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Article(id=1240633242907366346, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202401100, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1704556800000, receivedDateStr=2024-01-07, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773719614959, onlineDateStr=2026-03-17, pubDate=1716566400000, pubDateStr=2024-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773719614959, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773719614959, creator=13701087609, updateTime=1773719614959, updator=13701087609, issue=Issue{id=1240633237542851387, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='10', pageStart='1729', pageEnd='1920', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773719613680, creator=13701087609, updateTime=1773720039302, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240635022806405370, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240635022806405371, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240633237542851387, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1754, endPage=1759, ext={EN=ArticleExt(id=1240633243150635998, articleId=1240633242907366346, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Age-period cohort analyses of the burden of Alzheimer’s disease in the elderly population in China, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the epidemiological trends of Alzheimer’s disease in the elderly population in China from 1990 to 2019, and to provide a scientific basis for the specific formulation of prevention and treatment measures.

Methods

Based on data obtained from the Global Burden of Disease (GBD) 2019 database, we analyzed quantitative changes in the number of incidences and disability-adjusted life years (DALYs) of Alzheimer’s disease among people aged 60 to 89 years in China from 1990 to 2019. Trend changes over the period were assessed by calculating the annual percentage change (AAPC) and linkage regression analysis, age-period-cohort models were constructed by Stata17 to analyze trends in DALY incidence and rates along three dimensions: age, period, and cohort.

Results

The number of DALY and Alzheimer’s disease incidence cases in the Chinese elderly population in 2019 was 1 526 516 and 5 034 024 person-years, respectively, with 5 829 523 and 1 956 623 person-years of DALY and Alzheimer’s disease incidence in elderly men, and 943 563 and 3 077 401 person-years of DALY and Alzheimer’s disease incidence in elderly women, respectively. The Chinese elderly population in 2019 Incidence and DALY rates were 600.49 per 100 000 and 1 980.23 per 100 000, respectively, increasing at an average rate of 1.12% and 0.81% per year, with a more pronounced increase in elderly men than in elderly women.

Conclusion

China’s elderly population faces a heavy burden of disease from Alzheimer’s disease, and the government should take immediate action to alleviate the heavy morbidity and financial burden on patients.

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目的

分析中国老年人群1990—2019年阿尔茨海默病疾病负担及年龄-时期-队列效应，为卫生行政部门制定防治措施提供科学依据。

方法

基于2019年全球疾病负担(GBD)数据，分析1990—2019年中国60~89岁老年人群阿尔茨海默病的发病率、残疾调整生命年(DALY)，并计算平均年度变化百分比 (AAPC)和连接点回归分析预测其趋势变化，通过Stata 17.0软件构建年龄-时期-队列模型，分析发病率和DALY率在年龄、时期以及队列三个维度的变化趋势。

结果

2019年中国老年人群阿尔茨海默病发病例数和DALY分别为1 526 516和5 034 024人年，其中男性发病人数和DALY分别为5 829 523和1 956 623人年，女性发病人数和DALY分别为943 563和3 077 401人年。2019年中国老年人群的发病率和DALY率分别为600.49/10万和1 980.23/10万，平均每年以1.12%和0.81%速率增长，老年人群男性较老年人群女性增长的幅度更为明显。对于年龄越高的老人，其发病风险和DALY风险越高；出生越早的人群，其发病率和DALY风险越高，随后风险效应系数逐渐下降。

结论

中国老年人群阿尔茨海默病的疾病负担仍然较大，卫生行政部门应采取相关措施以减轻患者的疾病负担。

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魏洪娟，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=fUY1jAOb9ggVTnfLmzr9yQ==, magXml=sCS0R2vt7K+wzEj+Mzk4AQ==, pdfUrl=null, pdf=D7OMtNu4ts/5BtyyIJLlPQ==, pdfFileSize=723278, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=kHvvKNtHvwFBuQ0cXANiDA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=7TiiUoIDxrTnoRBpBSqk7g==, mapNumber=null, authorCompany=null, fund=null, authors=

