Article(id=1240395018163245763, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202408116, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1723046400000, receivedDateStr=2024-08-08, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773662817755, onlineDateStr=2026-03-16, pubDate=1753372800000, pubDateStr=2025-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773662817755, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773662817755, creator=13701087609, updateTime=1773662817755, updator=13701087609, issue=Issue{id=1240395006914130733, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='14', pageStart='2497', pageEnd='2688', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773662815073, creator=13701087609, updateTime=1773662858015, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240395187109810535, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240395187109810536, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240395006914130733, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2682, endPage=2688, ext={EN=ArticleExt(id=1240395018494595803, articleId=1240395018163245763, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Trends and predictions of the burden of spinal injuries in China, 1990-2021, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the burden of spinal injuries and its changing trends in China from 1990 to 2021, providing a theoretical basis for the prevention of spinal injuries.

Methods

Using the GBD 2021 database, indicators such as incidence, prevalence, and Years Lived with Disability (YLD) were extracted to describe the changes in the burden of spinal injuries in China. Data visualization was performed using the R language, the Joinpoint model was used to analyze the temporal trends of disease burden, the APC model was used to estimate age, period, and cohort effects, and the BAPC model was used to predict the standardized incidence rate of spinal injuries from 2022 to 2040.

Results

Compared to 1990, the YLD rate and standardized YLD rate of spinal injuries in China showed a decline in 2021, while other indicators increased; the disease burden increased with age, with males having a higher burden than females; falls were the main cause of the disease burden; the average annual percentage change in standardized incidence rate, standardized prevalence rate, and standardized YLD rate from 1990 to 2021 was 0.007%, 0.156%, and -0.344%, respectively; the age-period-cohort model showed that the incidence rate increased with age, fluctuated upwards with time, and fluctuated downwards with the birth cohort; the prediction model indicated that the standardized incidence rate of spinal injuries will show a declining trend from 2022 to 2040.

Conclusion

The burden of spinal injuries in China from 1990 to 2021 showed an upward trend, with gender and age differences, falls being the main cause, and the elderly and males being the key burden groups; effective measures should be taken for intervention.

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目的

分析1990—2021年中国脊髓损伤疾病负担及其变化趋势,为脊髓损伤的预防工作提供理论依据。

方法

利用GBD 2021数据库,提取发病、患病、伤残寿命损失年(YLD)等指标描述中国脊髓损伤疾病负担变化,R语言进行数据可视化,Joinpoint模型分析疾病负担时间变化趋势,APC模型估算年龄、时期、队列效应,BAPC模型预测2022—2040年脊髓损伤标化发病率。

结果

相比1990年,我国脊髓损伤的YLD率、标化YLD率在2021年出现下降,其余指标均增加;疾病负担随年龄增加而升高,男性高于女性 ;跌倒是疾病负担形成的主要原因 ;1990—2021年标化发病率、标化患病率、标化YLD率的平均年度变化百分比为0.007%,0.156%,-0.344%;APC模型显示发病率随年龄增大而升高,随时期增加呈波动上升,随出生队列递增呈波动下降;预测模型显示,2022—2040年脊髓损伤的标化发病率呈下降趋势。

结论

1990—2021年中国脊髓损伤疾病负担呈上升趋势,存在性别、年龄差异,跌倒是主要原因,中老年、男性是重点负担人群,应采取有效措施进行干预。

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舒钧与陈翰博为共同通信作者。舒钧,E-mail:
陈翰博,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=Wd9QvelcHV48OZK/HGwg9w==, magXml=wFRMijg9JOFCPWPCCvoWSA==, pdfUrl=null, pdf=fOkAg11oy20AkFVSA+yZug==, pdfFileSize=1896784, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=AonxOwRcmiy9NRV33upGOw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=c7ZRx9N3PZBWiYOyrLew8w==, mapNumber=null, authorCompany=null, fund=null, authors=

杨雪能(1997—),男,硕士,住院医师,研究方向:脊柱脊髓疾病

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杨雪能(1997—),男,硕士,住院医师,研究方向:脊柱脊髓疾病

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杨雪能(1997—),男,硕士,住院医师,研究方向:脊柱脊髓疾病

