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Article(id=1322589955579297908, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202408140, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1723305600000, receivedDateStr=2024-08-11, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793259617942, onlineDateStr=2026-10-29, pubDate=1736438400000, pubDateStr=2025-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793259617942, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793259617942, creator=13701087609, updateTime=1793259617942, updator=13701087609, issue=Issue{id=1322589954702688372, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='1736438400000', pubDateStr='2025-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793259617734, creator='13701087609', updateTime=1793260023378, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322591656147276425, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322591656147276426, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322589954702688372, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=40, endPage=44, ext={EN=ArticleExt(id=1322589955944202357, articleId=1322589955579297908, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Age-period-cohort analysis of trends in AIDS and sexually transmitted infection mortality attributed to unsafe sexual behavior in China from 1990 to 2019, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To evaluate the long-term trends in mortality rates attributed to AIDS and sexually transmitted infections (STIs) due to unsafe sexual behavior in China from 1990 to 2019.

Methods

Data on AIDS and STI mortality attributed to unsafe sexual behavior were sourced from the Global Burden of Disease Study (GBD) 2019. An age-period-cohort model was employed to assess potential age, period, and cohort effects on long-term trends.

Results

From 1990 to 2019, the overall annual percentage change in mortality rates attributed to unsafe sexual behavior was 3.4% (95%CI: 3.0%-3.7%) for females and 6.4% (95%CI: 6.0%-6.8%) for males in China. Among different age groups, males aged 25 to 79 showed a higher annual percentage change than females (P<0.05). In the reference cohort, male mortality rates increased with age, while female mortality rates declined after the age of 79. The period mortality risk for males exhibited a consistently increasing trend, whereas the period mortality risk for females slightly decreased between 2010 and 2014 but increased thereafter. Mortality risks for both males and females born after 1925-1929 showed an upward trend over time.

Conclusion

Between 1990 and 2019, there was an increase in mortality rates attributed to AIDS and STIs due to unsafe sexual behavior among both males and females in China. Unsafe sexual behavior remains a significant issue in the prevention and control of AIDS and STIs. Strengthening sexual education, promoting condom use during sexual activities, and ensuring cleanliness in sexual behavior are essential.

, authors=Yi-wei QIU, Li CHENG, Ru-hai BAI, authorsList=Yi-wei QIU, Li CHENG, Ru-hai BAI, authorCompany=null, correspAuthors=Ru-hai BAI, 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=1322589964735463555, articleId=1322589955579297908, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=1990—2019年中国归因于不安全性行为的艾滋病和性传播感染死亡趋势的年龄-时期-队列分析, 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

评估1990—2019年中国归因于不安全性行为的艾滋病和性传播感染死亡率的长期趋势。

方法

归因于不安全性行为的艾滋病和性传播感染数据来源于全球疾病负担研究（GBD）2019，采用年龄-时期-队列模型来评估长期趋势下潜在的年龄、时期、队列效应。

结果

1990—2019年中国女性归因于不安全性行为的艾滋病和性传播感染死亡率的总体年度变化百分比为3.4%（95%CI:3.0%～3.7%），男性为6.4%（95%CI:6.0%～6.8%）。对于各年龄组，25～79岁之间，男性的年度变化百分比均高于女性（P<0.05）。在参考队列中，男性的死亡率随着年龄的增长而增加，女性在79岁以后年龄死亡率下降。男性的时期死亡风险呈现单调上升趋势，女性的时期死亡风险在2010—2014年略微下降，2015年之后有所增加。1925—1929年后出生的男女性死亡风险随着出生时间的推移呈上升趋势。

结论

1990—2019年，中国男性和女性归因于不安全性行为的艾滋病和性传播感染死亡率都有所增加。不安全性行为是当前艾滋病和性传播感染防控面临的重要问题。加强性教育、性活动时使用安全套、注意性行为清洁等十分必要。

, authors=邱怡玮, 程丽, 柏如海, authorsList=邱怡玮, 程丽, 柏如海, authorCompany=null, correspAuthors=柏如海, authorNote=

邱怡玮（2003—），女，本科在读，研究方向:公共卫生

, correspAuthorsNote=
柏如海，E-mail:
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邱怡玮（2003—），女，本科在读，研究方向:公共卫生