李丽娜（1986—），女，本科，主管护师/讲师，研究方向：老年护理、老年痴呆疾病研究

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李丽娜（1986—），女，本科，主管护师/讲师，研究方向：老年护理、老年痴呆疾病研究

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李丽娜（1986—），女，本科，主管护师/讲师，研究方向：老年护理、老年痴呆疾病研究

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figureFileBig=EFNU8ELJQ3OVp02dH4tp5A==, tableContent=null), ArticleFig(id=1240633252550070774, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633242907366346, language=EN, label=Table 1, caption=

Trends in the incidence rate and DALY rate of Alzheimer’s disease among the elderly in China from 1990 to 2019

, figureFileSmall=null, figureFileBig=null, tableContent=
1990年2019年AAPC（%）
发病率（1/10万）
男性319.45474.611.37
女性537.41718.160.99
合计433.14600.491.12
发病人数（n）
男性153 751582 953
女性282 041943 563
合计435 7921 526 516
DALY率（1/10万）
男性1 190.241 592.971.02
女性1 916.632 342.270.69
合计1 569.151 980.230.81
DALY（人年）
男性572 8601 956 623
女性1 005 8833 077 401
合计1 578 7425 034 024
), ArticleFig(id=1240633252663316990, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633242907366346, language=CN, label=表1, caption=

1990—2019中国老年人群阿尔茨海默病发病率和DALY率趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
1990年2019年AAPC（%）
发病率（1/10万）
男性319.45474.611.37
女性537.41718.160.99
合计433.14600.491.12
发病人数（n）
男性153 751582 953
女性282 041943 563
合计435 7921 526 516
DALY率（1/10万）
男性1 190.241 592.971.02
女性1 916.632 342.270.69
合计1 569.151 980.230.81
DALY（人年）
男性572 8601 956 623
女性1 005 8833 077 401
合计1 578 7425 034 024
), ArticleFig(id=1240633252793340421, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633242907366346, language=EN, label=Table 2, caption=

Epidemiological trend analysis of Alzheimer’s disease in the elderly population in China from 1990 to 2019

, figureFileSmall=null, figureFileBig=null, tableContent=
DALY率
男性女性合计
趋势一年份1990—19971990—19961990—1996
APC0.77a（0.51~1.02）0.62a（0.25~0.99）0.56a（0.23~0.89）
趋势二年份1997—20061996—20071996—2007
APC2.34a（2.13~2.55）1.55a（1.39~1.72）1.75a（1.60~1.90）
趋势三年份2006—20152007—20152007—2015
APC-0.12（-0.32~0.08）-0.55a（-0.82~0.27）-0.43a（-0.67~0.18）
趋势四年份2015—20192015—20192015—2019
APC1.10a（0.51~1.69）0.92a（0.30~1.55）1.07a（0.49~1.66）
整体趋势年份1990—20191990—20191990—2019
AAPC1.02a（0.89~1.15）0.69a（0.55~0.83）0.81a（0.68~0.94）
发病率
男性女性合计
趋势一年份1990—19931990—19931990—1993
APC3.67a（3.40~3.93）3.90a（3.56~4.24）3.52a（3.30~3.75）
趋势二年份1993—20051993—20051993—2005
APC1.16a（1.13~1.20）1.03a（0.98~1.07）1.49a（1.46~1.52）
趋势三年份2005—20112005—20112005—2009
APC0.30a（0.12~0.34）-0.06（-0.19~0.08）0.57a（0.35~0.79）
趋势四年份2011—20192011—20192009—2019
APC0.78a（0.72~0.83）0.63a（0.56~0.70）0.89a（0.86~0.93）
整体趋势年份1990—20191990—20191990—2019
AAPC1.12a（1.08~1.16）0.99a（0.94~1.03）1.37a（1.33~1.41）
), ArticleFig(id=1240633254307484171, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633242907366346, language=CN, label=表2, caption=

