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Article(id=1322607865286742349, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322607837742747790, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202410254, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1729094400000, receivedDateStr=2024-10-17, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793263887949, onlineDateStr=2026-10-29, pubDate=1761321600000, pubDateStr=2025-10-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793263887949, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793263887949, creator=13701087609, updateTime=1793263887949, updator=13701087609, issue=Issue{id=1322607837742747790, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='20', pageStart='3649', pageEnd='3840', issueExtLink='null', onlineDate='null', pubDate='1761321600000', pubDateStr='2025-10-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793263881383, creator='13701087609', updateTime=1793264238791, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322609336933794638, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322607837742747790, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322609336933794639, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322607837742747790, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3686, endPage=3692, ext={EN=ArticleExt(id=1322607865739727182, articleId=1322607865286742349, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Study on the long-term impacts and trends of environmental factors on the burden of chronic respiratory diseases, China, 1990-2021, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To assess the impact of environmental factors on the chronic respiratory disease (CRD) burden among the Chinese population during 1990—2021, providing scientific evidence for formulating targeted prevention strategies and clinical interventions.

Methods

Based on the data of the Global Burden of Disease Study 2021 (GBD 2021), this study adopted descriptive epidemiological methods to analyze the disease burden indicators of chronic respiratory diseases (CRD). Further, the Joinpoint regression model was used to analyze the temporal trend changes of disease burden, and the Age-Period-Cohort (APC) model was constructed to systematically evaluate the impact of environmental risk factors on the disease burden of CRD.

Results

Both the CRD-standardised mortality rate and the standardised DALY rate showed a decreasing trend over the period (P<0.05). As of 2021, outdoor particulate matter has become the primary contributor to the burden of chronic respiratory disease in China. The impact of environmental factors on the disease burden of CRD in China increased with age, with those aged 80 years or older being the most severely affected. Cohort analyses showed that people born in 1912—1951 were more affected by environmental factors, especially indoor air pollution and ambient particulate matter.

Conclusion

The long-term impact of environmental factors on the disease burden of CRD among Chinese residents still cannot be ignored. It is necessary to further strengthen environmental monitoring, formulate and implement stricter environmental standards, especially in controlling outdoor air pollution.

, authors=Lei WANG1, Yu SHI1, Yan-ling ZHENG2, Li-ping ZHANG2, authorsList=Lei WANG, Yu SHI, Yan-ling ZHENG, Li-ping ZHANG, authorCompany=null, correspAuthors=Li-ping ZHANG, 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=1322607869439103323, articleId=1322607865286742349, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=中国1990—2021年环境因素对慢性呼吸系统疾病负担的长期影响及趋势研究, columnId=1228016571273113811, journalTitle=现代预防医学, columnName=环境与职业卫生, runingTitle=null, highlight=null, articleAbstract=
目的

系统评估1990—2021年环境因素对中国居民慢性呼吸系统疾病（Chronic respiratory diseases, CRD）疾病负担的影响，为制定针对性的预防策略和临床干预措施提供科学依据。

方法

基于2021年全球疾病负担研究（Global Burden of Disease Study 2021, GBD 2021）数据，本研究采用描述性流行病学方法分析慢性呼吸系统疾病（CRD）疾病负担指标。进一步运用Joinpoint回归模型分析疾病负担的时间趋势变化，并构建年龄—时期—队列（Age-Period-Cohort, APC）模型，系统评估环境危险因素对CRD疾病负担的影响。

结果

CRD标化死亡率和标化DALY率在此期间均呈下降趋势（P<0.05）。截止2021年，室外颗粒物已成为引起中国慢性呼吸系统疾病负担的首要因素。环境因素对中国CRD疾病负担的影响随年龄增长而加剧。队列分析显示，1912—1951年出生的人群受环境因素影响较大，尤其是室内空气污染和环境颗粒物。

结论

环境因素对中国居民CRD疾病负担的长期影响仍不容忽视，需要进一步加强环境监测，制定并执行更为严格的环境标准，尤其是在控制室外空气污染方面。

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王磊（2001—），男，硕士在读，研究方向：流行病与卫生统计学