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邱怡玮（2003—），女，本科在读，研究方向:公共卫生

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Journal of Tropical Medicine, 2019, 19(5): 629-632.(In Chinese), articleTitle=Clinical application study of a domestic human immunodeficiency virus nucleic acid quantitative detection kit, refAbstract=null)], funds=[Fund(id=1322589973925183662, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589955579297908, awardId=202410288092Z, language=CN, fundingSource=国家级大学生创新创业训练计划(202410288092Z), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322589965947617412, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589955579297908, xref=null, ext=[AuthorCompanyExt(id=1322589965968588933, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589955579297908, companyId=1322589965947617412, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Affairs, Nanjing University of Science and Technology, Nanjing, Jiangsu 210000, China), 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language=EN, label=Figure 3, caption=Longitudinal age-specific, sex-specific risk of death from AIDS and sexually transmitted infections attributable to unsafe sex, with corresponding 95%CI, in China, figureFileSmall=b6x7t7NcX1KBcw3zl3tBQA==, figureFileBig=XjD5LUv3skjWcm0VLvQwaw==, tableContent=null), ArticleFig(id=1322589973413478567, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589955579297908, language=CN, label=图3, caption=中国特定年龄组、不同性别归因于不安全性行为的艾滋病和性传播感染死亡风险的纵向年龄曲线及相应的95%CI, figureFileSmall=b6x7t7NcX1KBcw3zl3tBQA==, figureFileBig=XjD5LUv3skjWcm0VLvQwaw==, tableContent=null), ArticleFig(id=1322589973480587432, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589955579297908, language=EN, label=Figure 4, caption=Period relative risks and 95%CI for the risk of death from AIDS and sexually transmitted infections attributable to unsafe sex, by sex, in China, figureFileSmall=HRarvTCKHPagvGPkDVEHMg==, figureFileBig=5Ux4xeYEpDdS4mV2G7RDyw==, tableContent=null), ArticleFig(id=1322589973543501993, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589955579297908, language=CN, label=图4, caption=中国不同性别归因于不安全性行为的艾滋病和性传播感染死亡风险的时期相对风险和95%CI, figureFileSmall=HRarvTCKHPagvGPkDVEHMg==, figureFileBig=5Ux4xeYEpDdS4mV2G7RDyw==, tableContent=null), ArticleFig(id=1322589973610610858, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589955579297908, language=EN, label=Figure 5, caption=Cohort relative risks and 95%CI for risk of death from AIDS and sexually transmitted infections attributable to unsafe sex, by sex, in China, figureFileSmall=+H4kiRCtgOai6QB9YRwLSw==, figureFileBig=5c/F68T+tXSsqddZv14WIw==, tableContent=null), ArticleFig(id=1322589973673525419, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589955579297908, language=CN, label=图5, caption=中国不同性别归因于不安全性行为的艾滋病和性传播感染死亡风险的队列相对风险和95%CI, figureFileSmall=+H4kiRCtgOai6QB9YRwLSw==, figureFileBig=5c/F68T+tXSsqddZv14WIw==, tableContent=null), ArticleFig(id=1322589973757411500, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589955579297908, language=EN, label=Table 1, caption=

Levels of AIDS and sexually transmitted infection deaths attributable to unsafe sex, China, 1990—2019

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年份（年）粗死亡率（1/10万）标化死亡率（1/10万）
男性女性男性女性
19900.200.220.250.25
20000.430.410.480.47
20100.840.420.960.64
20191.951.051.550.79
总变化率（%）*875377520216
), ArticleFig(id=1322589973837103277, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322589955579297908, language=CN, label=表1, caption=

1990—2019年中国归因于不安全性行为的艾滋病和性传播感染死亡水平

, figureFileSmall=null, figureFileBig=null, tableContent=
年份（年）粗死亡率（1/10万）标化死亡率（1/10万）
男性女性男性女性
19900.200.220.250.25
20000.430.410.480.47
20100.840.420.960.64
20191.951.051.550.79
总变化率（%）*875377520216
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1990—2019年中国归因于不安全性行为的艾滋病和性传播感染死亡趋势的年龄-时期-队列分析
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邱怡玮 , 程丽 , 柏如海
现代预防医学 | 流行病与统计方法 2025,52(1): 40-44
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现代预防医学 |流行病与统计方法 2025 , 52 (1) : 40 -44
1990—2019年中国归因于不安全性行为的艾滋病和性传播感染死亡趋势的年龄-时期-队列分析
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邱怡玮, 程丽, 柏如海
作者信息
  • 南京理工大学公共事务学院，江苏 南京 210000
通讯作者:
柏如海，E-mail:
作者简介:

邱怡玮（2003—），女，本科在读，研究方向:公共卫生

Age-period-cohort analysis of trends in AIDS and sexually transmitted infection mortality attributed to unsafe sexual behavior in China from 1990 to 2019
Yi-wei QIU, Li CHENG, Ru-hai BAI
Affiliations
  • School of Public Affairs, Nanjing University of Science and Technology, Nanjing, Jiangsu 210000, China
出版时间: 2025-01-10 doi: 10.20043/j.cnki.MPM.202408140
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摘要
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目的

评估1990—2019年中国归因于不安全性行为的艾滋病和性传播感染死亡率的长期趋势。

方法

归因于不安全性行为的艾滋病和性传播感染数据来源于全球疾病负担研究（GBD）2019，采用年龄-时期-队列模型来评估长期趋势下潜在的年龄、时期、队列效应。

结果

1990—2019年中国女性归因于不安全性行为的艾滋病和性传播感染死亡率的总体年度变化百分比为3.4%（95%CI:3.0%～3.7%），男性为6.4%（95%CI:6.0%～6.8%）。对于各年龄组，25～79岁之间，男性的年度变化百分比均高于女性（P<0.05）。在参考队列中，男性的死亡率随着年龄的增长而增加，女性在79岁以后年龄死亡率下降。男性的时期死亡风险呈现单调上升趋势，女性的时期死亡风险在2010—2014年略微下降，2015年之后有所增加。1925—1929年后出生的男女性死亡风险随着出生时间的推移呈上升趋势。

结论

1990—2019年，中国男性和女性归因于不安全性行为的艾滋病和性传播感染死亡率都有所增加。不安全性行为是当前艾滋病和性传播感染防控面临的重要问题。加强性教育、性活动时使用安全套、注意性行为清洁等十分必要。

艾滋病  /  性传播感染  /  不安全性行为  /  死亡率  /  年龄-时期-队列效应
Objective

To evaluate the long-term trends in mortality rates attributed to AIDS and sexually transmitted infections (STIs) due to unsafe sexual behavior in China from 1990 to 2019.

Methods

Data on AIDS and STI mortality attributed to unsafe sexual behavior were sourced from the Global Burden of Disease Study (GBD) 2019. An age-period-cohort model was employed to assess potential age, period, and cohort effects on long-term trends.

Results

From 1990 to 2019, the overall annual percentage change in mortality rates attributed to unsafe sexual behavior was 3.4% (95%CI: 3.0%-3.7%) for females and 6.4% (95%CI: 6.0%-6.8%) for males in China. Among different age groups, males aged 25 to 79 showed a higher annual percentage change than females (P<0.05). In the reference cohort, male mortality rates increased with age, while female mortality rates declined after the age of 79. The period mortality risk for males exhibited a consistently increasing trend, whereas the period mortality risk for females slightly decreased between 2010 and 2014 but increased thereafter. Mortality risks for both males and females born after 1925-1929 showed an upward trend over time.

Conclusion

Between 1990 and 2019, there was an increase in mortality rates attributed to AIDS and STIs due to unsafe sexual behavior among both males and females in China. Unsafe sexual behavior remains a significant issue in the prevention and control of AIDS and STIs. Strengthening sexual education, promoting condom use during sexual activities, and ensuring cleanliness in sexual behavior are essential.