1990—2019年中国老年人群阿尔茨海默病流行病学趋势分析

, figureFileSmall=null, figureFileBig=null, tableContent=
DALY率
男性女性合计
趋势一年份1990—19971990—19961990—1996
APC0.77a（0.51~1.02）0.62a（0.25~0.99）0.56a（0.23~0.89）
趋势二年份1997—20061996—20071996—2007
APC2.34a（2.13~2.55）1.55a（1.39~1.72）1.75a（1.60~1.90）
趋势三年份2006—20152007—20152007—2015
APC-0.12（-0.32~0.08）-0.55a（-0.82~0.27）-0.43a（-0.67~0.18）
趋势四年份2015—20192015—20192015—2019
APC1.10a（0.51~1.69）0.92a（0.30~1.55）1.07a（0.49~1.66）
整体趋势年份1990—20191990—20191990—2019
AAPC1.02a（0.89~1.15）0.69a（0.55~0.83）0.81a（0.68~0.94）
发病率
男性女性合计
趋势一年份1990—19931990—19931990—1993
APC3.67a（3.40~3.93）3.90a（3.56~4.24）3.52a（3.30~3.75）
趋势二年份1993—20051993—20051993—2005
APC1.16a（1.13~1.20）1.03a（0.98~1.07）1.49a（1.46~1.52）
趋势三年份2005—20112005—20112005—2009
APC0.30a（0.12~0.34）-0.06（-0.19~0.08）0.57a（0.35~0.79）
趋势四年份2011—20192011—20192009—2019
APC0.78a（0.72~0.83）0.63a（0.56~0.70）0.89a（0.86~0.93）
整体趋势年份1990—20191990—20191990—2019
AAPC1.12a（1.08~1.16）0.99a（0.94~1.03）1.37a（1.33~1.41）
), ArticleFig(id=1240633254387175954, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633242907366346, language=EN, label=Table 3, caption=

Age-period-cohort model analysis of the incidence rate of Alzheimer’s disease in elderly population in China from 1990 to 2019

, figureFileSmall=null, figureFileBig=null, tableContent=
效应系数标准误Z值P值置信区间上限置信区间下限
年龄（岁）
60~<65-805.177.26-110.900.00-819.40-790.94
65~<70-745.666.79-109.810.00-758.97-732.35
70~<75-533.437.00-76.180.00-547.15-519.71
75~<8013.977.051.980.050.1527.79
80~<85693.036.90100.390.00679.50706.56
时期（年）
1991—1995-155.196.52-23.790.00-167.98-142.40
1996—2000-60.886.99-8.700.00-74.58-47.17
2001—2005-21.627.08-3.050.00-35.50-7.75
2006—20109.116.971.310.19-4.5622.77
2011—201561.726.709.220.0048.6074.85
队列（年）
1906—1910279.0914.9818.630.00249.73308.46
1911—1915169.8611.7714.430.00146.79192.93
1916—1920105.0510.559.960.0084.37125.72
1921—192572.839.707.510.0053.8291.83
1926—193040.588.824.600.0023.2857.87
1931—19357.477.660.980.33-7.5422.48
1936—1940-34.448.40-4.100.00-50.92-17.97
1941—1945-72.888.95-8.140.00-90.42-55.34
1946—1950-121.469.60-12.650.00-140.28-102.64
1951—1956-184.1410.88-16.930.00-205.46-162.82
偏差320.00
AIC-609.95
BIC-578.28
), ArticleFig(id=1240633254483644951, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633242907366346, language=CN, label=表3, caption=