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BMJ Open, 2023, 13(10): e075049., articleTitle=Global, regional and National burden of traumatic brain injury and spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019, refAbstract=null)], funds=[Fund(id=1240413546983519108, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, awardId=YNWR-MY-2020-059, language=CN, fundingSource=云南省“高层次人才培养支持计划”(YNWR-MY-2020-059), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240413537399534003, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, xref=null, ext=[AuthorCompanyExt(id=1240413537407922612, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, companyId=1240413537399534003, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Kunming Medical University Second Affiliated Hospital, Kunming, Yunnan 650101, China), AuthorCompanyExt(id=1240413537416311222, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, companyId=1240413537399534003, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=昆明医科大学第二附属医院)])], figs=[ArticleFig(id=1240413545708450612, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, language=EN, label=Fig.1, caption=Spinal Cord Burden by Age and Gender, and Major Causes in China, 2021, figureFileSmall=p8GfS033g2IOSHYruDqlzQ==, figureFileBig=NHgwimwgOtafSySigk5ulA==, tableContent=null), ArticleFig(id=1240413545817502524, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, language=CN, label=图1, caption=2021年中国脊髓损伤疾病负担年龄、性别差异及主要原因分析

注:A为脊髓损伤疾病负担的年龄、性别差异;B为脊髓损伤的原因占比。

, figureFileSmall=p8GfS033g2IOSHYruDqlzQ==, figureFileBig=NHgwimwgOtafSySigk5ulA==, tableContent=null), ArticleFig(id=1240413545960108868, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, language=EN, label=Fig.2, caption=Analysis of Gender and Age Differences in Spinal Cord Disease Burden in China, 1990—2021, figureFileSmall=lYRsBuEJrdFAi3qBZa5p3Q==, figureFileBig=aLmOqwDSFX2htXr9TJLkHg==, tableContent=null), ArticleFig(id=1240413546048189261, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, language=CN, label=图2, caption=1990—2021年中国脊髓损伤疾病负担性别、年龄差异分析

注:A为1990—2021年脊髓损伤疾病负担的性别趋势;B为1990—2021年脊髓损伤疾病负担年龄趋势。

, figureFileSmall=lYRsBuEJrdFAi3qBZa5p3Q==, figureFileBig=aLmOqwDSFX2htXr9TJLkHg==, tableContent=null), ArticleFig(id=1240413546157241171, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, language=EN, label=Fig.3, caption=Temporal Trend of Spinal Cord Disease Burden in China, 1990—2021, figureFileSmall=1PaJjM+wLgJKCGjMG8q7lg==, figureFileBig=P7u8q7Q8NGQS+Y4ALMoyIw==, tableContent=null), ArticleFig(id=1240413546274681690, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, language=CN, label=图3, caption=1990—2021年中国脊髓损伤疾病负担时间变化趋势, figureFileSmall=1PaJjM+wLgJKCGjMG8q7lg==, figureFileBig=P7u8q7Q8NGQS+Y4ALMoyIw==, tableContent=null), ArticleFig(id=1240413546392122207, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, language=EN, label=Fig.4, caption=Age-Period-Cohort Analysis of the Incidence of Spinal Cord in China from 1990 to 2021 and Prediction of Standardized Incidence Rate of Spinal Cord, figureFileSmall=mt7ju7p/nQv5tFGCvEi1UQ==, figureFileBig=dz9Dz2/fpCblMpPL/l1CfA==, tableContent=null), ArticleFig(id=1240413546513757029, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, language=CN, label=图4, caption=1990—2021年中国脊髓损伤发病率的年龄-时期-队列分析及标化发病率的预测

注:A为脊髓损伤发病率的年龄、时期、队列效应;B为2022—2040年年脊髓损伤标化发病率的预测。

, figureFileSmall=mt7ju7p/nQv5tFGCvEi1UQ==, figureFileBig=dz9Dz2/fpCblMpPL/l1CfA==, tableContent=null), ArticleFig(id=1240413546660557676, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, language=EN, label=Table 1, caption=

