Article(id=1311350537472274626, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202512292, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1765987200000, receivedDateStr=2025-12-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579931848, onlineDateStr=2026-09-28, pubDate=1787587200000, pubDateStr=2026-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579931848, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579931848, creator=13701087609, updateTime=1790579931848, updator=13701087609, issue=Issue{id=1311350363295417204, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='16', pageStart='2881', pageEnd='3072', issueExtLink='null', onlineDate='null', pubDate='1787587200000', pubDateStr='2026-08-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1790579890321, creator='13701087609', updateTime=1790584112451, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311368072267653663, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311368072267653664, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3041, endPage=3049, ext={EN=ArticleExt(id=1311350537652629699, articleId=1311350537472274626, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Burden and forecast analysis of lower respiratory tract infection diseases, China,1990—2023, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the changes in the disease burden of lower respiratory tract infections (LRIs) in China from 1990 to 2023 and predict future trends.

Methods

Based on the Global Burden of Disease Study 2023, the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life year (DALYs) rate (ASDR) of LRIs in China from 1990 to 2023 were described; the Joinpoint model was used to analyze the temporal trend; the age-period-cohort (APC) model was applied to decompose age, period and cohort effects; the R programming was performed to analyze the correlation with the Socio-demographic Index (SDI), the changing characteristics of pathogens, and the trend over the next 12 years.

Results

From 1990 to 2023, the ASIR, ASMR and ASDR of LRIs in China decreased significantly (EAPC: -3.46%, -6.42%, and -9.29%, respectively,P<0.001). Joinpoint analysis indicated that affected by non-pharmaceutical interventions during the COVID-19 pandemic, ASIR reached a trough in 2020, while ASMR and ASDR bottomed out in 2021, followed by a rebound. APC results indicated that the net drift values for ASIR, ASMR, and ASDR of -2.16%, -4.94%, and -4.93%, respectively (P<0.05), driven by the combined effects of age, period, and cohort. The disease burden of all age groups decreased significantly, but the age group with the heaviest disease burden changed from <5 age group to ≥70 age group. The trend of ASDR attributed to various pathogens was consistent with the overall trend. Bacteria were the main pathogens, among which Streptococcus pneumoniae was dominant. Projections indicate that by 2035, the ASIR, ASMR, and ASDR of LRIs in China would decrease to 1 282.49, 6.30, and 91.24 per 100 000 population, respectively.

Conclusion

From 1990 to 2023, the disease burden of LRIs and pathogen-related burden in China decreased significantly. Although the burden will continue to decline over the next 12 years, bacterial infections and the elderly population remain the long-term priorities for prevention and control.

, authors=Xiao YU, Qing-qing JIANG, Hao-tian CHEN, Shuang-shuang WANG, You-de LIU, authorsList=Xiao YU, Qing-qing JIANG, Hao-tian CHEN, Shuang-shuang WANG, You-de LIU, authorCompany=null, correspAuthors=You-de LIU, 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=1311350540395704528, articleId=1311350537472274626, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=1990—2023年中国下呼吸道感染疾病负担及预测分析, 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—2023年中国下呼吸道感染(LRIs)疾病负担变化特征并预测未来趋势。

方法

基于2023年全球疾病负担研究数据,描述1990—2023年中国LRIs标化发病率(ASIR)、标化死亡率(ASMR)、标化伤残调整寿命年(DALYs)率(ASDR);利用Joinpoint模型分析时间变化趋势;利用年龄-时期-队列(APC)模型解析年龄、时期和队列效应;利用R语言编程分析与社会人口学指数(SDI)的关联性、病原体变化特征及未来12年变化趋势。

结果

1990—2023年,中国LRIs的ASIR、ASMR和ASDR均显著下降,EAPC分别为-3.46%、-6.42%、-9.29%(P<0.001);Joinpoint分析表明,受新冠疫情非药物干预措施影响,ASIR于2020年、ASMR和ASDR于2021年降至低点后出现回升。APC结果显示,ASIR、ASMR和ASDR的净漂移值分别为-2.16%、-4.94%、-4.93%(P<0.05),受年龄、时期、队列效应共同影响。各年龄组疾病负担均明显下降,负担重心由<5岁儿童转向≥70岁老年人群。各类病原体所致ASDR变化趋势与总体一致,细菌为主要病原体,其中肺炎链球菌占主导地位。预测显示,2035年中国LRIs 的ASIR、ASMR和ASDR将分别降至1 282.49/10万、6.30/10万、91.24/10万。

结论

1990—2023年中国LRIs疾病负担及主要病原体相关负担显著降低,尽管未来12年将持续走低,但细菌感染、老年人群仍为长期防控重点。

, authors=于晓, 姜青青, 陈浩田, 王爽爽, 刘友德, authorsList=于晓, 姜青青, 陈浩田, 王爽爽, 刘友德, authorCompany=null, correspAuthors=刘友德, authorNote=

于晓(1994—),女,硕士,主管医师,研究方向:医院感染管理

, correspAuthorsNote=
刘友德,E-mail:
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于晓(1994—),女,硕士,主管医师,研究方向:医院感染管理