AIDS  /  Sexually transmitted infections  /  Unsafe sexual behavior  /  Mortality rate  /  Age-period-cohort effects
邱怡玮, 程丽, 柏如海. 1990—2019年中国归因于不安全性行为的艾滋病和性传播感染死亡趋势的年龄-时期-队列分析. 现代预防医学, 2025 , 52 (1) : 40 -44 . DOI: 10.20043/j.cnki.MPM.202408140
Yi-wei QIU, Li CHENG, Ru-hai BAI. Age-period-cohort analysis of trends in AIDS and sexually transmitted infection mortality attributed to unsafe sexual behavior in China from 1990 to 2019[J]. Modern Preventive Medicine, 2025 , 52 (1) : 40 -44 . DOI: 10.20043/j.cnki.MPM.202408140
正文
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不安全性行为（unsafe sex）是指未采取避孕措施、未避免感染与传播感染性疾病或处于不健康的精神状态下进行的性行为，包括无保护措施的性行为、受酒精或毒品影响的性行为以及以金钱或毒品为交换条件的性行为[1]。全球范围内，1990—2019年由于不安全性行为导致的年龄标准化伤残调整寿命年增加了39.3%，在2019年达到了570.78/10万人[1]。不安全性行为会增加艾滋病和性传播疾病感染风险，是艾滋病和性传播感染发生的重要危险因素之一[2]。多年以来，我国艾滋病的死亡率一直居乙类传染病首位[3]。研究发现，随着时间推移，中国艾滋病死亡率逐年上升（2004年为0.057；2016年为1.034）[4]。截至2020年底，中国有105.3万艾滋病患者，累积报告死亡人数为35.1万人[5]。既往较少有研究评估归因于不安全性行为的艾滋病和性传播感染死亡率的长期趋势。本研究利用全球疾病负担数据库（Global Burden of Disease，GBD）评估中国归因于不安全性行为的艾滋病和性传播感染死亡率的长期趋势，旨在为艾滋病和性传播感染的防治工作和卫生资源分配提供参考。
1　资料与方法
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1.1　资料来源
本研究所用数据来源于GBD 2019。GBD 2019对1990—2019年369种疾病和伤害的发病率、患病率、死亡率等信息提供了系统科学的评估[6]。
本研究中的不安全性行为被定义为由于性传播而导致的疾病风险，研究所估算的GBD中与不安全性行为相关的结果包括艾滋病、宫颈癌和所有性传播疾病，但新生儿因垂直传播而感染的性病除外。
1.2　统计分析
为了探索归因于不安全性行为的艾滋病和性传播感染死亡率长期趋势下潜在的年龄、时期、队列效应，本研究使用了年龄-时期-队列模型（age-period-cohort，APC），具体方程式为:
其中，时间效应αage、时期效应βper和队列效应γcoh是这一多元回归模型中的系数。在APC模型中，年龄效应代表不同年龄组的不同风险，时期效应代表不同时期的风险差异，队列效应代表不同出生队列的风险差异。
利用APC模型，本研究对以下参数进行了估计。净漂移是指随着时间推移的总体年度百分比变化[7]。局部漂移是指特定年龄组的年度百分比变化。死亡率的纵向年龄曲线代表年龄效应，表示在调整时期偏差后，参考队列中特定年龄的纵向死亡率[7]。时期相对风险，代表时期效应，反映不同时期的不同死亡风险；队列相对风险，代表队列效应，反映不同出生队列的不同死亡风险[8]。
本研究将死亡率数据分为1990—1994年（中位数为1992年）至2015—2019年（中位数为2017年）的连续6个5年时间段分组。年龄组根据5岁时间间隔分为10～14岁至80～84岁15个连续年龄组。出生队列划分为1910—1914年（中位数为1912年）到2005—2009年（中位数为2007年）的20个队列。所有统计检验均为双侧检验，检验水准α=0.05。
2　结果
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2.1　归因于不安全性行为的艾滋病和性传播感染死亡率趋势