Analysis of Spinal Cord Disease Burden in China in 1990 and 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
总体(95% UI)女性(95% UI)
1990年2021年1990年2021年
YLDs
数(万人)59.4(41.8~76.0)75.2(53.3~98.4)21.6(15.2~27.3)26.9(18.8~35.4)
率(1/10万)50.5(35.5~64.6)52.8(37.5~69.1)38.0(26.8~47.9)38.8(27.0~51.0)
标化率(1/10万)52.1(36.9~66.4)41.6(29.3~54.4)39.5(28.1~49.9)30.0(20.9~39.8)
发病
数(万人)6.9(5.5~8.8)9.9(7.2~13.7)2.4(1.8~3.3)3.7(2.5~5.4)
率(1/10万)5.9(4.7~7.5)7.0(5.1~9.6)4.3(3.2~5.8)5.3(3.6~7.8)
标化率(1/10万)6.1(4.8~7.8)6.2(4.7~8.4)4.5(3.4~6.2)4.4(3.1~6.4)
患病
数(万人)169.4(157.4~184.4)276.7(255.8~300.8)63.5(58.7~69.0)103.0(93.4~113.5)
率(1/10万)144.0(133.8~156.7)194.4(179.8~211.4)111.4(103.0~121.1)148.2(134.5~163.5)
标化率(1/10万)149.8(139.7~162.1)151.7(140.4~165.0)116.9(108.3~126.4)113.3(102.9~125.7)
男性(95% UI)
1990年2021年
YLDs
数(万人)37.8(26.6~48.8)48.3(34.2~63.5)
率(1/10万)62.3(43.9~80.4)66.3(47.0~87.2)
标化率(1/10万)63.7(45.1~81.9)52.7(37.2~69.5)
发病
数(万人)4.5(3.6~5.7)6.3(4.8~8.3)
率(1/10万)7.4(5.9~9.4)8.6(6.5~11.4)
标化率(1/10万)7.5(6.0~9.5)7.9(6.0~10.3)
患病
数(万人)105.9(98.2~115.3)173.7(160.6~187.9)
率(1/10万)174.6(161.9~190.1)238.5(220.6~258.0)
标化率(1/10万)180.1(167.2~195.3)188.3(173.9~205.0)
), ArticleFig(id=1240413546769609589, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240395018163245763, language=CN, label=表1, caption=

1990,2021年中国脊髓损伤疾病负担分析

, figureFileSmall=null, figureFileBig=null, tableContent=
总体(95% UI)女性(95% UI)
1990年2021年1990年2021年
YLDs
数(万人)59.4(41.8~76.0)75.2(53.3~98.4)21.6(15.2~27.3)26.9(18.8~35.4)
率(1/10万)50.5(35.5~64.6)52.8(37.5~69.1)38.0(26.8~47.9)38.8(27.0~51.0)
标化率(1/10万)52.1(36.9~66.4)41.6(29.3~54.4)39.5(28.1~49.9)30.0(20.9~39.8)
发病
数(万人)6.9(5.5~8.8)9.9(7.2~13.7)2.4(1.8~3.3)3.7(2.5~5.4)
率(1/10万)5.9(4.7~7.5)7.0(5.1~9.6)4.3(3.2~5.8)5.3(3.6~7.8)
标化率(1/10万)6.1(4.8~7.8)6.2(4.7~8.4)4.5(3.4~6.2)4.4(3.1~6.4)
患病
数(万人)169.4(157.4~184.4)276.7(255.8~300.8)63.5(58.7~69.0)103.0(93.4~113.5)
率(1/10万)144.0(133.8~156.7)194.4(179.8~211.4)111.4(103.0~121.1)148.2(134.5~163.5)
标化率(1/10万)149.8(139.7~162.1)151.7(140.4~165.0)116.9(108.3~126.4)113.3(102.9~125.7)
男性(95% UI)
1990年2021年
YLDs
数(万人)37.8(26.6~48.8)48.3(34.2~63.5)
率(1/10万)62.3(43.9~80.4)66.3(47.0~87.2)
标化率(1/10万)63.7(45.1~81.9)52.7(37.2~69.5)
发病
数(万人)4.5(3.6~5.7)6.3(4.8~8.3)
率(1/10万)7.4(5.9~9.4)8.6(6.5~11.4)
标化率(1/10万)7.5(6.0~9.5)7.9(6.0~10.3)
患病
数(万人)105.9(98.2~115.3)173.7(160.6~187.9)
率(1/10万)174.6(161.9~190.1)238.5(220.6~258.0)
标化率(1/10万)180.1(167.2~195.3)188.3(173.9~205.0)
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1990—2021年中国脊髓损伤疾病负担变化趋势与预测
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杨雪能 , 李锐娟 , 李波 , 罗文东 , 杨振东 , 袁勇 , 董明林 , 郭立民 , 舒钧 , 陈翰博
现代预防医学 | 临床与预防 2025,52(14): 2682-2688
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现代预防医学 | 临床与预防 2025, 52(14): 2682-2688
1990—2021年中国脊髓损伤疾病负担变化趋势与预测
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杨雪能, 李锐娟, 李波, 罗文东, 杨振东, 袁勇, 董明林, 郭立民, 舒钧 , 陈翰博
作者信息
  • 昆明医科大学第二附属医院
  • 杨雪能(1997—),男,硕士,住院医师,研究方向:脊柱脊髓疾病