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Analysis of the burden of respiratory syncytial virus lower respiratory tract infections in China from 1992 to 2021[J]. Modern Preventive Medicine, 2025, 52(3): 430-435.(In Chinese), articleTitle=Analysis of the burden of respiratory syncytial virus lower respiratory tract infections in China from 1992 to 2021, refAbstract=null), Reference(id=1311350550122295593, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, doi=null, pmid=null, pmcid=null, year=2021, volume=8, issue=1, pageStart=393, pageEnd=414, url=null, language=null, rfNumber=[26], rfOrder=35, authorNames=Ursin RL, Klein SL, journalName=Annu Rev Virol, refType=null, unstructuredReference=Ursin RL, Klein SL. Sex differences in respiratory viral pathogenesis and treatments[J]. 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Beijing: National Health Commission, 2024.(In Chinese), articleTitle=2023 national health literacy monitoring report, refAbstract=null)], funds=[Fund(id=1311350546007683333, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, awardId=202303081264, language=CN, fundingSource=山东省医药卫生科技项目(202303081264), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1311350540622196945, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, xref=null, ext=[AuthorCompanyExt(id=1311350540630585554, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, companyId=1311350540622196945, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Yantai Qishan Hospital, Yantai, Shandong 264000, China), AuthorCompanyExt(id=1311350540638974163, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, companyId=1311350540622196945, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=烟台市奇山医院,山东 烟台 264000)])], figs=[ArticleFig(id=1311350544237687031, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=EN, label=Fig.1, caption=Trends in the burden of LRIs in China, 1990-2023, figureFileSmall=MDTGL+LIx4QksKpBdwgUIQ==, figureFileBig=AHL40dT6jCDr4WXPuRgQVA==, tableContent=null), ArticleFig(id=1311350544363516152, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=CN, label=图1, caption=1990—2023年中国LRIs疾病负担变化趋势

注:A为ASIR变化趋势;B为ASMR变化趋势;C为ASDR变化趋势;*为P<0.05。

, figureFileSmall=MDTGL+LIx4QksKpBdwgUIQ==, figureFileBig=AHL40dT6jCDr4WXPuRgQVA==, tableContent=null), ArticleFig(id=1311350544992661753, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=EN, label=Fig.2, caption=Correlation analysis between the burden of LRIs and SDI in China, 1990-2023, figureFileSmall=J5rvLd6r4Gs7siuZf/xIMQ==, figureFileBig=yhZZjeQcl49acNpcDvglrA==, tableContent=null), ArticleFig(id=1311350545055576314, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=CN, label=图2, caption=1990—2023年中国LRIs 疾病负担与SDI相关性分析

注:A为ASIR与SDI相关性;B为ASMR与SDI相关性;C为ASDR与SDI相关性。

, figureFileSmall=J5rvLd6r4Gs7siuZf/xIMQ==, figureFileBig=yhZZjeQcl49acNpcDvglrA==, tableContent=null), ArticleFig(id=1311350545122685179, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=EN, label=Fig.3, caption=Age-period-cohort model of disease burden of lower respiratory infections LRIs in China, 1990-2023, figureFileSmall=7JtEH2/TSizUPgk3PJ0bOA==, figureFileBig=AaD6+gnlUuxvmS/Qwz3d2g==, tableContent=null), ArticleFig(id=1311350545189794044, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=CN, label=图3, caption=1990—2023年中国LRIs疾病负担年龄-时期-队列模型

注:A为ASIR纵向年龄曲线;B为ASMR纵向年龄曲线;C为ASDR纵向年龄曲线;D为ASIR时期率比;E为ASMR时期率比;F为ASDR时期率比;G为ASIR队列率比;H为ASMR队列率比;I为ASDR队列率比;阴影区域为95%CI。

, figureFileSmall=7JtEH2/TSizUPgk3PJ0bOA==, figureFileBig=AaD6+gnlUuxvmS/Qwz3d2g==, tableContent=null), ArticleFig(id=1311350545269485821, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=EN, label=Fig.4, caption=Stacked area chart of ASDR caused by pathogens in LRIs of China, 1990-2023, figureFileSmall=WadB5JX4SrtmjUsNEY3olw==, figureFileBig=HoFcMnVcrcd9dcvPk/umlQ==, tableContent=null), ArticleFig(id=1311350545407897854, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=CN, label=图4, caption=1990—2023年中国LRIs中病原体所致ASDR的堆积面积图, figureFileSmall=WadB5JX4SrtmjUsNEY3olw==, figureFileBig=HoFcMnVcrcd9dcvPk/umlQ==, tableContent=null), ArticleFig(id=1311350545462423807, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=EN, label=Fig.5, caption=Sankey diageam of ASDR caused by pathogens in LRIs of China, 1990-2023, figureFileSmall=fRPDjGVLAbKbsLkGp9wQJw==, figureFileBig=m4NSt2yFYNqPrKRTz54P+g==, tableContent=null), ArticleFig(id=1311350545521144064, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=CN, label=图5, caption=1990—2023年中国LRIs中病原体所致ASDR的桑基图, figureFileSmall=fRPDjGVLAbKbsLkGp9wQJw==, figureFileBig=m4NSt2yFYNqPrKRTz54P+g==, tableContent=null), ArticleFig(id=1311350545605030145, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=EN, label=Fig.6, caption=Predicted trends in the burden of LRIs in China, 2024-2035, figureFileSmall=okh7Pj9pX31pczk0Ahgf4Q==, figureFileBig=2/0NBF+Nnz5qa0lB76wNAQ==, tableContent=null), ArticleFig(id=1311350545705693442, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=CN, label=图6, caption=2024—2035年中国LRIs疾病负担预测趋势

注:A为ASIR预测;B为ASMR预测;C为ASDR预测;阴影区域为95%CI。

, figureFileSmall=okh7Pj9pX31pczk0Ahgf4Q==, figureFileBig=2/0NBF+Nnz5qa0lB76wNAQ==, tableContent=null), ArticleFig(id=1311350545781190915, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=EN, label=Table 1, caption=