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张利萍，E-mail:
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Trends in mortality and disability-adjusted life years for chronic respiratory diseases and their risk factors from 1990 to 2017: Analysis from the 2017 global burden of disease study [J]. Chinese Journal of the British Medical Journal, 2020, 23 (7): 382-389. (In Chinese), articleTitle=Trends in mortality and disability-adjusted life years for chronic respiratory diseases and their risk factors from 1990 to 2017: Analysis from the 2017 global burden of disease study, refAbstract=null), Reference(id=1322607882894430644, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, doi=null, pmid=null, pmcid=null, year=2024, volume=16, issue=4, pageStart=442, pageEnd=447, url=null, language=null, rfNumber=[24], rfOrder=38, authorNames=苏鑫, 范雯怡, 徐昕晔, journalName=中国癌症防治杂志, refType=null, unstructuredReference=苏鑫，范雯怡，徐昕晔, 等. 中国居民癌症等四大慢病危险因素及归因疾病负担分析 [J]. 中国癌症防治杂志, 2024, 16 (4): 442-447., articleTitle=中国居民癌症等四大慢病危险因素及归因疾病负担分析, refAbstract=null), Reference(id=1322607882965733813, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, doi=null, pmid=null, pmcid=null, year=2024, volume=16, issue=4, pageStart=442, pageEnd=447, url=null, language=null, rfNumber=[24], rfOrder=39, authorNames=Su X, Fan WY, Xu XY, journalName=Chinese Journal of Cancer Prevention and Control, refType=null, unstructuredReference=Su X, Fan WY, Xu XY, et al. Analysis of risk factors for four major chronic diseases, including cancer, and their attributable disease burden among Chinese residents [J]. Chinese Journal of Cancer Prevention and Control, 2024, 16 (4): 442-447. (In Chinese), articleTitle=Analysis of risk factors for four major chronic diseases, including cancer, and their attributable disease burden among Chinese residents, refAbstract=null), Reference(id=1322607883058008502, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, doi=null, pmid=null, pmcid=null, year=2007, volume=29, issue=6, pageStart=108, pageEnd=112, url=null, language=null, rfNumber=[25], rfOrder=40, authorNames=陈金花, 卢军, journalName=重庆建筑大学学报, refType=null, unstructuredReference=陈金花，卢军. 室内空气污染治理的研究进展 [J]. 重庆建筑大学学报, 2007, 29 (6): 108-112., articleTitle=室内空气污染治理的研究进展, refAbstract=null), Reference(id=1322607883171254711, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, doi=null, pmid=null, pmcid=null, year=2007, volume=29, issue=6, pageStart=108, pageEnd=112, url=null, language=null, rfNumber=[25], rfOrder=41, authorNames=Chen JH, Lu J, journalName=Journalof Chongqing Jianzhu University, refType=null, unstructuredReference=Chen JH, Lu J. On indoor air pollution and indoor air quality control [J]. Journalof Chongqing Jianzhu University, 2007, 29 (6): 108-112. (In Chinese), articleTitle=On indoor air pollution and indoor air quality control, refAbstract=null)], funds=[Fund(id=1322607876498117004, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, awardId=72163033; 72174175, language=CN, fundingSource=国家自然科学基金资助项目(72163033; 72174175), fundOrder=null, country=null), Fund(id=1322607876774941069, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, awardId=null, language=CN, fundingSource=新疆维吾尔自治“十四五”高等学校特色学科-公共卫生与预防医学, fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322607869627847004, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, xref=1., ext=[AuthorCompanyExt(id=1322607869636235613, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, companyId=1322607869627847004, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang 830017, China), AuthorCompanyExt(id=1322607869640429918, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, companyId=1322607869627847004, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.新疆医科大学公共卫生学院，新疆　乌鲁木齐　830017)]), AuthorCompany(id=1322607869711733087, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, xref=2., ext=[AuthorCompanyExt(id=1322607869720121696, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, companyId=1322607869711733087, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.新疆医科大学医学工程技术学院)])], figs=[ArticleFig(id=1322607873406914941, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=EN, label=Fig.1, caption=Trends in disease burden by gender, figureFileSmall=W4L35GsIifWtBqeNah2Nqg==, figureFileBig=oVCLIBS5Rzx3VyNDQ5fssw==, tableContent=null), ArticleFig(id=1322607873490801022, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=CN, label=图1, caption=不同性别的疾病负担变化趋势

注：A 不同性别的死亡例数和ASMR变化趋势；B 不同性别的DALY和ASDR变化趋势。

, figureFileSmall=W4L35GsIifWtBqeNah2Nqg==, figureFileBig=oVCLIBS5Rzx3VyNDQ5fssw==, tableContent=null), ArticleFig(id=1322607873784402303, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=EN, label=Fig.2, caption=Trends in disease burden by age group, figureFileSmall=0pDlcbYRXPXlgkCT8cuRbA==, figureFileBig=XfF03mt0uYyWNSAO5Arkuw==, tableContent=null), ArticleFig(id=1322607873851511168, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=CN, label=图2, caption=年龄分层的疾病负担变化趋势

