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Article(id=1324044682463949124, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324044540067328424, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202511313, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1763568000000, receivedDateStr=2025-11-20, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793606451859, onlineDateStr=2026-11-02, pubDate=1777046400000, pubDateStr=2026-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793606451859, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793606451859, creator=13701087609, updateTime=1793606451859, updator=13701087609, issue=Issue{id=1324044540067328424, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='8', pageStart='1345', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='1777046400000', pubDateStr='2026-04-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793606417910, creator='13701087609', updateTime=1793606417910, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1508, endPage=1515, ext={EN=ArticleExt(id=1324044683898401093, articleId=1324044682463949124, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Comparative analysis of trends in the burden of lower respiratory infections between China and G20 countries, 2010-2023, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To systematically compare the differences and temporal trends in the burden of lower respiratory infections (LRIs) between China and G20 countries from 2010 to 2023, and to provide scientific evidence for the formulation of targeted prevention and control strategies.

Methods

Data on incidence, mortality, and disability-adjusted life years (DALYs) of LRIs in China and G20 countries during 2010-2023 were extracted from the Global Burden of Disease (GBD) 2023 database. Statistical analysis was conducted using R software (version 4.4.2), and the estimated annual percentage change (EAPC) was calculated based on a log-linear regression model to assess time trends. Decomposition analysis was applied to quantify the contributions of population growth, population aging, and epidemiological changes to disease burden. The attributable proportions and temporal variations of major risk factors were also evaluated.

Results

From 2010 to 2023, the burden of lower respiratory infections showed a significant downward trend in both China and G20 countries, with a faster decline observed in China for mortality and DALYs (EAPCs: -5.29 and-8.66 vs-3.17 and-4.07, respectively). Decomposition analysis indicated that epidemiological changes were the primary driver of the reduction in disease burden, while population aging and growth exerted relatively limited positive effects. Risk factor analysis revealed that air pollution and tobacco exposure were the major attributable factors. In China, the proportion attributable to ambient particulate matter pollution showed an increasing trend, whereas that attributable to household solid fuel pollution decreased significantly. Children (<5 years) and older adults (≥75 years) were identified as the key populations bearing the disease burden, with males having a slightly higher burden than females.

Conclusion

The burden of lower respiratory infections in China has declined more rapidly than the G20 average; however, the impacts of ambient particulate matter pollution and tobacco exposure have become increasingly prominent. Strengthening air quality management and tobacco control measures, with particular focus on protecting children and the elderly, is essential to further reduce the disease burden.

, authors=Pan-fang SHA1, Ya-jun ZHU2, Zhi XU3, Ying ZHANG1, Zhi-feng CAI4, authorsList=Pan-fang SHA, Ya-jun ZHU, Zhi XU, Ying ZHANG, Zhi-feng CAI, authorCompany=null, correspAuthors=Zhi-feng CAI, 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=1324044688734433618, articleId=1324044682463949124, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=2010年至2023年中国与G20国家下呼吸道感染负担趋势的比较分析, columnId=1228016573844226129, journalTitle=现代预防医学, columnName=疾病预防控制, runingTitle=null, highlight=null, articleAbstract=
目的

本研究旨在系统比较2010—2023年中国与G20国家下呼吸道感染疾病负担的差异及其变化趋势，为制定针对性防控策略提供科学依据。

方法

基于全球疾病负担研究（Global Burden of Disease，GBD）2023数据库，提取2010—2023年中国和G20国家下呼吸道感染的发病率、死亡率和伤残调整生命年（Disability-Adjusted Life Years，DALYs）数据。采用R软件（版本4.4.2）进行统计分析，基于对数线性回归模型计算年均百分比变化（Estimated Annual Percentage Change，EAPC）评估时间趋势。运用分解分析方法量化人口增长、老龄化和流行病学变化对疾病负担的贡献，并评估主要危险因素的归因比例及其时间变化。

结果

2010—2023年，中国和G20国家下呼吸道感染负担均呈显著下降趋势，但中国死亡率和DALYs下降速度更快（EAPC分别为-5.29和-8.66 vs -3.17和-4.07）。分解分析显示，流行病学变化是减轻疾病负担的主要驱动因素，人口老龄化和人口增长的正向影响相对有限。危险因素分析表明，空气污染和烟草暴露是主要归因因素，中国环境颗粒物污染归因比例呈上升趋势，而固燃家庭污染显著下降。儿童（<5岁）和老年人（≥75岁）是疾病负担的重点人群，男性负担略高于女性。