Disease burden of LRIs in China, 1990-2023(1/10万,95%CI)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量1990年
男性女性总体
ASIR
中国5 877.06(5 303.25~6 501.61)4 742.74(4 335.24~5 183.12)5 307.10(4 812.62~5 842.75)
<5岁29 734.53(25 053.08~34 975.75)19 331.12(16 116.05~22 789.15)24 810.71(20 818.02~29 185.44)
5~14岁4 048.91(3 124.20~5 270.97)3 556.63(2 765.84~4 536.91)3 811.72(2 956.78~4 950.74)
15~49岁850.85(751.48~954.87)1 027.26(902.03~1 160.00)936.09(826.99~1 055.05)
50~693 906.07(3 477.27~4 391.33)4 337.90(3 856.15~4 930.43)4 114.25(3 660.77~4 650.05)
≥70岁13 122.88(11 601.76~14 955.27)13 435.40(11 907.00~15 316.15)13 300.84(11 861.14~15 252.95)
ASMR
中国65.95(53.95~78.50)49.64(39.86~62.43)57.59(49.01~67.04)
<5岁367.93(286.35~457.33)253.31(207.73~308.55)313.68(267.91~364.17)
5~14岁7.13(4.48~10.43)6.93(4.21~10.74)7.03(5.11~9.29)
15~49岁3.72(2.36~5.29)3.33(2.00~5.14)3.53(2.57~4.67)
50~69岁26.89(17.81~36.44)21.73(12.99~34.20)24.4(17.82~31.60)
≥70岁230.14(155.83~306.33)219.52(143.22~340.76)224.1(165.34~294.48)
ASDR
中国3 944.12(3 217.21~4 806.34)2 842.28(2 385.26~3 378.02)3 418.54(2 936.43~3 967.67)
<5岁32 954.31(25 654.59~40 953.95)22 661.33(18 605.64~27 614.52)28 082.76(23 990.48~32 604.04)
5~14岁584.58(368.81~852.82)567.92(346.33~874.99)576.56(419.67~760.89)
15~49岁218.38(137.09~310.38)198.43(120.19~306.73)208.74(150.33~274.34)
50~69岁796.09(525.73~1 078.50)634.55(379.09~991.13)718.22(521.61~924.22)
≥70岁3 504.87(2 418.62~4 676.38)3 138.69(2 038.61~4 886.79)3 296.35(2 440.63~4 296.09)
变量2023年
男性女性总体
ASIR
中国2 235.28(2 061.04~2 443.36)1 882.03(1 736.17~2 052.36)2 050.45(1 891.31~2 235.71)
<5岁5 654.80(4 779.45~6 632.89)3 515.53(2 863.73~4 159.13)4 658.02(3 894.82~5 471.68)
5~14岁2 138.11(1 652.32~2 798.49)2 133.66(1 655.43~2 671.73)2 136.03(1 651.04~2 681.60)
15~49岁639.72(566.67~720.66)761.59(667.33~870.15)697.96(617.85~789.04)
50~692 158.15(1 933.87~2 395.30)2 049.19(1 821.49~2 305.20)2 103.68(1 878.52~2 331.64)
≥70岁9 156.39(8 286.72~10 150.94)7 415.4(6 630.67~8 282.33)8 217.77(7 391.42~9 088.55)
ASMR
中国11.70(8.15~17.08)6.99(5.06~9.38)9.11(7.00~11.37)
<5岁8.72(6.06~11.43)6.79(5.42~8.73)7.82(6.23~9.59)
5~14岁1.2(0.76~1.79)0.95(0.62~1.48)1.08(0.74~1.49)
15~49岁1.2(0.80~1.74)0.53(0.35~0.78)0.88(0.63~0.19)
50~69岁7.82(5.30~12.38)3.42(2.20~5.13)5.62(4.11~7.87)
≥70岁116.88(78.69~175.30)81.38(55.79~115.07)97.74(72.43~128.20)
ASDR
中国286.22(218.88~379.06)180.94(142.30~222.92)232.15(188.27~279.96)
<5岁784.33(546.87~1 025.28)608.44(487.41~780.64)702.37(561.61~859.22)
5~14岁100.20(64.67~148.11)79.59(52.72~122.18)90.54(62.14~122.95)
15~49岁64.53(42.74~93.46)29.76(19.54~43.38)47.92(34.27~64.37)
50~69岁230.29(157.45~363.60)100.39(65.08~148.11)165.35(121.44~233.06)
≥70岁1 469.48(987.86~2 187.19)946.22(644.56~1 331.49)1 187.37(887.38~1 557.52)
变量1990-2023 EAPC
男性女性总体
ASIR
中国-3.46(-3.68~-3.25)-3.43(-3.65~-3.21)-3.46(-3.67~-3.24)
<5岁-5.50(-5.82~-5.18)-6.50(-6.94~-6.06)-5.82(-6.17~-5.48)
5~14岁-2.21(-2.52~-1.90)-1.81(-2.07~-1.54)-2.03(-2.31~-1.74)
15~49岁-1.31(-1.47~-1.15)-1.21(-1.36~-1.06)-1.26(-1.41~-1.11)
50~69-2.27(-2.46~-2.08)-2.50(-2.67~-2.32)-2.38(-2.56~-2.20)
≥70岁-1.50(-1.66~-1.34)-2.33(-2.50~-2.16)-1.93(-2.09~-1.77)
ASMR
中国-6.08(-6.34~-5.83)-6.74(-7.03~-6.45)-6.42(-6.68~-6.16)
<5岁-12.15(-12.89~-11.42)-11.76(-12.60~-10.92)-12.00(-12.77~-11.22)
5~14岁-6.41(-6.76~-6.07)-6.87(-7.18~-6.56)-6.60(-6.93~-6.28)
15~49岁-4.34(-4.72~-3.96)-6.41(-6.81~-6.01)-5.11(-5.51~-4.71)
50~69岁-4.45(-4.86~-4.03)-6.43(-6.79~-6.07)-5.20(-5.60~-4.81)
≥70岁-2.46(-2.61~-2.30)-3.35(-3.49~-3.22)-2.89(-3.02~-2.75)
ASDR
中国-9.10(-9.46~-8.74)-9.45(-9.91~-8.98)-9.29(-9.69~-8.89)
<5岁-12.14(-12.87~-11.41)-11.76(-12.60~-10.92)-11.99(-12.76~-11.21)
5~14岁-6.35(-6.70~-6.01)-6.78(-7.10~-6.46)-6.53(-6.86~-6.20)
15~49岁-4.64(-5.03~-4.25)-6.62(-7.03~-6.21)-5.39(-5.81~-4.98)
50~69岁-4.43(-4.83~-4.03)-6.39(-6.75~-6.04)-5.18(-5.56~-4.79)
≥70岁-3.11(-3.27~-2.95)-4.05(-4.20~-3.90)-3.54(-3.68~-3.39)
), ArticleFig(id=1311350545873465604, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350537472274626, language=CN, label=表1, caption=