1990—2019年中国老年人群阿尔茨海默病发病率年龄-时期-队列模型分析

, figureFileSmall=null, figureFileBig=null, tableContent=
效应系数标准误Z值P值置信区间上限置信区间下限
年龄（岁）
60~<65-805.177.26-110.900.00-819.40-790.94
65~<70-745.666.79-109.810.00-758.97-732.35
70~<75-533.437.00-76.180.00-547.15-519.71
75~<8013.977.051.980.050.1527.79
80~<85693.036.90100.390.00679.50706.56
时期（年）
1991—1995-155.196.52-23.790.00-167.98-142.40
1996—2000-60.886.99-8.700.00-74.58-47.17
2001—2005-21.627.08-3.050.00-35.50-7.75
2006—20109.116.971.310.19-4.5622.77
2011—201561.726.709.220.0048.6074.85
队列（年）
1906—1910279.0914.9818.630.00249.73308.46
1911—1915169.8611.7714.430.00146.79192.93
1916—1920105.0510.559.960.0084.37125.72
1921—192572.839.707.510.0053.8291.83
1926—193040.588.824.600.0023.2857.87
1931—19357.477.660.980.33-7.5422.48
1936—1940-34.448.40-4.100.00-50.92-17.97
1941—1945-72.888.95-8.140.00-90.42-55.34
1946—1950-121.469.60-12.650.00-140.28-102.64
1951—1956-184.1410.88-16.930.00-205.46-162.82
偏差320.00
AIC-609.95
BIC-578.28
), ArticleFig(id=1240633254571725340, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633242907366346, language=EN, label=Table 4, caption=

APC model analysis of the DALY rate of Alzheimer’s disease in elderly population in China from 1990 to 2019

, figureFileSmall=null, figureFileBig=null, tableContent=
效应系数标准误Z值P值置信区间上限置信区间下限
年龄（岁）
60~<65-3 137.6411.49-272.990.00-3 160.17-3 115.11
65~<70-2 981.6010.75-277.360.00-3 002.67-2 960.53
70~<75-2 491.3711.08-224.770.00-2 513.09-2 469.64
75~<80-1 360.9811.16-121.950.00-1 382.85-1 339.10
80~<852 567.4310.93234.930.002 546.012 588.85
时期（年）
1991—1995-531.8210.33-51.490.00-552.07-511.58
1996—2000-368.2111.07-33.260.00-389.91-346.51
2001—2005-109.4311.21-9.760.00-131.40-87.46
2006—2010134.5811.0412.190.00112.94156.21
2011—2015327.8710.6030.930.00307.09348.65
队列（年）
1906—1910721.9923.7130.440.00675.51768.47
1911—1915635.6118.6434.110.00599.08672.13
1916—1920555.1916.7033.250.00522.46587.91
1921—1925418.9715.3527.290.00388.88449.06
1926—1930260.4513.9718.640.00233.07287.83
1931—193582.2412.126.780.0058.48106.00
1936—1940-115.6213.30-8.690.00-141.69-89.54
1941—1945-323.1014.17-22.810.00-350.86-295.33
1946—1950-531.9315.20-34.990.00-561.72-502.13
1951—1956-740.8117.22-43.030.00-774.56-707.06
偏差810.00
AIC-1 588.75
BIC-1 557.08
), ArticleFig(id=1240633254668194341, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240633242907366346, language=CN, label=表4, caption=

1990—2019年中国老年人群阿尔茨海默病DALY率年龄-时期-队列模型分析

, figureFileSmall=null, figureFileBig=null, tableContent=
效应系数标准误Z值P值置信区间上限置信区间下限
年龄（岁）
60~<65-3 137.6411.49-272.990.00-3 160.17-3 115.11
65~<70-2 981.6010.75-277.360.00-3 002.67-2 960.53
70~<75-2 491.3711.08-224.770.00-2 513.09-2 469.64
75~<80-1 360.9811.16-121.950.00-1 382.85-1 339.10
80~<852 567.4310.93234.930.002 546.012 588.85
时期（年）
1991—1995-531.8210.33-51.490.00-552.07-511.58
1996—2000-368.2111.07-33.260.00-389.91-346.51
2001—2005-109.4311.21-9.760.00-131.40-87.46
2006—2010134.5811.0412.190.00112.94156.21
2011—2015327.8710.6030.930.00307.09348.65
队列（年）
1906—1910721.9923.7130.440.00675.51768.47
1911—1915635.6118.6434.110.00599.08672.13
1916—1920555.1916.7033.250.00522.46587.91
1921—1925418.9715.3527.290.00388.88449.06
1926—1930260.4513.9718.640.00233.07287.83
1931—193582.2412.126.780.0058.48106.00
1936—1940-115.6213.30-8.690.00-141.69-89.54
1941—1945-323.1014.17-22.810.00-350.86-295.33
1946—1950-531.9315.20-34.990.00-561.72-502.13
1951—1956-740.8117.22-43.030.00-774.56-707.06
偏差810.00
AIC-1 588.75
BIC-1 557.08
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中国老年人群阿尔茨海默病疾病负担的年龄-时期-队列分析
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李丽娜 1 , 魏洪娟 2 , 杨雪雯 3 , 刘新研 4 , 李强 2 , 韩树国 5 , 赵宇 3
现代预防医学 | 流行病与统计方法 2024,51(10): 1754-1759
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现代预防医学 | 流行病与统计方法 2024, 51(10): 1754-1759
中国老年人群阿尔茨海默病疾病负担的年龄-时期-队列分析
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李丽娜1, 魏洪娟2 , 杨雪雯3, 刘新研4, 李强2, 韩树国5, 赵宇3
作者信息
  • 1.哈尔滨技师学院（哈尔滨劳动技师学院），黑龙江 哈尔滨 150025
  • 2.齐齐哈尔医学院护理学院
  • 3.齐齐哈尔医学院附属第三医院
  • 4.哈尔滨医科大学公共卫生学院
  • 5.齐齐哈尔市卫生健康综合监督执法局