通讯作者:

舒钧与陈翰博为共同通信作者。舒钧,E-mail:
陈翰博,E-mail:
Trends and predictions of the burden of spinal injuries in China, 1990-2021
Xue-neng YANG, Rui-juan LI, Bo LI, Wen-dong LUO, Zhen-dong YANG, Yong YUAN, Ming-lin DONG, Li-min GUO, Jun SHU , Han-bo CHEN
Affiliations
  • Kunming Medical University Second Affiliated Hospital, Kunming, Yunnan 650101, China
出版时间: 2025-07-25 doi: 10.20043/j.cnki.MPM.202408116
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目的

分析1990—2021年中国脊髓损伤疾病负担及其变化趋势,为脊髓损伤的预防工作提供理论依据。

方法

利用GBD 2021数据库,提取发病、患病、伤残寿命损失年(YLD)等指标描述中国脊髓损伤疾病负担变化,R语言进行数据可视化,Joinpoint模型分析疾病负担时间变化趋势,APC模型估算年龄、时期、队列效应,BAPC模型预测2022—2040年脊髓损伤标化发病率。

结果

相比1990年,我国脊髓损伤的YLD率、标化YLD率在2021年出现下降,其余指标均增加;疾病负担随年龄增加而升高,男性高于女性 ;跌倒是疾病负担形成的主要原因 ;1990—2021年标化发病率、标化患病率、标化YLD率的平均年度变化百分比为0.007%,0.156%,-0.344%;APC模型显示发病率随年龄增大而升高,随时期增加呈波动上升,随出生队列递增呈波动下降;预测模型显示,2022—2040年脊髓损伤的标化发病率呈下降趋势。

结论

1990—2021年中国脊髓损伤疾病负担呈上升趋势,存在性别、年龄差异,跌倒是主要原因,中老年、男性是重点负担人群,应采取有效措施进行干预。

脊髓损伤  /  疾病负担  /  变化趋势  /  预测  /  中国
Objective

To analyze the burden of spinal injuries and its changing trends in China from 1990 to 2021, providing a theoretical basis for the prevention of spinal injuries.

Methods

Using the GBD 2021 database, indicators such as incidence, prevalence, and Years Lived with Disability (YLD) were extracted to describe the changes in the burden of spinal injuries in China. Data visualization was performed using the R language, the Joinpoint model was used to analyze the temporal trends of disease burden, the APC model was used to estimate age, period, and cohort effects, and the BAPC model was used to predict the standardized incidence rate of spinal injuries from 2022 to 2040.

Results

Compared to 1990, the YLD rate and standardized YLD rate of spinal injuries in China showed a decline in 2021, while other indicators increased; the disease burden increased with age, with males having a higher burden than females; falls were the main cause of the disease burden; the average annual percentage change in standardized incidence rate, standardized prevalence rate, and standardized YLD rate from 1990 to 2021 was 0.007%, 0.156%, and -0.344%, respectively; the age-period-cohort model showed that the incidence rate increased with age, fluctuated upwards with time, and fluctuated downwards with the birth cohort; the prediction model indicated that the standardized incidence rate of spinal injuries will show a declining trend from 2022 to 2040.