注：A 不同年龄段的死亡例数变化趋势；B 不同年龄段的DALY变化趋势；C 不同年龄段的死亡率变化趋势；D 不同年龄段的DALY率变化趋势）。

, figureFileSmall=0pDlcbYRXPXlgkCT8cuRbA==, figureFileBig=XfF03mt0uYyWNSAO5Arkuw==, tableContent=null), ArticleFig(id=1322607873914425729, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=EN, label=Fig.3, caption=Percentage attribution of different risk factors, figureFileSmall=zDlGCL1BXTkrkX1z75zLVw==, figureFileBig=FDhv/Tw8yK1o/CCiQ/6XJQ==, tableContent=null), ArticleFig(id=1322607873981534594, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=CN, label=图3, caption=不同风险因素归因百分比, figureFileSmall=zDlGCL1BXTkrkX1z75zLVw==, figureFileBig=FDhv/Tw8yK1o/CCiQ/6XJQ==, tableContent=null), ArticleFig(id=1322607874178666883, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=EN, label=Fig.4, caption=Age-period-cohort model analysis of CRD in China under different environmental factors from 1990 to 2021, figureFileSmall=mOAu3pm82FO0U1jBsc2uEg==, figureFileBig=4+r23Q3t8RSFn/XiBLEutA==, tableContent=null), ArticleFig(id=1322607874254164356, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=CN, label=图4, caption=1990—2021年中国不同环境因素下CRD的年龄—时期—队列模型分析

注：A 死亡率（ASMR）的年龄—时期—队列效应分解；B 伤残调整寿命年率（ASDR）的年龄—时期—队列效应分解。

, figureFileSmall=mOAu3pm82FO0U1jBsc2uEg==, figureFileBig=4+r23Q3t8RSFn/XiBLEutA==, tableContent=null), ArticleFig(id=1322607874317078917, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=EN, label=Table 1, caption=

The burden of CRD disease attributable to environmental factors in China in 1990 and 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
分类死亡例数（例 95% UI）ASMR（/10万 95% UI）DALY（人年 95% UI）ASDR（/10万 95% UI）
全人群
1990年367 772(279 212~450 337)68.75(52.20~84.22)6 359 520(4 885 275~7 797 651)943.53(723.83~1 149.08)
2021年177 446(102 150~303 817)10.07(5.78~17.13)2 584 536(1 512 516~4 431 580)134.09(78.22~229.46)
男性
1990年186 998(139 033~238 222)82.66(62.75~103.05)3 334 785(2 467 606~4 273 106)1 096.22(825.85~1 377.76)
2021年100 537(56 502~173 537)14.03(7.93~23.93)1 449 409(812 022~2 508 028)172.30(97.56~296.24)
女性
1990年180 773(122 605~229 000)60.19(41.91~76.12)3 024 735(2 090 229~3 836 152)835.64(582.94~1 051.95)
2021年76 909(39 876~134 387)14.03(7.93~23.93)1 135 127(623 770~1 975 769)107.25(58.47~187.23)
), ArticleFig(id=1322607874384187782, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=CN, label=表1, caption=

1990年、2021年中国归因于环境因素的CRD疾病负担

, figureFileSmall=null, figureFileBig=null, tableContent=
分类死亡例数（例 95% UI）ASMR（/10万 95% UI）DALY（人年 95% UI）ASDR（/10万 95% UI）
全人群
1990年367 772(279 212~450 337)68.75(52.20~84.22)6 359 520(4 885 275~7 797 651)943.53(723.83~1 149.08)
2021年177 446(102 150~303 817)10.07(5.78~17.13)2 584 536(1 512 516~4 431 580)134.09(78.22~229.46)
男性
1990年186 998(139 033~238 222)82.66(62.75~103.05)3 334 785(2 467 606~4 273 106)1 096.22(825.85~1 377.76)
2021年100 537(56 502~173 537)14.03(7.93~23.93)1 449 409(812 022~2 508 028)172.30(97.56~296.24)
女性
1990年180 773(122 605~229 000)60.19(41.91~76.12)3 024 735(2 090 229~3 836 152)835.64(582.94~1 051.95)
2021年76 909(39 876~134 387)14.03(7.93~23.93)1 135 127(623 770~1 975 769)107.25(58.47~187.23)
), ArticleFig(id=1322607874518405511, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=EN, label=Table 2, caption=