1990—2023年中国LRIs疾病负担(1/10万,95%CI)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量1990年
男性女性总体
ASIR
中国5 877.06(5 303.25~6 501.61)4 742.74(4 335.24~5 183.12)5 307.10(4 812.62~5 842.75)
<5岁29 734.53(25 053.08~34 975.75)19 331.12(16 116.05~22 789.15)24 810.71(20 818.02~29 185.44)
5~14岁4 048.91(3 124.20~5 270.97)3 556.63(2 765.84~4 536.91)3 811.72(2 956.78~4 950.74)
15~49岁850.85(751.48~954.87)1 027.26(902.03~1 160.00)936.09(826.99~1 055.05)
50~693 906.07(3 477.27~4 391.33)4 337.90(3 856.15~4 930.43)4 114.25(3 660.77~4 650.05)
≥70岁13 122.88(11 601.76~14 955.27)13 435.40(11 907.00~15 316.15)13 300.84(11 861.14~15 252.95)
ASMR
中国65.95(53.95~78.50)49.64(39.86~62.43)57.59(49.01~67.04)
<5岁367.93(286.35~457.33)253.31(207.73~308.55)313.68(267.91~364.17)
5~14岁7.13(4.48~10.43)6.93(4.21~10.74)7.03(5.11~9.29)
15~49岁3.72(2.36~5.29)3.33(2.00~5.14)3.53(2.57~4.67)
50~69岁26.89(17.81~36.44)21.73(12.99~34.20)24.4(17.82~31.60)
≥70岁230.14(155.83~306.33)219.52(143.22~340.76)224.1(165.34~294.48)
ASDR
中国3 944.12(3 217.21~4 806.34)2 842.28(2 385.26~3 378.02)3 418.54(2 936.43~3 967.67)
<5岁32 954.31(25 654.59~40 953.95)22 661.33(18 605.64~27 614.52)28 082.76(23 990.48~32 604.04)
5~14岁584.58(368.81~852.82)567.92(346.33~874.99)576.56(419.67~760.89)
15~49岁218.38(137.09~310.38)198.43(120.19~306.73)208.74(150.33~274.34)
50~69岁796.09(525.73~1 078.50)634.55(379.09~991.13)718.22(521.61~924.22)
≥70岁3 504.87(2 418.62~4 676.38)3 138.69(2 038.61~4 886.79)3 296.35(2 440.63~4 296.09)
变量2023年
男性女性总体
ASIR
中国2 235.28(2 061.04~2 443.36)1 882.03(1 736.17~2 052.36)2 050.45(1 891.31~2 235.71)
<5岁5 654.80(4 779.45~6 632.89)3 515.53(2 863.73~4 159.13)4 658.02(3 894.82~5 471.68)
5~14岁2 138.11(1 652.32~2 798.49)2 133.66(1 655.43~2 671.73)2 136.03(1 651.04~2 681.60)
15~49岁639.72(566.67~720.66)761.59(667.33~870.15)697.96(617.85~789.04)
50~692 158.15(1 933.87~2 395.30)2 049.19(1 821.49~2 305.20)2 103.68(1 878.52~2 331.64)
≥70岁9 156.39(8 286.72~10 150.94)7 415.4(6 630.67~8 282.33)8 217.77(7 391.42~9 088.55)
ASMR
中国11.70(8.15~17.08)6.99(5.06~9.38)9.11(7.00~11.37)
<5岁8.72(6.06~11.43)6.79(5.42~8.73)7.82(6.23~9.59)
5~14岁1.2(0.76~1.79)0.95(0.62~1.48)1.08(0.74~1.49)
15~49岁1.2(0.80~1.74)0.53(0.35~0.78)0.88(0.63~0.19)
50~69岁7.82(5.30~12.38)3.42(2.20~5.13)5.62(4.11~7.87)
≥70岁116.88(78.69~175.30)81.38(55.79~115.07)97.74(72.43~128.20)
ASDR
中国286.22(218.88~379.06)180.94(142.30~222.92)232.15(188.27~279.96)
<5岁784.33(546.87~1 025.28)608.44(487.41~780.64)702.37(561.61~859.22)
5~14岁100.20(64.67~148.11)79.59(52.72~122.18)90.54(62.14~122.95)
15~49岁64.53(42.74~93.46)29.76(19.54~43.38)47.92(34.27~64.37)
50~69岁230.29(157.45~363.60)100.39(65.08~148.11)165.35(121.44~233.06)
≥70岁1 469.48(987.86~2 187.19)946.22(644.56~1 331.49)1 187.37(887.38~1 557.52)
变量1990-2023 EAPC
男性女性总体
ASIR
中国-3.46(-3.68~-3.25)-3.43(-3.65~-3.21)-3.46(-3.67~-3.24)
<5岁-5.50(-5.82~-5.18)-6.50(-6.94~-6.06)-5.82(-6.17~-5.48)
5~14岁-2.21(-2.52~-1.90)-1.81(-2.07~-1.54)-2.03(-2.31~-1.74)
15~49岁-1.31(-1.47~-1.15)-1.21(-1.36~-1.06)-1.26(-1.41~-1.11)
50~69-2.27(-2.46~-2.08)-2.50(-2.67~-2.32)-2.38(-2.56~-2.20)
≥70岁-1.50(-1.66~-1.34)-2.33(-2.50~-2.16)-1.93(-2.09~-1.77)
ASMR
中国-6.08(-6.34~-5.83)-6.74(-7.03~-6.45)-6.42(-6.68~-6.16)
<5岁-12.15(-12.89~-11.42)-11.76(-12.60~-10.92)-12.00(-12.77~-11.22)
5~14岁-6.41(-6.76~-6.07)-6.87(-7.18~-6.56)-6.60(-6.93~-6.28)
15~49岁-4.34(-4.72~-3.96)-6.41(-6.81~-6.01)-5.11(-5.51~-4.71)
50~69岁-4.45(-4.86~-4.03)-6.43(-6.79~-6.07)-5.20(-5.60~-4.81)
≥70岁-2.46(-2.61~-2.30)-3.35(-3.49~-3.22)-2.89(-3.02~-2.75)
ASDR
中国-9.10(-9.46~-8.74)-9.45(-9.91~-8.98)-9.29(-9.69~-8.89)
<5岁-12.14(-12.87~-11.41)-11.76(-12.60~-10.92)-11.99(-12.76~-11.21)
5~14岁-6.35(-6.70~-6.01)-6.78(-7.10~-6.46)-6.53(-6.86~-6.20)
15~49岁-4.64(-5.03~-4.25)-6.62(-7.03~-6.21)-5.39(-5.81~-4.98)
50~69岁-4.43(-4.83~-4.03)-6.39(-6.75~-6.04)-5.18(-5.56~-4.79)
≥70岁-3.11(-3.27~-2.95)-4.05(-4.20~-3.90)-3.54(-3.68~-3.39)
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1990—2023年中国下呼吸道感染疾病负担及预测分析
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于晓 , 姜青青 , 陈浩田 , 王爽爽 , 刘友德
现代预防医学 | 疾病预防控制 2026,53(16): 3041-3049
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现代预防医学 |疾病预防控制 2026 , 53 (16) : 3041 -3049
1990—2023年中国下呼吸道感染疾病负担及预测分析
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于晓(1994—),女,硕士,主管医师,研究方向:医院感染管理