Conclusion

The burden of spinal injuries in China from 1990 to 2021 showed an upward trend, with gender and age differences, falls being the main cause, and the elderly and males being the key burden groups; effective measures should be taken for intervention.

Spinal injuries  /  Disease burden  /  Trend  /  Prediction  /  China
杨雪能, 李锐娟, 李波, 罗文东, 杨振东, 袁勇, 董明林, 郭立民, 舒钧, 陈翰博. 1990—2021年中国脊髓损伤疾病负担变化趋势与预测. 现代预防医学, 2025 , 52 (14) : 2682 -2688 . DOI: 10.20043/j.cnki.MPM.202408116
Xue-neng YANG, Rui-juan LI, Bo LI, Wen-dong LUO, Zhen-dong YANG, Yong YUAN, Ming-lin DONG, Li-min GUO, Jun SHU, Han-bo CHEN. Trends and predictions of the burden of spinal injuries in China, 1990-2021[J]. Modern Preventive Medicine, 2025 , 52 (14) : 2682 -2688 . DOI: 10.20043/j.cnki.MPM.202408116
脊髓损伤是严重影响中枢神经系统的损害,致损伤平面以下完全或不完全感觉和或运动功能丧失,并发相关疾病而过早死亡[1-2],幸存者则面临生活质量严重下降[3],每年造成超过450万伤残寿命损失年,WHO数据显示,全球约有1 500万脊髓损伤患者,中国约374万例,且每年新增9万例,持续增加的患者表明脊髓损伤已成为我国重要的医疗挑战,且脊髓损伤与入学率和经济参与率下降相关,带来严重的社会、经济和个人负担[4]。大多数脊髓损伤患者由创伤(如跌倒、交通事故等)引起,这意味着脊髓损伤是可以预防的[5]。鉴于我国庞大的人口及老龄化趋势,脊髓损伤疾病负担可能会增加,故进行流行病学研究是十分必要的。
本研究采用多种分析方法,以更科学地揭示1990至2021年中国脊髓损伤疾病负担的动态变化。数据来源于全球疾病负担(Global Burden of Disease Study 2021,GBD 2021)数据库[6],综合运用Joinpoint回归模型识别疾病负担变化的关键时间节点,并通过平均年度变化百分比(average annual percent change, AAPC)量化趋势,揭示负担变化轨迹[7]。年龄-时期-队列(Age-Period-Cohort , APC)模型则通过解析年龄、时期与出生队列效应,分析不同年龄层与出生年代人群在特定时间段内的负担差异[8]。此外,本研究应用贝叶斯年龄-时期-队列(Bayesian age-period-cohort, BAPC)模型开展未来趋势预测,综合历史趋势与年龄、时期、队列等因素,为2022至2040年脊髓损伤负担变化提供科学预测[6]
本研究近三十年的时间跨度分析,提供了脊髓损伤现状、主要原因及防控形势的关键数据,为制定公共卫生政策和资源配置方案提供科学依据。通过结合实际数据和预测模型,我们能够为未来干预措施提供有效的策略建议,旨在减轻脊髓损伤带来的社会、经济及个人负担,并推动相关公共卫生政策的改进和优化。
数据来自GBD 2021,该数据库全面分析全球204个国家和地区及811个次级国家地区的371种疾病和伤害及87种危险因素的疾病负担。本研究以“Spinal Injuries”为研究疾病,“All causes”为损伤原因,“YLD”“Incidence”“Prevalence”为指标,提取1990—2021年分年龄段、性别的数据并进行分析。
选取发病人数、发病率、患病人数、患病率、伤残寿命损失年(Years Lived with Disability, YLD)及其标化率评估中国脊髓损伤的疾病负担情况,采用各损伤原因的发病、患病人数及YLD人年数百分比评估主要损伤原因。