Changes in ASMR and ASDR attributable to environmental factors by gender in China from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
变量全人群男性
年份APCa(95% CI)年份APCa(95% CI)
ASMR全因素
AAPC1990—2021-6.260(-6.922~-5.593)a1990—2021-5.947(-6.162~-5.742)a
Trend 11990—1993-1.982(-2.587~-1.374)a1990—1994-2.130(-2.640~1.617)a
Trend 21994—2000-3.928(-4.308~-3.546)a1995—2003-3.524(-3.866~-3.180)a
Trend 32001—2003-5.158(-7.910~-2.325)a2004—2021-8.284(-8.596~-7.791)a
Trend 42004—2006-10.069(-13.286~-6.734)a
Trend 52007—2009-6.563(-10.720~-2.213)a
Trend 62010—2013-10.816(-13.288~-8.274)a
Trend 72014—2021-6.953(-8.083~-5.809)a
ASDR全因素
AAPC1990—2021-6.180(-6.979~-5.374)a1990—2021-6.181(-6.362~5.999)a
Trend 11990—1993-2.227(-2.874~-1.575)a1990—1993-2.216(-2.813~1.615)a
Trend 21994—2000-4.236(-4.655~-3.815)a1994—2003-3.951(-4.199~-3.703)a
Trend 32001—2003-5.728(-8.786~-2.567)a2004—2021-8.365(-8.646~-8.084)a
Trend 42004—2018-8.745(-9.017~-8.472)a
Trend 52019—2021-1.726(-13.681~11.885)
Trend 6
Trend 7
变量女性
年份APCa(95% CI)
ASMR全因素
AAPC1990—2021-6.551(-7.311~-5.784)a
Trend 11990—1994-2.225(-2.880~-1.566)a
Trend 21995—2003-5.051(-5.372~-4.730)a
Trend 32004—2006-11.247(-14.530~-7.838)a
Trend 42007—2009-7.391(-11.457~-3.139)a
Trend 52010—2013-11.788(-14.160~-9.350)a
Trend 62014—2018-7.615(-9.592~-5.593)a
Trend 72019—2021-1.748(-8.873~5.934)
ASDR全因素
AAPC1990—2021-6.485(-7.206~-5.758)a
Trend 11990—1993-2.080(-2.966~-1.187)a
Trend 21994—2000-4.642(-5.104~-4.177)a
Trend 32001—2003-6.745(-9666~-3.730)a
Trend 42004—2010-9.132(-9.766~-8.494)a
Trend 52011—2013-10.618(-15.294~-5.683)a
Trend 62014—2018-7.817(-9.679~-5.916)a
Trend 72019—2021-1.884(-8.718~5.461)
), ArticleFig(id=1322607874589708680, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=CN, label=表2, caption=

1990—2021年中国分性别归因于环境因素CRD的ASMR、ASDR变化情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量全人群男性
年份APCa(95% CI)年份APCa(95% CI)
ASMR全因素
AAPC1990—2021-6.260(-6.922~-5.593)a1990—2021-5.947(-6.162~-5.742)a
Trend 11990—1993-1.982(-2.587~-1.374)a1990—1994-2.130(-2.640~1.617)a
Trend 21994—2000-3.928(-4.308~-3.546)a1995—2003-3.524(-3.866~-3.180)a
Trend 32001—2003-5.158(-7.910~-2.325)a2004—2021-8.284(-8.596~-7.791)a
Trend 42004—2006-10.069(-13.286~-6.734)a
Trend 52007—2009-6.563(-10.720~-2.213)a
Trend 62010—2013-10.816(-13.288~-8.274)a
Trend 72014—2021-6.953(-8.083~-5.809)a
ASDR全因素
AAPC1990—2021-6.180(-6.979~-5.374)a1990—2021-6.181(-6.362~5.999)a
Trend 11990—1993-2.227(-2.874~-1.575)a1990—1993-2.216(-2.813~1.615)a
Trend 21994—2000-4.236(-4.655~-3.815)a1994—2003-3.951(-4.199~-3.703)a
Trend 32001—2003-5.728(-8.786~-2.567)a2004—2021-8.365(-8.646~-8.084)a
Trend 42004—2018-8.745(-9.017~-8.472)a
Trend 52019—2021-1.726(-13.681~11.885)
Trend 6
Trend 7
变量女性
年份APCa(95% CI)
ASMR全因素
AAPC1990—2021-6.551(-7.311~-5.784)a
Trend 11990—1994-2.225(-2.880~-1.566)a
Trend 21995—2003-5.051(-5.372~-4.730)a
Trend 32004—2006-11.247(-14.530~-7.838)a
Trend 42007—2009-7.391(-11.457~-3.139)a
Trend 52010—2013-11.788(-14.160~-9.350)a
Trend 62014—2018-7.615(-9.592~-5.593)a
Trend 72019—2021-1.748(-8.873~5.934)
ASDR全因素
AAPC1990—2021-6.485(-7.206~-5.758)a
Trend 11990—1993-2.080(-2.966~-1.187)a
Trend 21994—2000-4.642(-5.104~-4.177)a
Trend 32001—2003-6.745(-9666~-3.730)a
Trend 42004—2010-9.132(-9.766~-8.494)a
Trend 52011—2013-10.618(-15.294~-5.683)a
Trend 62014—2018-7.817(-9.679~-5.916)a
Trend 72019—2021-1.884(-8.718~5.461)
), ArticleFig(id=1322607874665206153, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=EN, label=Table 3, caption=