1990—2019年归因于不安全性行为的艾滋病和性传播感染的男性和女性粗死亡率（crude mortality rate，CMR）和年龄标准化死亡率（age-standardized mortality rate，ASMR）总体呈波动上升趋势。男性粗死亡率从1990年的0.20/10万上升到2019年的1.95/10万，增长了875%，女性从1990年的0.22/10万上升到2019年的1.05/10万，增长了377%。男性ASMR从1990年的0.25/10万上升到2019年的1.55/10万，增长了520%，女性从1990年的0.25/10万上升到2019年的0.79/10万，增长了216%。1992年后男性ASMR一直高于女性。见表1、图1。
2.2　归因于不安全性行为的艾滋病和性传播感染死亡率的年度百分比变化
女性1990—2019年归因于不安全性行为的艾滋病和性传播感染死亡率的总体年度变化百分比为3.4%（95%CI:3.0%～3.7%），其中15～19岁年龄组年度变化百分比最高，为4.7%(95%CI: 3.2%～6.3%),75～79岁最低,为1.1% (95%CI:-0.1%～2.3%)。男性为6.4%（95%CI:6.0%～6.8%），其中50～54岁年龄组年度变化百分比最高，为7.1%(95%CI: 6.4%～7.8%), 80～84岁最低，为3.4%(95%CI: 1.2%～5.7%)。25～79岁之间，男性的年度变化百分比均高于女性（P<0.05）。见图2。
2.3　归因于不安全性行为的艾滋病和性传播感染死亡风险的纵向年龄曲线
图3显示了归因于不安全性行为的艾滋病和性传播感染死亡率的纵向年龄曲线。在同一队列中，男性和女性归因于不安全性行为的艾滋病和性传播感染导致的死亡率随着年龄的增长而增加。60岁以后，男性死亡率高于女性（P<0.05），且男性死亡率呈指数增加，女性在79岁以后死亡率下降。见图3。
2.4　归因于不安全性行为的艾滋病和性传播感染死亡风险的时期相对风险
研究发现，就时期效应而言，中国男性归因于不安全性行为的艾滋病和性传播感染死亡风险随着时间推移持续增加，2015—2019年的死亡风险是1990—1994年的5.05倍。对于女性而言，归因于不安全性行为的艾滋病和性传播感染死亡风险在2010—2014年略微下降，2015年之后继续增加。2015—2019年的死亡风险是1990—1994年的2.72倍。见图4。
2.5　归因于不安全性行为的艾滋病和性传播感染死亡风险的队列相对风险
1920—1924年前出生的男女性归因于不安全性行为的艾滋病和性传播感染死亡风险随着出生时间的推移有所下降。1925—1929年后出生的男女性死亡风险随着出生时间的推移呈上升趋势。1910—1914年至1950—1954年女性队列死亡风险大于男性，1960—1964年至1990—1994年男性队列死亡风险大于女性。见图5。
3　讨论
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本研究描述了中国归因于不安全性行为的艾滋病和性传播感染死亡率的长期趋势，利用APC模型探索了长期趋势下潜在的年龄、时期、队列效应。
研究结果显示，过去30年，我国归因于不安全性行为的艾滋病和性传播感染的ASMR和粗死亡率在中国男性和女性中均有上升，这一结果与以往研究一致[4]。过去近20年，中国不安全性行为持续增加，且已成为我国目前艾滋病和性传播感染的主要原因[9]。中国公安部门认定的性工作者人数从1986年的2.5万人增加到1992年的25万人，到1996年增加到42万人，实际涉及商业性交易人数估计在300～400万人之间，性工作者是不安全性行为产生的重要人群[10]。本研究显示，过去30年男性归因于不安全性行为的艾滋病和性传播感染死亡率增加幅度明显高于女性，这可能与男男性行为的比例增加有关。过去12年，中国男男性行为增长了近15倍，从2006年的1.5%上升到2018年的23.4%[11]。男男性行为者是中国艾滋病流行的核心人群，在中国承担着较重的艾滋病与性传播感染负担，成为我国艾滋病和性传播感染防治面临的主要挑战之一[12]。艾滋病的治疗效果也可能是造成男女性归因于不安全性行为的艾滋病和性传播感染死亡率差异的原因。研究表明，抗逆转病毒疗法（antiretroviral therapy，ART）不仅有助于降低全球艾滋病的死亡率，而且女性比男性受益更多[13-14]。自2002年中国政府免费提供抗反转病毒药物以来，为监测和评估治疗过程而建立的免费抗反转录病毒药物数据库表明，与男性相比，女性能够获得更好的抗反转录病毒治疗效果[14]。