应用R 4.3.1进行数据可视化;应用Joinpoint 5.0.2软件计算各指标的年度变化百分比(annual percent change, APC)及AAPC,分析疾病负担时间变化趋势;应用APC模型探讨中国脊髓损伤发病率的年龄、时期、队列效应,鉴于80岁以上人口占比较少,故将80岁及以上人口合并为一组,每5年一个年龄组,共纳入17个年龄组;最后应用BAPC模型预测2022—2040年中国脊髓损伤的标化发病率,所有分析中,p值<0.05被视为具有统计学显著性。
2021年,中国脊髓损伤发病数99.36万例,发病率7.0/10万,标化发病率6.2/10万,男性显著高于女性;患病总数276.63万例,患病率194.4/10万,标化患病率151.7/10万,男性较高;YLD为575.18万人年,YLD率52.8/10万,标化率41.6/10万,男性伤残寿命损失年亦高于女性。从年龄分布看,发病数、患病数、YLD数峰值分别出现在≥80岁(0.99万例)、70~74岁(34.56万例)、50~54岁(9.53万人年)。发病率随年龄升高,≥80岁为最高;患病率在70~74岁前上升,后下降;YLD率随年龄增长,在65~69岁达峰,见图1
2021年,中国全体、男性及女性居民脊髓损伤的前三大病因依次为跌倒、机动车辆道路伤害和行人道路伤害。全体居民各年龄段发病主因均为跌倒;<5岁组中,YLD和患病数占比最高为火器暴力,余年龄段以跌倒为主因。见图1
1990—2021年,中国脊髓损伤发病数、发病率及标化发病率分别上升43.3%、18.6%、1.6%;患病数、患病率及标化患病率上升63.3%、34.9%、1.3%;YLD、YLD率分别上升26.5%、4.6%;但标化YLD率下降25.2%,见表1。各项疾病负担指标除标化YLD率外均波动上升,且男性指标始终高于女性。
1990—2021年,60岁以下居民标化YLD率整体下降,随年龄增长降幅趋缓;60岁以上呈上升趋势,且随年龄增大而升高,60~74岁组最高。各年龄段标化发病率于2008年显著上升,45岁以上随年龄递增,50~74岁组始终居首,除5岁以下外,各年龄段标化患病率均上升,50~64岁组保持最高,见图2
1990—2021年,中国脊髓损伤总体、男性、女性标化YLD率AAPC分别为-0.344%、-0.346%、-0.298%;标化发病率AAPC分别为0.007%、0.017%、-0.001%;标化患病率AAPC分别为0.156%、0.305%、-0.066%。见图3
1990—2021年,中国脊髓损伤发病率净漂移为0.017%,随年龄增长上升,80岁以上组最高。年龄效应显示,0~14岁略降,15岁后随龄增高,80岁以上达峰。时期效应中,以2007年为基准(相对危险度(relative risk, RR),RR=1.000),1990—2007年下降,2007—2012年持平,2012—2021年上升,2021年达最高(RR=1.209)。队列效应上,以1965年为参考(RR=1.00),1910—1960年出生人群风险上升,1960年达峰(RR=1.000),此后逐步下降,见图4A
预测显示,2022—2040年中国脊髓损伤标化发病率将下降,全人群由2019年的5.43/10万降至2040年的4.48/10万,女性由1.88/10万降至1.53/10万,男性由3.73/10万降至2.95/10万。见图4B
本研究显示,2021年中国脊髓损伤发病人数达9.9万例,患病人数达276.6万例,YLD人年数为575.2万人年,疾病负担较重。
1990年至2021年中国脊髓损伤YLD率及标化YLD率下降,但发病及患病相关指标增高,疾病负担仍呈上升趋势。这与经济、医疗及人口结构变化相关,经济发展改变了生活方式,更多人尝试极限运动,交通事故频发,导致脊髓损伤发病增加[9-10];医疗技术进步提高了确诊率,增加疾病的患病人数;疾病管理和康复服务匮乏及脊髓损伤复杂的病理变化导致过早死亡和YLD增加[11-12];同时,老年人比例上升也是发病及患病相关指标升高的一个重要原因。
跌倒是脊髓损伤疾病负担形成的首要因素,国内外多项研究一致支持这一结论[13-14]。原因包括公共环境安全隐患;老年人口增多,身体机能衰退,使他们更易跌倒[15];医疗资源分配不均衡,导致中老年人健康管理未受到应有的关注[16];以及现代科技产品使用导致的颈椎力学变化等。性别差异也是脊髓损伤疾病负担的特征之一。男性的疾病负担明显高于女性,这种与男性从事高危工作比例较高相关[17]。跌倒及交通事故为主要原因,而男性作为主要汽车驾驶群体,受伤风险显著高于女性[18];此外,生理结构差异和雌激素相关的神经修复功能也可能是性别差异的关键因素[19-20]。这一趋势具有全球普遍性[21],表明无论地理或社会文化背景,性别差异和跌倒作为风险因素均广泛存在。