结论

中国下呼吸道感染疾病负担下降速度快于G20国家平均水平，但环境颗粒物污染和吸烟暴露的影响日益突出。应继续加强空气质量治理，强化控烟措施，重点关注儿童和老年人群的防护，优化医疗服务体系，以进一步降低下呼吸道感染疾病负担。

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沙盘芳（1977—），女，本科，副主任护师，研究方向：流行疾病调查和研究

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蔡志锋，E-mail：
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注：图A/B：中国和G20国家人群下呼吸道感染发病情况；图C/D：中国/G20国家人群下呼吸道感染伤残调整生命年（DALYs）及每10万人口DALYs率。

, figureFileSmall=+hTeaSSNUIfuGPL9ChBJxg==, figureFileBig=9v0Q7ttA7lUrk74FSlHI2A==, tableContent=null), ArticleFig(id=1324044694463852931, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044682463949124, language=EN, label=Fig. 3, caption=Decomposition analysis of changes in incidence and disability-adjusted life years (DALYs) of lower respiratory infections in China and G20 countries, 2010 -2023, figureFileSmall=PdLReD6pZ2jvPSBcK9YcTg==, figureFileBig=qnlx7pQJiyzZFaDoyQdeDw==, tableContent=null), ArticleFig(id=1324044694577099140, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044682463949124, language=CN, label=图3, caption=2010—2023年中国与G20国家人群下呼吸道感染发病率和伤残调整生命年（DALYs）变化的分解分析

注：图A：G20国家及中国人群下呼吸道感染发病率总变化的分解；图B：同期下呼吸道感染所致DALYs变化的分解。

, figureFileSmall=PdLReD6pZ2jvPSBcK9YcTg==, figureFileBig=qnlx7pQJiyzZFaDoyQdeDw==, tableContent=null), ArticleFig(id=1324044694644208005, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044682463949124, language=EN, label=Fig. 4, caption=Proportional contribution of risk factors attributable to DALYs from lower respiratory infections in China and G20 countries, 2023, figureFileSmall=0K70qFqaTVFWcHsAhiKkbw==, figureFileBig=G3DM4zk5V+LZdcKJGPzplQ==, tableContent=null), ArticleFig(id=1324044694711316870, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044682463949124, language=CN, label=图4, caption=2023年中国与G20国家人群中归因于下呼吸道感染DALYs的风险因素构成比例, figureFileSmall=0K70qFqaTVFWcHsAhiKkbw==, figureFileBig=G3DM4zk5V+LZdcKJGPzplQ==, tableContent=null), ArticleFig(id=1324044694778425735, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044682463949124, language=EN, label=Fig. 5, caption=Temporal trends in the proportional contribution of risk factors attributable to DALYs from lower respiratory infections in China and G20 countries, 2010-2023, figureFileSmall=TI2OQfpKuQ8hnIvhq2+m/g==, figureFileBig=gsHqmvjJJSI30BVaaZQT4A==, tableContent=null), ArticleFig(id=1324044694874894728, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044682463949124, language=CN, label=图5, caption=2010—2023年中国与G20国家人群中归因于下呼吸道感染DALYs的风险因素构成比例的时间趋势, figureFileSmall=TI2OQfpKuQ8hnIvhq2+m/g==, figureFileBig=gsHqmvjJJSI30BVaaZQT4A==, tableContent=null), ArticleFig(id=1324044694962975113, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044682463949124, language=EN, label=Table 1, caption=

Burden of lower respiratory infections in china and G20 countries, 2010-2023, and trends in change