    • 李丽娜（1986—），女，本科，主管护师/讲师，研究方向：老年护理、老年痴呆疾病研究

通讯作者:

魏洪娟，E-mail:
Age-period cohort analyses of the burden of Alzheimer’s disease in the elderly population in China
Li-na LI1, Hong-juan WEI2 , Xue-wen YANG3, Xin-yan LIU4, Qiang LI2, Shu-guo HAN5, Yu ZHAO3
Affiliations
  • Harbin Technician College (Harbin Labor Technician College), Harbin, Heilongjiang 150025, China
出版时间: 2024-05-25 doi: 10.20043/j.cnki.MPM.202401100
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摘要
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目的

分析中国老年人群1990—2019年阿尔茨海默病疾病负担及年龄-时期-队列效应，为卫生行政部门制定防治措施提供科学依据。

方法

基于2019年全球疾病负担(GBD)数据，分析1990—2019年中国60~89岁老年人群阿尔茨海默病的发病率、残疾调整生命年(DALY)，并计算平均年度变化百分比 (AAPC)和连接点回归分析预测其趋势变化，通过Stata 17.0软件构建年龄-时期-队列模型，分析发病率和DALY率在年龄、时期以及队列三个维度的变化趋势。

结果

2019年中国老年人群阿尔茨海默病发病例数和DALY分别为1 526 516和5 034 024人年，其中男性发病人数和DALY分别为5 829 523和1 956 623人年，女性发病人数和DALY分别为943 563和3 077 401人年。2019年中国老年人群的发病率和DALY率分别为600.49/10万和1 980.23/10万，平均每年以1.12%和0.81%速率增长，老年人群男性较老年人群女性增长的幅度更为明显。对于年龄越高的老人，其发病风险和DALY风险越高；出生越早的人群，其发病率和DALY风险越高，随后风险效应系数逐渐下降。

结论

中国老年人群阿尔茨海默病的疾病负担仍然较大，卫生行政部门应采取相关措施以减轻患者的疾病负担。

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

To analyze the epidemiological trends of Alzheimer’s disease in the elderly population in China from 1990 to 2019, and to provide a scientific basis for the specific formulation of prevention and treatment measures.

Methods

Based on data obtained from the Global Burden of Disease (GBD) 2019 database, we analyzed quantitative changes in the number of incidences and disability-adjusted life years (DALYs) of Alzheimer’s disease among people aged 60 to 89 years in China from 1990 to 2019. Trend changes over the period were assessed by calculating the annual percentage change (AAPC) and linkage regression analysis, age-period-cohort models were constructed by Stata17 to analyze trends in DALY incidence and rates along three dimensions: age, period, and cohort.