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于晓, 姜青青, 陈浩田, 王爽爽, 刘友德
作者信息
  • 烟台市奇山医院,山东 烟台 264000
通讯作者:
刘友德,E-mail:
作者简介:

于晓(1994—),女,硕士,主管医师,研究方向:医院感染管理

Burden and forecast analysis of lower respiratory tract infection diseases, China,1990—2023
Xiao YU, Qing-qing JIANG, Hao-tian CHEN, Shuang-shuang WANG, You-de LIU
Affiliations
  • Yantai Qishan Hospital, Yantai, Shandong 264000, China
出版时间: 2026-08-25 doi: 10.20043/j.cnki.MPM.202512292
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目的

分析1990—2023年中国下呼吸道感染(LRIs)疾病负担变化特征并预测未来趋势。

方法

基于2023年全球疾病负担研究数据,描述1990—2023年中国LRIs标化发病率(ASIR)、标化死亡率(ASMR)、标化伤残调整寿命年(DALYs)率(ASDR);利用Joinpoint模型分析时间变化趋势;利用年龄-时期-队列(APC)模型解析年龄、时期和队列效应;利用R语言编程分析与社会人口学指数(SDI)的关联性、病原体变化特征及未来12年变化趋势。

结果

1990—2023年,中国LRIs的ASIR、ASMR和ASDR均显著下降,EAPC分别为-3.46%、-6.42%、-9.29%(P<0.001);Joinpoint分析表明,受新冠疫情非药物干预措施影响,ASIR于2020年、ASMR和ASDR于2021年降至低点后出现回升。APC结果显示,ASIR、ASMR和ASDR的净漂移值分别为-2.16%、-4.94%、-4.93%(P<0.05),受年龄、时期、队列效应共同影响。各年龄组疾病负担均明显下降,负担重心由<5岁儿童转向≥70岁老年人群。各类病原体所致ASDR变化趋势与总体一致,细菌为主要病原体,其中肺炎链球菌占主导地位。预测显示,2035年中国LRIs 的ASIR、ASMR和ASDR将分别降至1 282.49/10万、6.30/10万、91.24/10万。

结论

1990—2023年中国LRIs疾病负担及主要病原体相关负担显著降低,尽管未来12年将持续走低,但细菌感染、老年人群仍为长期防控重点。

下呼吸道感染  /  疾病负担  /  病原体  /  社会人口学指数  /  预测
Objective

To analyze the changes in the disease burden of lower respiratory tract infections (LRIs) in China from 1990 to 2023 and predict future trends.