, figureFileSmall=null, figureFileBig=null, tableContent=
指标发生率（/10万）死亡率（/10万）
中国G20中国G20
男性
20102 836.51（2 606.44，3 121.11）3 504.21（3 289.99，3 759.62）20.64（17.22，24.40）36.06（32.60，39.68）
20232 235.28（2 061.04，2 443.36）2 825.97（2 658.52，3 024.17）11.70（8.15，17.08）26.80（24.07，29.76）
EAPC-2.78（-4.10，-1.45）-2.66（-3.74，-1.56）-4.71（-5.58，-3.84）-3.05（-3.93，-2.16）
女性
20102 184.39（2 023.68，2 385.81）3 086.71（2 879.49，3 306.52）14.70（11.88，17.72）28.81（25.47，32.41）
20231 882.03（1 736.17，2 052.36）2 526.20（2 380.73，2 704.29）6.99（5.06，9.38）20.56（17.67，23.84）
EAPC-2.11（-3.19，-1.01）-2.43（-3.36，-1.50）-5.98（-6.72，-5.23）-3.39（-4.27，-2.50）
全体
20102 511.40（2 309.61，2 744.32）3 274.05（3 064.00，3 512.93）17.42（15.09，19.96）31.56（28.95，34.14）
20232 050.45（1 891.31，2 235.71）2 662.65（2 504.85，2 851.20）9.11（7.00，11.37）23.14（20.94，25.35）
EAPC-2.51（-3.73，-1.28）-2.54（-3.54，-1.52）-5.29（-6.10，-4.47）-3.17（-4.06，-2.28）
指标DALYs（/10万）
中国G20
男性
2010747.95（662.48，837.40）1 394.27（1 255.48，1 570.27）
2023286.22（218.88，379.06）961.72（839.68，1 109.35）
EAPC-8.11（-9.38，-6.82）-3.85（-4.95，-2.73）
女性
2010556.25（494.08，621.59）1 378.87（1 210.34，1 571.06）
2023180.94（142.30，222.92）887.86（753.96，1 021.43）
EAPC-9.29（-10.46，-8.10）-4.32（-5.38，-3.25）
全体
2010653.48（599.84，713.43）1 374.43（1 273.00，1 502.96）
2023232.15（188.27，279.96）918.25（825.57，1 020.63）
EAPC-8.66（-9.90，-7.41）-4.07（-5.16，-2.97）
), ArticleFig(id=1324044695109775754, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044682463949124, language=CN, label=表1, caption=

2010—2023年中国与G20国家下呼吸道感染疾病负担及变化趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
指标发生率（/10万）死亡率（/10万）
中国G20中国G20
男性
20102 836.51（2 606.44，3 121.11）3 504.21（3 289.99，3 759.62）20.64（17.22，24.40）36.06（32.60，39.68）
20232 235.28（2 061.04，2 443.36）2 825.97（2 658.52，3 024.17）11.70（8.15，17.08）26.80（24.07，29.76）
EAPC-2.78（-4.10，-1.45）-2.66（-3.74，-1.56）-4.71（-5.58，-3.84）-3.05（-3.93，-2.16）
女性
20102 184.39（2 023.68，2 385.81）3 086.71（2 879.49，3 306.52）14.70（11.88，17.72）28.81（25.47，32.41）
20231 882.03（1 736.17，2 052.36）2 526.20（2 380.73，2 704.29）6.99（5.06，9.38）20.56（17.67，23.84）
EAPC-2.11（-3.19，-1.01）-2.43（-3.36，-1.50）-5.98（-6.72，-5.23）-3.39（-4.27，-2.50）
全体
20102 511.40（2 309.61，2 744.32）3 274.05（3 064.00，3 512.93）17.42（15.09，19.96）31.56（28.95，34.14）
20232 050.45（1 891.31，2 235.71）2 662.65（2 504.85，2 851.20）9.11（7.00，11.37）23.14（20.94，25.35）
EAPC-2.51（-3.73，-1.28）-2.54（-3.54，-1.52）-5.29（-6.10，-4.47）-3.17（-4.06，-2.28）
指标DALYs（/10万）
中国G20
男性
2010747.95（662.48，837.40）1 394.27（1 255.48，1 570.27）
2023286.22（218.88，379.06）961.72（839.68，1 109.35）
EAPC-8.11（-9.38，-6.82）-3.85（-4.95，-2.73）
女性
2010556.25（494.08，621.59）1 378.87（1 210.34，1 571.06）
2023180.94（142.30，222.92）887.86（753.96，1 021.43）
EAPC-9.29（-10.46，-8.10）-4.32（-5.38，-3.25）
全体
2010653.48（599.84，713.43）1 374.43（1 273.00，1 502.96）
2023232.15（188.27，279.96）918.25（825.57，1 020.63）
EAPC-8.66（-9.90，-7.41）-4.07（-5.16，-2.97）
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2010年至2023年中国与G20国家下呼吸道感染负担趋势的比较分析
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沙盘芳 1 , 朱亚军 2 , 徐志 3 , 张颖 1 , 蔡志锋 4
现代预防医学 | 疾病预防控制 2026,53(8): 1508-1515
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现代预防医学 |疾病预防控制 2026 , 53 (8) : 1508 -1515
2010年至2023年中国与G20国家下呼吸道感染负担趋势的比较分析
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沙盘芳1, 朱亚军2, 徐志3, 张颖1, 蔡志锋4
作者信息
  • 1.张家港市第五人民医院公共卫生科，江苏　张家港　215600
  • 2.张家港市第五人民医院呼吸与危重症医学科
  • 3.张家港市第五人民医院科教科
  • 4.张家港市疾病预防控制中心中心部
通讯作者:
蔡志锋，E-mail：
作者简介:

沙盘芳（1977—），女，本科，副主任护师，研究方向：流行疾病调查和研究

Comparative analysis of trends in the burden of lower respiratory infections between China and G20 countries, 2010-2023
Pan-fang SHA1, Ya-jun ZHU2, Zhi XU3, Ying ZHANG1, Zhi-feng CAI4
Affiliations
  • Department of Public Health, Zhangjiagang Fifth People's Hospital, Zhangjiagang, Jiangsu 215600, China
出版时间: 2026-04-25 doi: 10.20043/j.cnki.MPM.202511313
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摘要
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目的

本研究旨在系统比较2010—2023年中国与G20国家下呼吸道感染疾病负担的差异及其变化趋势，为制定针对性防控策略提供科学依据。

方法

基于全球疾病负担研究（Global Burden of Disease，GBD）2023数据库，提取2010—2023年中国和G20国家下呼吸道感染的发病率、死亡率和伤残调整生命年（Disability-Adjusted Life Years，DALYs）数据。采用R软件（版本4.4.2）进行统计分析，基于对数线性回归模型计算年均百分比变化（Estimated Annual Percentage Change，EAPC）评估时间趋势。运用分解分析方法量化人口增长、老龄化和流行病学变化对疾病负担的贡献，并评估主要危险因素的归因比例及其时间变化。

结果

2010—2023年，中国和G20国家下呼吸道感染负担均呈显著下降趋势，但中国死亡率和DALYs下降速度更快（EAPC分别为-5.29和-8.66 vs -3.17和-4.07）。分解分析显示，流行病学变化是减轻疾病负担的主要驱动因素，人口老龄化和人口增长的正向影响相对有限。危险因素分析表明，空气污染和烟草暴露是主要归因因素，中国环境颗粒物污染归因比例呈上升趋势，而固燃家庭污染显著下降。儿童（<5岁）和老年人（≥75岁）是疾病负担的重点人群，男性负担略高于女性。

结论

中国下呼吸道感染疾病负担下降速度快于G20国家平均水平，但环境颗粒物污染和吸烟暴露的影响日益突出。应继续加强空气质量治理，强化控烟措施，重点关注儿童和老年人群的防护，优化医疗服务体系，以进一步降低下呼吸道感染疾病负担。

下呼吸道感染  /  疾病负担  /  中国  /  G20国家  /  趋势分析
Objective

To systematically compare the differences and temporal trends in the burden of lower respiratory infections (LRIs) between China and G20 countries from 2010 to 2023, and to provide scientific evidence for the formulation of targeted prevention and control strategies.

Methods

Data on incidence, mortality, and disability-adjusted life years (DALYs) of LRIs in China and G20 countries during 2010-2023 were extracted from the Global Burden of Disease (GBD) 2023 database. Statistical analysis was conducted using R software (version 4.4.2), and the estimated annual percentage change (EAPC) was calculated based on a log-linear regression model to assess time trends. Decomposition analysis was applied to quantify the contributions of population growth, population aging, and epidemiological changes to disease burden. The attributable proportions and temporal variations of major risk factors were also evaluated.

Results

From 2010 to 2023, the burden of lower respiratory infections showed a significant downward trend in both China and G20 countries, with a faster decline observed in China for mortality and DALYs (EAPCs: -5.29 and-8.66 vs-3.17 and-4.07, respectively). Decomposition analysis indicated that epidemiological changes were the primary driver of the reduction in disease burden, while population aging and growth exerted relatively limited positive effects. Risk factor analysis revealed that air pollution and tobacco exposure were the major attributable factors. In China, the proportion attributable to ambient particulate matter pollution showed an increasing trend, whereas that attributable to household solid fuel pollution decreased significantly. Children (<5 years) and older adults (≥75 years) were identified as the key populations bearing the disease burden, with males having a slightly higher burden than females.