Results

The number of DALY and Alzheimer’s disease incidence cases in the Chinese elderly population in 2019 was 1 526 516 and 5 034 024 person-years, respectively, with 5 829 523 and 1 956 623 person-years of DALY and Alzheimer’s disease incidence in elderly men, and 943 563 and 3 077 401 person-years of DALY and Alzheimer’s disease incidence in elderly women, respectively. The Chinese elderly population in 2019 Incidence and DALY rates were 600.49 per 100 000 and 1 980.23 per 100 000, respectively, increasing at an average rate of 1.12% and 0.81% per year, with a more pronounced increase in elderly men than in elderly women.

Conclusion

China’s elderly population faces a heavy burden of disease from Alzheimer’s disease, and the government should take immediate action to alleviate the heavy morbidity and financial burden on patients.

Alzheimer’s disease  /  Incidence  /  Disease burden  /  Age-period-cohort model
李丽娜, 魏洪娟, 杨雪雯, 刘新研, 李强, 韩树国, 赵宇. 中国老年人群阿尔茨海默病疾病负担的年龄-时期-队列分析. 现代预防医学, 2024 , 51 (10) : 1754 -1759 . DOI: 10.20043/j.cnki.MPM.202401100
Li-na LI, Hong-juan WEI, Xue-wen YANG, Xin-yan LIU, Qiang LI, Shu-guo HAN, Yu ZHAO. Age-period cohort analyses of the burden of Alzheimer’s disease in the elderly population in China[J]. Modern Preventive Medicine, 2024 , 51 (10) : 1754 -1759 . DOI: 10.20043/j.cnki.MPM.202401100
正文
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阿尔茨海默病是痴呆症最常见的原因[1]，主要发生在老年群体，发病率和患病率随着年龄的增长而增加[2]。中国已经进入老龄化社会，65岁以上人口有2.60亿，占全国总人口的18.70%[3]。因此，阿尔茨海默病的疾病负担在中国迅速增加，目前有将近600万人患有阿尔茨海默病[4]，已经成为一个日益严重的公共卫生问题，给社会和家庭带来了严重的经济和疾病负担。本研究基于全球疾病负担数据库2019（Global Burden of Diseases 2019，GBD 2019）的数据分析1990—2019年老年人群阿尔茨海默病的疾病负担，旨在为预防阿尔茨海默病的措施制定提供科学依据。
1　材料与方法
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1.1　数据来源
阿尔茨海默病相关数据来自GBD 2019，该数据库提供了1990—2019年全球、区域和国家多种疾病的年龄和性别特定全因和特定原因发病率、死亡率等其他指标的内部一致估计[5]。本研究提取了1990—2019年中国60至89岁老年人群阿尔茨海默病的相关数据，变量包括年份、年龄、性别和原因。以发病率、发病人数、伤残调整寿命年（DALY）、DALY率作为主要分析指标。
1.2　数据分析
1.2.1　联结点回归模型
中国老年人群阿尔茨海默病的发病率和DALY率的连续变化用联结点回归模型描述，主要通过将年度变化百分比(Annual percent change, APC)和平均年度变化百分比(Average annual percent change,AAPC)与0进行比较来评价不同区段发病率的变化趋势是否具有统计学意义，P<0.05为差异具有统计学意义[6]。采用美国国家癌症研究所开发的Joinpoint 4.9.0.1版软件进行回归分析。