Methods

Based on the Global Burden of Disease Study 2023, the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life year (DALYs) rate (ASDR) of LRIs in China from 1990 to 2023 were described; the Joinpoint model was used to analyze the temporal trend; the age-period-cohort (APC) model was applied to decompose age, period and cohort effects; the R programming was performed to analyze the correlation with the Socio-demographic Index (SDI), the changing characteristics of pathogens, and the trend over the next 12 years.

Results

From 1990 to 2023, the ASIR, ASMR and ASDR of LRIs in China decreased significantly (EAPC: -3.46%, -6.42%, and -9.29%, respectively,P<0.001). Joinpoint analysis indicated that affected by non-pharmaceutical interventions during the COVID-19 pandemic, ASIR reached a trough in 2020, while ASMR and ASDR bottomed out in 2021, followed by a rebound. APC results indicated that the net drift values for ASIR, ASMR, and ASDR of -2.16%, -4.94%, and -4.93%, respectively (P<0.05), driven by the combined effects of age, period, and cohort. The disease burden of all age groups decreased significantly, but the age group with the heaviest disease burden changed from <5 age group to ≥70 age group. The trend of ASDR attributed to various pathogens was consistent with the overall trend. Bacteria were the main pathogens, among which Streptococcus pneumoniae was dominant. Projections indicate that by 2035, the ASIR, ASMR, and ASDR of LRIs in China would decrease to 1 282.49, 6.30, and 91.24 per 100 000 population, respectively.

Conclusion

From 1990 to 2023, the disease burden of LRIs and pathogen-related burden in China decreased significantly. Although the burden will continue to decline over the next 12 years, bacterial infections and the elderly population remain the long-term priorities for prevention and control.

