段为痴呆症负担集中的“爆发期”，吸烟行为风险暴露的累积效应在极端老龄化阶段呈现指数级放大趋势。值得注意的是，在60岁以下人群中，尽管绝对疾病负担水平较低，但其增长速率最快，中年重度吸烟与多年后痴呆风险的提升支持了这一累积暴露机制[27]。在时间维度上，归因于吸烟的ADRD的相对风险整体呈上升趋势，并在2020—2023年达到峰值，类似的时期效应亦在既往研究中有所报道[22]，这可能反映了人口老龄化加速、痴呆诊断水平提高以及吸烟所致慢性损伤的滞后显现等多重因素的共同作用。出生队列分析显示，较晚出生队列的疾病负担风险整体较低，且女性下降幅度更为显著，这与多国队列研究中观察到的代际性痴呆风险下降趋势一致，这可能反映教育水平、生活方式和危险因素控制在不同世代之间的变化[22]。
在归因于的本研究的创新点和优势在于利用长期数据，结合年龄-时期-队列模型分析吸烟相关ADRD疾病负担的性别、年龄及出生队列差异，为政策制定提供参考。局限在于未细分ADRD亚型，未来研究细化痴呆亚型分析，以提升预测精度和政策指导价值。
综上所述，本研究系统呈现了1990—2023年中国归因于吸烟的阿尔茨海默病及其他痴呆（ADRD）负担的时空格局及趋势。尽管年龄标准化负担有所下降，但绝对值仍持续上升，男性承担主要疾病负担，性别差异显著；近年疫情亦对既有下降趋势产生阶段性扰动。年龄-时期-队列分析进一步表明，ADRD疾病负担随年龄增长和历时推移呈上升趋势，而出生队列效应整体下降，提示代际吸烟暴露模式的改变正在对疾病风险产生长期缓释作用。针对这一复杂局面，应推进分层、精准的控烟与认知健康干预策略。宏观层面需建立高位统筹机制，强化跨部门政策协同，完善无烟环境立法，实施税价联动及健康警示措施；中观层面应抓住全生命周期关键干预期，尤其是60岁前男性群体，通过社区戒烟服务、认知筛查及健康教育，营造支持性环境；微观层面需实施个体化干预，对长期吸烟或存在认知风险者提供戒烟、行为干预及持续随访支持，通过替代性健康行为与数字健康技术实现持续管理。总体而言，中国吸烟相关ADRD防控正迈入人口老龄化、性别差异及慢病交织的复杂阶段。未来政策应注重性别敏感、全生命周期导向的综合治理，以有效遏制其疾病负担的增长，推动健康老龄化目标实现。
基金
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  • 国家自然科学基金青年项目(72504167)
  • 山西省基础研究计划（自由探索类）资助项目(202303021212136)
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2026年第53卷第8期
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doi: 10.20043/j.cnki.MPM.202601351
  • 接收时间：2026-01-22
  • 首发时间：2026-11-02
  • 出版时间：2026-04-25
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  • 收稿日期：2026-01-22
基金
国家自然科学基金青年项目(72504167)
山西省基础研究计划（自由探索类）资助项目(202303021212136)
作者信息
    1.山西医科大学公共卫生学院社会医学教研室，山西　太原　030001
    2.社区健康与卫生发展研究中心

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郑建中与佟岩为共同通信作者。郑建中，E-mail：
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