1.2.2　年龄-时期-队列模型
用年龄-时期-队列模型分析1990—2019年中国老年人群阿尔茨海默病在年龄、时期和队列三个维度的发病率和DALY率的变化。年龄-时期-队列模型的表达式如下:
其中，i、j和k是年龄、时期和队列的指数，它们相互关联，使得j=i+k-1，αi表示第i个年龄组的系数; βj表示第j个时期组的系数; γk第k个队列组的系数;本研究假设一个年龄段内阿尔茨海默病导致的发病人数在一段时间内服从泊松分布，使用对数转换后的人口变量的偏移量来解释每个年龄组的人口增长[7]，在进行统计分析时，发病率、DALY率和人口数据分组均以5年为间隔，统计在1990—2019时间区段采用连续 5 年时间间隔（共分为6个组），以及连续5年的年龄间隔（从60至89 岁，共分为5个组），根据老年人口的定义选择60~89岁人群进行研究。模型拟合优度指标为赤池信息准则即(akaike information criterion, AIC)和贝叶斯信息准则(bayesian information criterion,BIC)，AIC与BIC的值越小代表模型拟合度越优。选择内生因子算法对1990—2019年中国老年人群阿尔茨海默病的发病和疾病负担的趋势变化进行年龄、时期以及队列因素的定量分析。利用Stata17.0软件完成年龄-时期-队列模型构建，分析年龄、时期与队列因素对中国老年人群阿尔茨海默病的影响。
2　结果
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2.1　1990—2019中国老年人群阿尔茨海默病发病率和DALY率趋势
2019年，中国老年人群阿尔茨海默病发病达1 526 516例，其中女性发病例数为943 563，男性发病例数为582 953。2019年中国老年人群DALY达5 034 024人年，其中男性DALY为1 956 623人年，女性DALY为3 077 401人年。与1990年相比，2019年中国老年人群阿尔茨海默病的发病率和DALY率均呈逐渐上升的趋势，平均每年分别以1.12%和0.81%速率上升。男性发病率和DALY率的上升趋势较女性明显，平均每年分别增长1.37%和1.02%，见图1、表1。
2.2　1990—2019年中国老年人群阿尔茨海默病年度变化百分比分析
1990—2019年中国老年人群DALY率的趋势变化经历了三个转折点，其中男性DALY率的转折点分别是1997年、2006和2015年，而女性和整体人群DALY率的转折点分别是1996年、2007和2015年。在男性DALY率的变化中，区段1990—1997年、1997—2006年和2015—2019年的APC值分别为0.77%、2.34%和1.10%，并且这三个区段的变化具有统计学意义。女性和整体人群DALY率的变化趋势与男性一致，在区段1990—1996年、1996—2007年和2015—2019年的APC值均大于零且具有统计学意义。
在发病率的趋势变化中，男性和整体人群发病率的变化趋势一致，在1990—2019年经历了三个转折点，男性的转折点分别为1993年、2005年和2011年，整体人群的转折点分别为1993年、2005年和2019年，男性和整体人群的四个时间区段APC值均大于零，并且具有统计学意义。女性发病率的变化所经历的转折点与男性一致，但在2005—2011年，APC值为-0.06%，在该区段发病率平均以0.06%的速率下降，并且该下降趋势具有统计学意义，见表2。
2.3　1990—2019中国老年人群阿尔茨海默病发病率年龄-时期-队列分析
发病风险的年龄效应和时期效应呈现逐渐升高的趋势，年龄效应的系数变化经历了由负转正，由-805.17升高至693.03，且各年龄段的效应系数的P值小于0.05，差异具有统计学意义。时期效应系数由-155.19升高至61.72，除2006年，其余各个年份的变化均具有统计学意义。队列效应的变化呈现与年龄效应和时期效应相反的趋势，效应系数由279.09降至-184.14，除队列1931年，其余队列的变化均具有统计学意义，见图2、表3。
2.4　[STBZ]1990—2019中国老年人群阿尔茨海默病DALY率年龄-时期-队列分析
DALY风险的年龄效应和时期效应从1990—2019年呈现逐年升高的趋势，年龄效应的效应系数由-3 137.64升高至2 567.43，表明DALY的年龄风险随着年龄升高逐渐上升，未观察到拐点。时期效应在1991年的效应系数为-531.82，而在2011年则为327.87，表明随着时期推移，阿尔茨海默病的DALY风险逐年升高。队列效应的变化呈现与年龄效应和时期效应相反的趋势，效应系数由721.99降至-740.81，效应系数的变化由正转负，并且逐渐下降，见图3、表4。
3　讨论