Lower respiratory infections  /  Disease burden  /  Pathogen  /  Socio-demographic index  /  Prediction
于晓, 姜青青, 陈浩田, 王爽爽, 刘友德. 1990—2023年中国下呼吸道感染疾病负担及预测分析. 现代预防医学, 2026 , 53 (16) : 3041 -3049 . DOI: 10.20043/j.cnki.MPM.202512292
Xiao YU, Qing-qing JIANG, Hao-tian CHEN, Shuang-shuang WANG, You-de LIU. Burden and forecast analysis of lower respiratory tract infection diseases, China,1990—2023[J]. Modern Preventive Medicine, 2026 , 53 (16) : 3041 -3049 . DOI: 10.20043/j.cnki.MPM.202512292
2023年全球疾病负担(Global Burden of Disease,GBD)数据显示[1],下呼吸道感染(Lower respiratory infections,LRIs)是全球全年龄段人群死因第4名,导致约250万例死亡和9 870万伤残调整寿命年(Disability-adjusted life years,DALYs)发生,其中肺炎链球菌是首要致死病原体。LRIs疾病负担主要集中于<5岁儿童、≥70岁老年人以及低社会人口指数(Socio-demographic Index,SDI)国家[2]。我国LRIs流行趋势与全球趋势相呼应,但在易感人群分布、病原体构成及地域差异方面具有特异性[3-4],仍是重要的公共卫生难题。新型冠状病毒肺炎(COVID-19)大流行期间,非药物干预措施(Non-pharmaceutical interventions,NPIs)的实施使全球及我国LRIs疾病负担与病原谱构成发生复杂演变,为未来LRIs精准防控带来了新挑战。本文基于GBD 2023数据,对1990—2023年中国LRIs疾病负担、病原体及人群变化特征进行分析并对未来趋势进行预测,为优化LRIs防控策略提供依据。
本文从GBD 2023数据库中摘取LRIs疾病负担及病原体相关疾病负担数据,以标化发病率(Age-standardized incidence rate,ASIR)、标化死亡率(Age-standardized mortality rate,ASMR)和标化DALYs率(Age-standardized DALYs rate,ASDR)作为主要评价指标。GBD数据库定义的LRIs不包括COVID-19、结核病和百日咳。GBD数据库中LRIs共归因于26种病原体,结合相关指南、专家共识[5-6]和临床病原谱特征,将其分为革兰阳性菌(Gram-positive bacteria,G+)、革兰阴性菌(Gram-negative bacteria,G-)、病毒、真菌、非典型病原体、其他分枝杆菌(非肺结核、非麻风)及其他病原体七大类。SDI是衡量地区/国家社会人口发展水平的综合指标,取值0~1,全球204个国家/地区按SDI值分为五层[7]。2023年我国SDI为0.728,已属高SDI国家,以此衡量SDI与疾病负担的动态关联。
利用Joinpoint模型分析疾病负担时间变化趋势,计算年度百分比变化(Annual percent change,APC)、估计年度百分比变化(Estimated annual percentage change,EAPC)及其95%可信区间(CI)。采用美国国家癌症研究所年龄-时期-队列(Age-period-cohort,APC)模型在线工具评估年龄、时期和队列效应(http://analy‐sistools.nci.nih.gov/apc/)。采用R 4.5.2分析疾病负担与SDI关联性、绘制病原体所致ASDR变化趋势的桑基图和堆积面积图,并采用贝叶斯年龄-时期-队列(Bayesian Age-Period-Cohort,BAPC)模型预测未来12年疾病负担变化趋势。用Origin 2025软件进行绘图。P<0.05具有显著性。
1990—2023年中国LRIs疾病负担整体显著降低,ASMR、ASDR的下降趋势较ASIR更显著。见表1。Joinpoint分析显示,ASIR、ASMR和ASDR分别在2015—2020年、2002-2008年和2001—2011年下降幅度最大,APC分别为-6.52%、-8.99%、-11.40%(P<0.05)。受COVID-19疫情影响,ASIR于2020年、ASMR和ASDR于2021年降至最低点后回升,APC分别为8.45%、4.53%、7.35%(P<0.05)。见图1。进一步分析显示,1990—2023年中国LRIs疾病负担与SDI间存在高度负相关,r值分别为-0.92、-0.94、-0.94(P<0.001)。见图2。
1990—2023年中国LRIs各年龄组疾病负担均显著减轻。1990年疾病负担以<5岁年龄组最重、15~49岁年龄组最轻。1990—2023年间<5岁年龄组下降幅度最大,ASIR、ASMR和ASDR的EAPC分别为-5.82%、-12.00%、-11.99%(P<0.001);15~49岁年龄组ASIR、≥70岁年龄组ASMR和ASDR下降幅度最小,EAPC分别为-1.26%、-2.89%、-3.54%(P<0.001)。到了2023年,疾病负担重心转为≥70岁年龄组最高,但15~49岁年龄组仍最低。见表1。
APC模型显示,1990—2023年中国LRIs的 ASIR、ASMR和ASDR净漂移值分别为-2.16%、-4.94%、-4.93%(P<0.05),表明疾病负担受年龄、时期、队列共同影响,整体风险持续降低。见图3。
年龄效应:同队列人群的ASIR随年龄增长逐渐升高,55~59岁、60~64岁增长幅度最显著;ASMR和ASDR以15~19岁为拐点,先小幅降低后升高,均在55~59岁增长速度最快。时期效应:以2004—2008年为参照(RR=1),疾病负担随年份推移呈下降趋势,较近年份变化幅度较前缓慢,三者均在1994—1998年达到峰值(RR值分别为1.29、1.86、1.92),2019—2023年降至最低(RR值分别为0.75、0.54、0.56)。队列效应:以1969年出生队列为参照(RR=1),疾病负担随出生队列后移显著降低,1924年出生队列风险最高(RR值分别为2.83、5.78、5.72),2019年出生队列风险最低(RR值分别为0.41、0.06、0.06)。
堆积面积图显示,1990—2023年中国LRIs病原体所致ASDR整体呈下降趋势,与总体ASDR变化趋势相同,在2021—2023年略有回升。但不同病原体对ASDR的贡献存在差异,G+和病毒在2021—2023年略有回升,其他各类病原体在2020—2023年有所反弹。G+和G-是ASDR的主要来源,其占比主导地位保持稳定,降幅分别为93.67%、92.42%;病毒整体降幅最大为97.24%,其中,1990—2015年持续降低且占比相对稳定,2015—2020年降幅最大且占比也明显降低,2021年降至最低点;非典型病原体虽降幅较大为93.81%,但占比相对稳定;其他分类病原体整体保持下降趋势,但贡献水平始终较低,变化相对平缓。见图4。