本研究结果显示，过去30年，男性归因于不安全性行为的艾滋病和性传播感染死亡风险随着年龄的增加呈“J”字形上升趋势，这与既往研究结果一致[15]。一方面，大多数艾滋病和性传播感染者通常需要数年时间才能出现症状[16]。这种滞后效应一定程度导致归因于不安全性行为的艾滋病和性传播感染死亡风险随着年龄增加而增加。另外，无保护措施的商业异性性行为也是艾滋病和性传播感染在老年男性中传播并致死的主要途径[17]。老年男性个体的身体状况和性需求仍处于较高水平[4]，然而，由于缺乏性教育，这类人群对艾滋病知识的知晓程度和对风险的感知程度都极低，因此常发生不安全性行为[18]。而老年女性的死亡率主要由配偶间传染引起[17]。因此，对老年男性进行长期深入的艾滋病和性传播感染科普教育至关重要。
结果显示，从1990—1994年到2015—2019年，中国男性归因于不安全性行为的艾滋病和性传播感染的时期死亡风险随着时间推移持续增加，女性的时期死亡风险除在2010—2014年略微下降外，其他时期都呈上升趋势。随着时间推移，中国的社会思想观念更为包容，多元的性文化被更多社会群众了解，性文化的广泛传播带来性态度和性行为的日益开放[19]。然而，与此同时存在的性教育缺失、性教育不全面等问题逐渐暴露，多性伴、不使用避孕套等不安全的性行为发生频率大大增加[20]。但女性时期死亡风险在2010—2014年略微下降，可能与中国政府此前推出的一项名为国家免费抗反转录病毒的药物有关。截至2009年底，已有超过8万名艾滋病患者接受了抗反转录病毒治疗[21]。有研究表明，与男性相比，女性在接受抗反转录病毒治疗期间总体上有更好的免疫反应[22]。此外，在抗反转录病毒疗法试点的同时，中国也试行了预防母婴传播的可行性实验，即向艾滋病毒检测呈现阳性的母亲提供咨询、堕胎或抗反转录病毒治疗的选择[23]。服务范围在2007年至少覆盖85%的受感染孕妇，2010年至少达到90%[23]。
本研究结果显示，随着出生时间的推移，男性和女性归因于不安全性行为的艾滋病和性传播感染死亡风险增加，即晚出生者由于不安全性行为导致的艾滋病和性传播感染死亡风险更高。近几十年来，中国互联网的快速普及与发展、商业和婚外性行为增加、男男性行为者增多等现象的发生都增加了不安全性行为的暴露，包括无避孕套性交、拥有多个性伴侣、与临时性伴侣发生性关系等[24]。这些因素导致我国归因于不安全性行为的艾滋病和性传播感染死亡风险持续增加。另外，伴随着现代医学技术不断进步，检测艾滋病和性传播感染的途径增加，覆盖面也更加广泛，能够筛查出更多潜在的艾滋病和性传播感染患者[25]。
本研究存在一些局限性。一方面，这是一项生态学研究，对宏观趋势的分析结果并不一定适用于个体。另一方面，GBD关于不安全性行为导致的艾滋病和性传播感染的评估并未区分城市与农村地区，也没有省级层面的数据，未能对中国不同地区的不安全性行为导致的艾滋病和性传播感染进行分析，因此有必要开展针对不同地区的评估。
综上，1990—2019年，中国男性和女性归因于不安全性行为的艾滋病和性传播感染的死亡率总体呈现上升趋势，给中国医疗保健系统带来了沉重的疾病负担。由于性行为不洁、拥有多性伴、性活动中不使用避孕套等不安全性行为的频繁发生，归因于不安全性行为的艾滋病和性传播感染的死亡率带来的疾病负担仍然是今后面临的严重公共卫生问题。因此，中国应加大努力，如加强性教育、扩大安全套适用范围、对男男性行为者提供适当的性行为建议等，以减轻归因于不安全性行为的艾滋病和性传播对中国日益增加的影响。
基金
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  • 国家级大学生创新创业训练计划(202410288092Z)
文献
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doi: 10.20043/j.cnki.MPM.202408140
  • 接收时间：2024-08-11
  • 首发时间：2026-10-29
  • 出版时间：2025-01-10
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  • 收稿日期：2024-08-11
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国家级大学生创新创业训练计划(202410288092Z)
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    南京理工大学公共事务学院，江苏 南京 210000

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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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