Changes in ASMR and ASDR of CRD under different environmental factors in China from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
变量全人群AAPCa(95% CI)男性AAPCa(95% CI)女性AAPCa(95% CI)
ASMR
室外颗粒物污染-5.587(-6.073~-5.098)a-5.141(-5.762~-4.515)a-6.032(-6.444~-5.618)a
室外臭氧污染-3.734(-4.317~-3.147)a-3.338(-4.190~-2.479)a-4.241(-4.853~-3.625)a
非适宜温度（高温）-2.929(-3.729~-2.122)a-2.142(-2.966~-1.312)a-3.810(-4.607~-3.007)a
非适宜温度（低温）-4.032(-5.220~-2.828)a-3.666(-4.567~-2.575)a-4.363(-5.457~-3.256)a
室内空气污染-9.510(-10.125~-8.890)a-9.402(-10.020~-8.779)a-9.635(-10.888~-8.364)a
ASDR
室外颗粒物污染-5.547(-5.948~-5.144)a-5.296(-5.801~-4.788)a-5.799(-6.050~-5.548)a
室外臭氧污染-4.091(-4.664~-3.515)a-3.780(-4.519~-3.035)a-4.596(-5.201~-3.987)a
非适宜温度（高温）-3.225(-4.018~-2.426)a-2.502(-3.308~-1.690)a-4.120(-4.918~-3.316)a
非适宜温度（低温）-4.368(-5.540~-3.183)a-4.047(-4.931~-3.153)a-4.680(-5.740~-3.608)a
室内空气污染-9.464(-10.300~-8.620)a-9.519(-10.437~-8.591)a-9.391(-10.121~-8.655)a
), ArticleFig(id=1322607874937835914, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322607865286742349, language=CN, label=表3, caption=

1990—2021年中国不同环境因素下CRD的ASMR、ASDR变化情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量全人群AAPCa(95% CI)男性AAPCa(95% CI)女性AAPCa(95% CI)
ASMR
室外颗粒物污染-5.587(-6.073~-5.098)a-5.141(-5.762~-4.515)a-6.032(-6.444~-5.618)a
室外臭氧污染-3.734(-4.317~-3.147)a-3.338(-4.190~-2.479)a-4.241(-4.853~-3.625)a
非适宜温度（高温）-2.929(-3.729~-2.122)a-2.142(-2.966~-1.312)a-3.810(-4.607~-3.007)a
非适宜温度（低温）-4.032(-5.220~-2.828)a-3.666(-4.567~-2.575)a-4.363(-5.457~-3.256)a
室内空气污染-9.510(-10.125~-8.890)a-9.402(-10.020~-8.779)a-9.635(-10.888~-8.364)a
ASDR
室外颗粒物污染-5.547(-5.948~-5.144)a-5.296(-5.801~-4.788)a-5.799(-6.050~-5.548)a
室外臭氧污染-4.091(-4.664~-3.515)a-3.780(-4.519~-3.035)a-4.596(-5.201~-3.987)a
非适宜温度（高温）-3.225(-4.018~-2.426)a-2.502(-3.308~-1.690)a-4.120(-4.918~-3.316)a
非适宜温度（低温）-4.368(-5.540~-3.183)a-4.047(-4.931~-3.153)a-4.680(-5.740~-3.608)a
室内空气污染-9.464(-10.300~-8.620)a-9.519(-10.437~-8.591)a-9.391(-10.121~-8.655)a
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中国1990—2021年环境因素对慢性呼吸系统疾病负担的长期影响及趋势研究
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王磊 1 , 时雨 1 , 郑彦玲 2 , 张利萍 2
现代预防医学 | 环境与职业卫生 2025,52(20): 3686-3692
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现代预防医学 |环境与职业卫生 2025 , 52 (20) : 3686 -3692
中国1990—2021年环境因素对慢性呼吸系统疾病负担的长期影响及趋势研究
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王磊（2001—），男，硕士在读，研究方向：流行病与卫生统计学

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王磊1, 时雨1, 郑彦玲2, 张利萍2
作者信息
  • 1.新疆医科大学公共卫生学院，新疆　乌鲁木齐　830017
  • 2.新疆医科大学医学工程技术学院
通讯作者:
张利萍，E-mail:
作者简介:

王磊（2001—），男，硕士在读，研究方向：流行病与卫生统计学

Study on the long-term impacts and trends of environmental factors on the burden of chronic respiratory diseases, China, 1990-2021
Lei WANG1, Yu SHI1, Yan-ling ZHENG2, Li-ping ZHANG2
Affiliations
  • School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang 830017, China
出版时间: 2025-10-25 doi: 10.20043/j.cnki.MPM.202410254
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目的

系统评估1990—2021年环境因素对中国居民慢性呼吸系统疾病（Chronic respiratory diseases, CRD）疾病负担的影响，为制定针对性的预防策略和临床干预措施提供科学依据。

方法

基于2021年全球疾病负担研究（Global Burden of Disease Study 2021, GBD 2021）数据，本研究采用描述性流行病学方法分析慢性呼吸系统疾病（CRD）疾病负担指标。进一步运用Joinpoint回归模型分析疾病负担的时间趋势变化，并构建年龄—时期—队列（Age-Period-Cohort, APC）模型，系统评估环境危险因素对CRD疾病负担的影响。

结果

CRD标化死亡率和标化DALY率在此期间均呈下降趋势（P<0.05）。截止2021年，室外颗粒物已成为引起中国慢性呼吸系统疾病负担的首要因素。环境因素对中国CRD疾病负担的影响随年龄增长而加剧。队列分析显示，1912—1951年出生的人群受环境因素影响较大，尤其是室内空气污染和环境颗粒物。

结论

环境因素对中国居民CRD疾病负担的长期影响仍不容忽视，需要进一步加强环境监测，制定并执行更为严格的环境标准，尤其是在控制室外空气污染方面。

慢性呼吸系统疾病（CRD）  /  疾病负担  /  环境危险因素  /  趋势分析
Objective

To assess the impact of environmental factors on the chronic respiratory disease (CRD) burden among the Chinese population during 1990—2021, providing scientific evidence for formulating targeted prevention strategies and clinical interventions.