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神经系统疾病是造成全球疾病负担的主要原因，而阿尔茨海默病是对神经系统DALY影响比较大的疾病之一[8]，在全球范围内，中国阿尔茨海默病的护理费用高于全球平均水平，并且增长迅速，到2030年全球将花费2.11万亿美元用于阿尔茨海默病的治疗和护理[9]，因此，阿尔茨海默病给社会和个人带来了沉重的经济负担。本研究结果显示，2019年中国老年人群有1 526 516人发生阿尔茨海默病，并承受5 034 024人年的疾病负担，与1990年相比，增加了将近三倍；老年男性和老年女性的发病率和DALY率均呈现逐年升高的趋势，一项研究指出未来全球阿尔茨海默病的发病率和DALY率依旧会保持逐渐上升的趋势[10]，这与本研究的结果一致。随着中国老年人口的增加，阿尔茨海默病的负担将日益加重。这是因为阿尔茨海默病主要发生在老年人群[11]。因此，卫生行政部门应当优化阿尔茨海默病患者的医疗服务质量，并提升社会大众的认知水平。政府有责任整合区域内的各类资源，推动养老服务和养老医疗体系的进一步完善。同时，社会生活压力的增加可能导致一些不良生活方式的增加，例如吸烟、酗酒和缺乏体育锻炼，这些都与阿尔茨海默病的疾病负担增加相关[12]。本研究发现，中国女性阿尔茨海默症的发病率和DALY率远高于男性，表明中国女性正在承受更重的疾病负担，这可能是因为女性独特的生理结构和激素水平造成的[13-14]。研究发现，女性更有可能发生神经系统的结构性和功能性障碍，而且她们患上抑郁症和其他心理问题的风险是男性的两倍。此外，女性的平均预期寿命相对于男性来说更长，这导致她们在老年人口中所占的比重较大[15]。因此，应将老年女性作为阿尔茨海默病的重点干预人群。
阿尔茨海默病是一种与年龄相关的疾病，随着预期寿命的增加，其发病率在全球范围内显著增加[16]，本研究得到的结果与该结论相符，年龄因素是造成阿尔茨海默病发病和DALY风险的主要原因，随着年龄的增加，阿尔茨海默病发病风险和DALY风险逐渐升高，这一趋势预计在未来会因中国人口老龄化而持续增加；本研究显示随着时期的推移，阿尔茨海默病发病和DALY风险逐渐升高，可能与改革开放和经济发展水平增高，人民的生活和社会压力逐渐增加，心脑血管危险因素和不良生活习惯的增加，长期暴露在上述危险因素下，导致时期较近的老年人群阿尔茨海默病发病和DALY风险的升高。而队列因素是导致中国老人阿尔茨海默病的发病风险和DALY风险下降的主要因素，表明越早出生的队列其发病及DALY风险效应越高，而越晚出生的队列其阿尔茨海默病的发病和DALY风险逐渐下降。近年来研究表明，针对心血管、代谢、认知和行为等与阿尔茨海默病相关的因素进行的有效干预可能有助于降低阿尔茨海默病的疾病负担[17]。这些干预措施包括通过改善生活方式、促进健康饮食和提高认知水平等方面来降低患病风险[18]。越晚出生的队列人群更容易接受社会宣传教育，提高他们的健康知意识，可以降低阿尔茨海默病的发病和DALY风险。
综上所述，在中国老龄化的背景下，阿尔茨海默病的疾病负担将持续增长，导致较重的疾病负担不容忽视，目前尚无有效的治疗手段，阿尔茨海默病的控制仍以预防为主，我国卫生行政部门应该继续加强阿尔茨海默病防控的宣传教育和科普，尤其要重视老年人群的阿尔茨海默病的预防控制，以减轻患者及其家属的疾病和经济负担。
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2024年第51卷第10期
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doi: 10.20043/j.cnki.MPM.202401100
  • 接收时间：2024-01-07
  • 首发时间：2026-03-17
  • 出版时间：2024-05-25
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  • 收稿日期：2024-01-07
基金
齐齐哈尔市科技计划联合引导项目(LSFGG-2022046)
作者信息
    1.哈尔滨技师学院（哈尔滨劳动技师学院），黑龙江 哈尔滨 150025
    2.齐齐哈尔医学院护理学院
    3.齐齐哈尔医学院附属第三医院
    4.哈尔滨医科大学公共卫生学院
    5.齐齐哈尔市卫生健康综合监督执法局

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魏洪娟，E-mail:
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2种不同金属材料的力学参数
科
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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