脊髓损伤的疾病负担与年龄密切相关。研究表明脊髓损伤的发病率、发病人数、患病率、患病人数、YLD数、YLD率随年龄升高而增加,在50~74岁达到高峰。随着年龄增大,血管健康恶化、免疫功能下降,增加脊髓损伤修复难度,同时慢性疾病和退行性疾病的增加,影响中老年人活动,且其平衡能力、感觉和反应力减退,增加跌倒风险[22];骨量丢失导致椎体脆弱,跌倒后易压迫脊髓[23];居住环境中的安全隐患,如湿滑地面和照明不足,也增加了跌倒风险[24]
Joinpoint回归分析显示,2012年后标化YLD率、标化发病率、标化患病率呈现上升趋势,但标化YLD率的AAPC值呈负值,表明脊髓损伤发病、患病人数增加,但伤残寿命损失年数下降,我国对脊髓损伤临床治疗及康复管理取得成效,男女发病、患病的AAPC值差异显著,女性呈负值、男性呈正值,提示女性的预防措施效果较好,男性仍需加强干预。调整偏差后,14岁以上的发病率变化不明显,14岁后逐渐上升,可能与青少年参与高风险活动相关,时期效应显示2012年后发病风险增加,可能与金融危机后交通运输等行业复苏有关[25],队列效应显示自1960年代起,脊髓损伤的发病风险呈下降趋势,可能与医疗条件的改善与疾病控制相关[26]
本研究基于BAPC模型分析脊髓损伤疾病负担[27-28]。模型显示,2022—2040年中国全体居民、男性和女性脊髓损伤的标准化发病率呈缓慢下降趋势,这与交通安全管理政策、创伤应急救助体系的完善以及居民预防意识的提高有关,但受人口数量及构成影响,发病人数仍会出现持续上升,相关疾病负担将加重。因此,我国脊髓损伤的疾病负担依然严峻,需在保持现有成效的基础上,继续加强预防措施,推动交通安全政策实施,以减轻脊髓损伤带来的社会和经济负担。
综上所述,1990—2019年中国脊髓损伤疾病负担呈上升趋势,造成严重的伤残寿命损失,且存在年龄和性别差异,50岁以上人群和男性居民的负担较重。尽管预测显示2022年后脊髓损伤标准化发病率下降,但人口基数增加,发病人数仍将上升。因此,需要加强全居民干预,改善道路基础设施,规范交通行为,减少交通事故,完善酒精和枪支管理政策,减少暴力事件发生,为高危人群提供适当的医疗资源,推动康复服务和设备发展,改善患者生活质量,减轻疾病负担。
本研究存在一定局限性。首先,GBD 2021数据库未提供中国各省的详细数据,未能分析不同地区脊髓损伤的负担差异及变化趋势。此外,数据库指标限制了脊髓损伤死亡率的统计,影响了对疾病负担的全面评估。未来应在中国开展更广泛的流行病学研究,调查各省的疾病负担现状及成因,并补充死亡率等关键数据,为脊髓损伤防治提供精准的数据支持,更科学应对公共卫生挑战。
  • 云南省“高层次人才培养支持计划”(YNWR-MY-2020-059)
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2025年第52卷第14期
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doi: 10.20043/j.cnki.MPM.202408116
  • 接收时间:2024-08-08
  • 首发时间:2026-03-16
  • 出版时间:2025-07-25
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  • 收稿日期:2024-08-08
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云南省“高层次人才培养支持计划”(YNWR-MY-2020-059)
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    昆明医科大学第二附属医院

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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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