Methods

Based on the data of the Global Burden of Disease Study 2021 (GBD 2021), this study adopted descriptive epidemiological methods to analyze the disease burden indicators of chronic respiratory diseases (CRD). Further, the Joinpoint regression model was used to analyze the temporal trend changes of disease burden, and the Age-Period-Cohort (APC) model was constructed to systematically evaluate the impact of environmental risk factors on the disease burden of CRD.

Results

Both the CRD-standardised mortality rate and the standardised DALY rate showed a decreasing trend over the period (P<0.05). As of 2021, outdoor particulate matter has become the primary contributor to the burden of chronic respiratory disease in China. The impact of environmental factors on the disease burden of CRD in China increased with age, with those aged 80 years or older being the most severely affected. Cohort analyses showed that people born in 1912—1951 were more affected by environmental factors, especially indoor air pollution and ambient particulate matter.

Conclusion

The long-term impact of environmental factors on the disease burden of CRD among Chinese residents still cannot be ignored. It is necessary to further strengthen environmental monitoring, formulate and implement stricter environmental standards, especially in controlling outdoor air pollution.

Chronic respiratory disease (CRD)  /  Disease burden  /  Environmental risk factors  /  Trend analysis
王磊, 时雨, 郑彦玲, 张利萍. 中国1990—2021年环境因素对慢性呼吸系统疾病负担的长期影响及趋势研究. 现代预防医学, 2025 , 52 (20) : 3686 -3692 . DOI: 10.20043/j.cnki.MPM.202410254
Lei WANG, Yu SHI, Yan-ling ZHENG, Li-ping ZHANG. Study on the long-term impacts and trends of environmental factors on the burden of chronic respiratory diseases, China, 1990-2021[J]. Modern Preventive Medicine, 2025 , 52 (20) : 3686 -3692 . DOI: 10.20043/j.cnki.MPM.202410254
正文
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1　前言
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慢性呼吸系统疾病（Chronic respiratory diseases, CRD），如慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease, COPD）和哮喘等，一直是全球死亡率较高的疾病。世界卫生组织发布的数据显示，截止2017年，我国慢阻肺死亡率居各国之首，成为居民第三位主要死因[1]。随着我国人口老龄化进程的持续深化，慢性呼吸系统疾病（CRD）的患病率呈显著上升趋势。流行病学数据显示，近年来CRD患病人数持续攀升，疾病负担日益加重[2]，已成为影响国民健康的重要公共卫生挑战[3]。流行病学研究表明，多种环境暴露因素与慢性呼吸系统疾病（CRD）的发生发展密切相关。尽管中国政府已采取措施改善环境质量，但这些风险依然存在[3-6]。基于世界卫生组织（World Health Organization, WHO）最新流行病学监测数据，CRD在中国的发病率逐年上升，与空气污染、吸烟及职业暴露等环境因素均密切相关。