桑基图进一步证实,1990—2023年各病原体流线整体收窄,所致ASDR显著降低。G+整体流量最高,以肺炎链球菌为主,其次为金黄色葡萄球菌。金黄色葡萄球菌在1990—2020年流量收窄但占比增加,其主要病原体的地位逐渐显现。G-整体流量仅次于G+,以肺炎克雷伯菌为主。病毒整体流量位居第三,主要包括流感、呼吸道合胞病毒(Respiratory syncytial virus,RSV),二者在2015—2020年流量收窄最大,2021年达到最低。非典型病原体流量相对较细且保持稳定,但非主要病原体。其他各病原体流量相对较细但随时间有分散趋势,其他分枝杆菌、曲霉菌属等条件致病菌的疾病负担逐渐显现。见图5。
BAPC预测显示,2024—2035年中国LRIs疾病负担持续降低,ASIR、ASMR和ASDR预计将分别从2024年的1 933.51/10万、10.94/10万、197.08/10万降至2035年的1 282.49/10万、6.30/10万、91.24/10万。与ASIR和ASMR相比,ASDR下降幅度更平缓,而在2023—2024年ASIR下降最明显,ASMR有短暂上升。见图6。
本研究依托GBD 2023数据,系统分析了1990—2023年中国LRIs疾病负担变化趋势并预测未来12年发展情况。结果显示,我国LRIs疾病负担整体显著降低,ASMR和ASDR下降较ASIR更显著,表明预防死亡和伤残的成效优于感染风险控制,与已有研究结果一致[8],该趋势与我国SDI提升相呼应,侧面凸显出我国医疗技术进步对LRIs诊疗精准化及疾病负担降低的推动作用。
值得注意的是,ASIR于2020年、ASMR和ASDR于2021年降至最低点后出现反弹,与既往研究趋势相呼应[9],APC分析同样提示2019年出生队列、2019—2023年时期效应的疾病风险最低,这一“V型”转变与COVID-19大流行密切相关。2020年初严格的NPIs有效抑制了多种呼吸道病原体传播[10],是疾病负担降至近30余年最低的关键。ASIR对防控措施最敏感,在2020年即达最低,体现了NPIs对疾病传播链的即时阻断及与前期防控成效的叠加作用。而ASMR和ASDR下降存在滞后性,可能与呼吸系统疾病存在发病-死亡时间差、既往感染慢性并发症持续存在、医疗资源向COVID-19倾斜导致其他重症LRIs诊疗延迟[11-12]有关,直至2021年医疗系统逐渐恢复常态才达到死亡和伤残风险的最低点。2022年后NPIs逐渐放宽,人口流动及聚集性活动逐渐恢复,多种呼吸道病原体感染“报复性”反弹[13],成为疾病负担回升的核心驱动因素,与Sanz-Muñoz等[14]提出的长期实施NPIs会出现“免疫负债”效应一致。此外,WHO报告指出[15],COVID-19大流行期间住院患者抗生素使用率远超临床需求,加剧了细菌耐药性,从而长期推高疾病负担。
堆积面积图与桑基图可视化分析显示,各类病原体所致ASDR总体显著降低,与总体ASDR变化吻合。G+和G-虽下降幅度均超90%,但仍是疾病负担的主要来源,证实了细菌感染仍是我国乃至全球LRIs防控的核心。G+中,肺炎链球菌贡献占比最高,其ASDR下降得益于肺炎链球菌结合疫苗(PCV)的广泛接种,但我国PCV未纳入国家免疫规划、接种覆盖率偏低[16],可能是其保持主体地位的重要原因。金黄色葡萄球菌ASDR下降明显但1990—2020年占比上升,与其耐药性增加治疗难度、易通过接触传播和有创操作引发医院感染、易继发于病毒感染以及易感人群增加等因素相关[17-18]。G-中肺炎克雷伯菌为优势病原体,与医院感染密切相关。本研究发现,2020—2023年肺炎克雷伯菌所致ASDR逐渐升高,印证了NPIs对医院内病原体构成的影响,与黄贵等的研究一致[19]。病毒所致ASDR下降幅度最大为97.24%,其中2015—2020年急剧下降、2021年达最低,体现了NPIs对呼吸道病毒传播的抑制作用及“免疫负债”的反弹效应,与多项研究中流感、RSV等病毒检出及住院负担在NPIs期间近乎消失、后期反弹的结论一致[20-21]。据报道[9],我国LRIs死亡的主要危险因素已演变为烟草和环境颗粒物污染,二者可降低宿主呼吸道防御能力,为病原体所致LRIs提供生物学通道[22]。
此外,人口老龄化是LRIs疾病负担增加的重要推手。本研究发现,1990—2023年各年龄组LRIs疾病负担整体下降,但形成了从“<5岁儿童负担最重”到“≥70岁老年人负担最重”的流行病学转变,与Shi等[23]的研究一致。<5岁年龄组下降幅度突出,得益于全球公共卫生策略、儿童健康干预措施的推广以及实施NPIs对婴幼儿群体形成的特殊保护[24-25]。APC结果显示,55~59岁、60~64岁ASIR增长幅度最大,与该年龄段免疫衰老、慢性病患病率上升、女性更年期雌激素水平下降,削弱了机体对呼吸道病原体的防御能力相关[26];ASMR、ASDR在55~59岁增长最快,该年龄段是老年防控的前置重点人群,从疾病严重程度和健康寿命损失两个维,间接凸显了老年群体作为LRIs防控优先级的必要性。到了2023年,≥70岁年龄组成为疾病负担最重的群体,APC模型也显示出生队列越早疾病负担越重,这是生命早期风险长期暴露、老年人生理功能衰退以及当前危险因素演变共同作用的结果。人口老龄化正抵消LRIs疾病负担的下降趋势,叠加“免疫负债”效应,加剧老年群体健康风险[27-28],甚至主导后期疾病负担回升。
BAPC预测显示,2024—2035年我国LRIs疾病负担持续降低,是全球及我国LRIs疾病负担长期下降历史趋势的合理延伸,与经济发展、医疗进步、居民健康素养提升及防护意识养成相关[29]。但ASDR下降较ASIR、ASMR平缓,可能与ASDR是综合反映发病、死亡与伤残负担的指标特性相关,且LRIs导致的慢性肺功能障碍等后遗症及人口老龄化可能加剧伤残负担。
本研究存在局限性:一是受GBD数据限制,仅分析国家层面疾病负担,未纳入南北方地区数据,可能掩盖区域差异;二是仅分析主要病原体类别,未对病原体亚型、耐药菌株及混合感染进一步分层,病原谱解析不够精细。
综上所述,1990—2023年我国LRIs疾病负担总体显著降低,彰显了医疗进步与防控策略的综合成效。COVID-19大流行期间疾病负担受NPIs影响降至最低后因“免疫负债”反弹,后疫情时期细菌仍是主要致病菌,年龄负担已从儿童转向老年群体。未来12年疾病负担将持续降低,在巩固已有成效的同时,应聚焦人口老龄化、环境污染及细菌耐药等问题,以推动LRIs疾病负担实质性降低。
  • 山东省医药卫生科技项目(202303081264)
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2026年第53卷第16期
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doi: 10.20043/j.cnki.MPM.202512292
  • 接收时间:2025-12-18
  • 首发时间:2026-09-28
  • 出版时间:2026-08-25
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  • 收稿日期:2025-12-18
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山东省医药卫生科技项目(202303081264)
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    烟台市奇山医院,山东 烟台 264000

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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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