已有研究多聚焦于特定区域或短时间跨度的CRD疾病负担分析[2, 7-8]，且环境因素多局限于PM2.5或非适宜温度[9]，缺乏对多种环境因素（如极端温度、室内空气污染、臭氧）的系统比较[10]。此外，现有研究多采用单一统计模型，未能区分年龄、时期和队列效应对疾病负担的独立影响[2,7]。本研究基于全球疾病负担（Global Burden of Disease Study 2021, GBD 2021）1990—2021年纵向数据，整合Joinpoint回归分析与年龄—时期—队列（Age-Period-Cohort, APC）模型，深入探讨了该时间段内环境因素对中国慢性呼吸系统疾病负担的影响，识别仍存在的风险，结果可为环境保护与疾病防控部门提供参考。
2　材料与方法
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2.1　数据来源
数据来源于全球疾病负担（GBD 2021）1990—2021年纵向数据（https://ghdx.healthdata.org）。GBD数据库通过整合中国疾病监测系统、国家死因登记报告系统及环境监测网络数据，采用标准化质量控制流程（如数据填补、异常值校正）确保准确性[8-11]。本研究从中下载整理了1990—2021年中国居民慢性呼吸系统疾病相关数据。
2.2　环境因素定义
研究定义的环境因素包括：室外颗粒物污染（以环境PM2.5含量水平衡量）；室外臭氧污染（环境O3）；室内空气污染（以家庭固体燃料使用为代理指标）；非适宜温度（高温：日平均温度高于该地点最适温度（即最低发病率温度）的97.5百分位数；低温：日平均温度低于该地点最适温度的2.5百分位数）[12]。
2.3　统计学分析
本研究利用R 4.3.3及GraphPad Prism 9.5工具绘制疾病负担变化趋势图，可视化及分析1990—2021年CRD的死亡水平变化，并解析1990—2021年CRD归因于不同环境因素的负担情况。本研究采用全球疾病负担（GBD）研究推荐的标准化指标评估体系，主要量化指标包括死亡数、标化死亡率和伤残调整寿命年（Disability Adjusted Life Years, DALY）率，分析归因于室内空气污染、室外颗粒物污染、非适宜温度（低温）、室外臭氧污染、非适宜温度（高温）的慢性呼吸系统疾病负担状况。
2.3.1　Joinpoint回归分析
本研究采用Joinpoint 5.2.0软件分析趋势转折点，通过置换检验（Permutation test）确定最优分段数，显著性水平设为α=0.05，依据贝叶斯信息准则（BIC）评估模型拟合优度[13]。计算年度百分比变化（Annual Percent Change, APC）、平均年度变化百分比（Average Annual Percent Change, AAPC）及其95%置信区间（95% CI）。
2.3.2　年龄—时期—队列模型（APC）分析
本研究基于R的网络分析工具（https: //analysistools.cancer.gov/apc/）构建年龄—时期—队列模型，采用内在估计器（(Intrinsic Estimator, IE）方法[14]解决线性依赖问题。年龄分组选择5年为一时间段（25~29，30~34，...，80+岁），遵循GBD研究标准，确保组内样本量均衡并减少随机波动[12]。由于GBD 2021数据特性，25岁以下人群归因于环境因素的CRD死亡及DALY负担均为0，且该群体CRD发病多与先天性疾病相关，与环境暴露关联较弱[15]。因此，本研究未纳入25岁以下数据，并将80岁及以上人群合并为最高年龄组。
2.3.3　疾病负担指标计算
本研究核心指标定义如下：标化死亡率（ASMR）：以WHO标准人口为参考，按年龄结构调整后每10万人口的死亡数，计算公式为：
其中，wi为标准人口年龄组权重，di为实际年龄组死亡率。
伤残调整寿命年（DALY）：包括早逝损失寿命年（YLL）和伤残损失寿命年（YLD），计算公式为：
标化DALY率（ASDR）：经年龄调整后的每10万人口DALY值，计算方法同ASMR。
3　结果
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3.1　1990—2021年不同性别及不同年龄段归因于环境因素的慢性呼吸系统疾病负担状况
1990—2021年环境因素所致CRD负担呈下降趋势（表1，图1）。1990至2021年间，男性群体疾病负担的增长幅度显著高于女性群体及总体人群水平。不同年龄段的变化趋势，各年龄段的死亡人数、DALY和标准化值在年份间总体上呈下降趋势；80岁以上人群负担最高（图2）。1990—1994年，70~74岁年龄段人群DALY最高，70岁以下人群的疾病负担相对平稳。值得注意的是，2020年和2021年的疾病负担有所上升。
3.2　1990—2021年中国归因于不同环境因素的慢性呼吸系统疾病负担状况
在过去三十年中，室外颗粒物污染对慢性呼吸系统疾病（CRD）的影响明显下降；室外臭氧污染对CRD的影响也呈现出波动趋势，标准化死亡率和DALY先上升后下降再上升；非适宜温度条件对CRD的影响分为夏季高温和冬季低温，其中低温的影响最为显著；而室内空气污染对CRD的影响显著下降（图3）。
3.3　基于Joinpoint 模型的不同性别CRD发病趋势分析
连接点回归分析结果显示，环境因素导致的CRD的ASMR和ASDR总体呈下降趋势，男性下降速度最慢。1990—1993年，全人群、男性和女性的APC最大，全人群的ASMR和ASDR分别为-1.98(-2.58~ -1.37)和-2.23(-2.87~ -1.58)。2014—2021年相较于2010—2013年，下降趋势缓慢了3.86%（表2）。
在不同环境风险因素的AAPC值中，非适宜温度（高温）的AAPC值最大，室外臭氧污染的AAPC值仅次于非适宜温度（高温）；其中，室内固体燃料导致的空气污染下降速度最快（表3）。
3.4　年龄—时期—队列效应模型分析
年龄—时期—队列（APC）模型结果显示，CRD的死亡率和伤残调整生命年（DALY）率的年龄效应值普遍随着年龄增加而上升（图4）。归因于环境颗粒物的年龄效应值高于其他环境因素，并且增加幅度更大；其中，80岁及以上组的年龄效应值显著高于其他组，由于非适宜温度（高温）造成的疾病负担的年龄效应值最低，且变化趋势最为平稳；室内空气污染导致的死亡率随着年龄增长呈上升趋势，但其DALY率未显示出明显的年龄差异。
1992—2021年中国因环境因素造成的CRD疾病负担的时期效应呈下降趋势。1992—2006年期间，室内空气污染导致的CRD疾病负担在所有环境因素中最高，2007—2021年期间显著改善，疾病负担降至最低；与此相反，非适宜温度（高温）从2006年前的最低水平上升至现今的最高水平，但2012—2021年的下降趋势并不显著。
观察队列效应分析结果可以发现，1912—1996年因环境因素造成的CRD疾病负担呈长期下降趋势。1912—1951年出生的队列受环境因素影响较大，尤其是室内空气污染和环境颗粒物；其中，1912—1916年出生的队列效应系数最高。
4　讨论
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本研究基于GBD 2021数据，系统、全面地阐述了慢性呼吸系统疾病与不同环境因素相关的疾病负担，以及1990—2021年中国的CRD疾病负担变化趋势及年龄—时期—队列效应，评估1990—2021年中国家庭空气污染和空气污染物所致CRD死亡率和DALY的变化趋势，并采用综合方法比较各危险因素之间差异。
研究显示，1990—2021年中国居民CRD的标化死亡率和标化DALY率持续下降，与既往研究结论一致[16-18]。经济水平提升带动生活条件改善与医疗技术进步，为患者提供更有效治疗，显著提高生存率，是推动这一趋势的主要原因[2]。同时，环境危险因素引发的CRD死亡率和DALY亦显著降低，得益于全国性空气污染治理行动。过去三十年，室外颗粒物污染对CRD的影响明显减弱，印证空气质量改善政策成效显著[19]。政府通过强化排放标准、推广清洁能源、完善环境监测体系，以及倡导健康生活方式、建设“无烟”环境等措施，降低颗粒物浓度，为减轻CRD疾病负担筑牢根基[20-21]。
室外颗粒物、臭氧、室内空气污染和非适宜温度（低温、高温）是慢性呼吸系统疾病的主要环境危险因素[22-24]。2021年量化分析表明，室外颗粒物、臭氧污染及极端温度显著加剧CRD负担，而室内空气污染治理成效显著，彰显政府干预措施的积极作用[6, 25]。室外颗粒物在CRD疾病负担中的归因占比远超其他因素，且较2019、2020年呈上升趋势。这提示政府需持续强化空气质量管控，制定更严格的标准与排放限制，以有效降低室外颗粒物浓度，进一步减轻环境因素对CRD的健康威胁。
通过Joinpoint回归模型与APC模型分析1990—2021年中国居民慢性呼吸系统疾病（CRD）疾病负担发现：各类环境因素所致CRD负担的AAPC下降速率呈室内空气污染>室外颗粒物污染>非适宜温度（低温）>室外臭氧污染>非适宜温度（高温）的排序，其中室内空气污染改善最为显著，但室外颗粒物污染仍是待解决的公共卫生问题。性别差异分析显示男性CRD疾病负担风险更高且改善速率较慢，这可能与职业暴露、吸烟率及生理差异相关，需进一步探索机制以制定针对性干预策略。时间趋势分析表明，社会经济发展与环境政策对CRD负担变化影响显著，尽管室外颗粒物污染近年有所改善，但对CRD的健康威胁仍需通过强化交通、工业等重点领域的空气质量监管加以应对。
本研究的局限性在于数据的可获得性和模型的假设条件，包括：① 数据可获得性：GBD数据库中部分环境因素（如臭氧）的监测数据可能低估早期影响；② 模型假设：APC模型假设年龄、时期和队列效应相互独立，但实际可能存在交互作用，未来需引入交互项验证；③ 未涵盖新兴污染物：如微塑料、挥发性有机物等未被纳入GBD风险因素清单，可能遗漏潜在风险。
综上所述，环境因素对中国居民CRD疾病负担的影响依旧显著，政府必须持续监测和改进环境政策。通过针对高龄人群（80岁及以上）及特定出生队列（1912—1951年）的精准干预措施，可进一步降低CRD疾病负担。建议对高龄群体加强环境暴露监测，对早期队列人群实施代际健康干预计划。
基金
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  • 国家自然科学基金资助项目(72163033; 72174175)
  • 新疆维吾尔自治“十四五”高等学校特色学科-公共卫生与预防医学
文献
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2025年第52卷第20期
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doi: 10.20043/j.cnki.MPM.202410254
  • 接收时间：2024-10-17
  • 首发时间：2026-10-29
  • 出版时间：2025-10-25
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  • 收稿日期：2024-10-17
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国家自然科学基金资助项目(72163033; 72174175)
新疆维吾尔自治“十四五”高等学校特色学科-公共卫生与预防医学
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    1.新疆医科大学公共卫生学院，新疆　乌鲁木齐　830017
    2.新疆医科大学医学工程技术学院

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2种不同金属材料的力学参数
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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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