Conclusion

The burden of lower respiratory infections in China has declined more rapidly than the G20 average; however, the impacts of ambient particulate matter pollution and tobacco exposure have become increasingly prominent. Strengthening air quality management and tobacco control measures, with particular focus on protecting children and the elderly, is essential to further reduce the disease burden.

Lower respiratory infections  /  Disease burden  /  China  /  G20 countries  /  Trend analysis
沙盘芳, 朱亚军, 徐志, 张颖, 蔡志锋. 2010年至2023年中国与G20国家下呼吸道感染负担趋势的比较分析. 现代预防医学, 2026 , 53 (8) : 1508 -1515 . DOI: 10.20043/j.cnki.MPM.202511313
Pan-fang SHA, Ya-jun ZHU, Zhi XU, Ying ZHANG, Zhi-feng CAI. Comparative analysis of trends in the burden of lower respiratory infections between China and G20 countries, 2010-2023[J]. Modern Preventive Medicine, 2026 , 53 (8) : 1508 -1515 . DOI: 10.20043/j.cnki.MPM.202511313
正文
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下呼吸道感染是威胁全球公共卫生安全的重要疾病，主要涵盖肺炎、急性支气管炎及流感相关感染等类型[1]。下呼吸道感染已成为全球主要死亡病因，在5岁以下儿童和70岁以上老年人群中造成的健康威胁尤为严重，尽管抗菌药物和疫苗接种策略不断完善，2023年全球下呼吸道感染仍导致约250万人死亡[2]。在我国，2021年非COVID-19相关下呼吸道感染死亡病例约20.7万例[3]。随着人口老龄化、城市化及环境污染问题加剧，疾病负担呈现复杂态势[4]。
既往研究表明，下呼吸道感染的疾病负担受人口学特征、环境暴露、社会经济状况及医疗服务可及性等多重因素共同作用[5]。吸烟、大气污染（特别是PM2.5暴露）、家庭固体燃料使用及营养不良等已被确认为主要危险因素[6]，但这些因素在不同国家和地区的分布模式存在显著差异。二十国集团（G20）成立于1999年，由阿根廷、澳大利亚、巴西、加拿大、中国、法国、德国、印度、印度尼西亚、意大利、日本、韩国、墨西哥、俄罗斯、沙特阿拉伯、南非、土耳其、英国、美国及欧盟组成，涵盖发达经济体和新兴市场国家。选择G20国家作为比较对象具有独特价值。G20涵盖不同发展阶段和卫生体系，占全球GDP的85%以上、人口超过60%，相较于WHO分区或收入水平分组，更能映经济发展与疾病防控的动态关联[7]。且中国作为G20成员国，与该群体在经济发展、人口结构和卫生系统建设方面可比性强。
此前学界多聚焦于中国与全球整体的比较，存在以下局限：全球数据涵盖范围过广，难以反映经济发展阶段相近国家间的差异；多数研究仅描述疾病负担趋势，缺乏对人口学驱动因素的系统分解；危险因素归因分析多为静态呈现，较少关注时间演变特征。本研究以G20国家为比较基准，系统整合趋势分析、分解分析和危险因素归因分析三种方法，旨在识别中国特有的风险特征和优先干预领域，为制定精准防控策略提供更深层次的循证依据。
因此，本研究基于GBD 2023数据库，系统比较2010—2023年中国与G20国家下呼吸道感染的疾病负担变化趋势，评估发病率、死亡率和DALYs等核心指标及其性别、年龄分布特征。运用分解分析方法定量评估人口增长、人口老龄化和流行病学变化的贡献度，并分析主要危险因素的归因比例及时间变化趋势，为制定针对性防控策略和优化公共卫生资源配置提供科学依据。
1　资料与方法
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1.1　数据来源
本研究的数据源自美国华盛顿大学健康测量与评估中心发布的2023年全球疾病负担（Global Burden of Disease，GBD）数据库。该数据库涵盖了1990—2023年期间全球范围内各国家和地区多种疾病的发病情况、死亡情况以及疾病负担相关指标[8]。在既往GBD研究中，将单一国家数据与全球整体或国家集团数据进行比较，以评估该国在全球疾病负担格局中的相对位置[9-10]。本研究采用G20作为比较基准，实质上是用更具代表性和可比性的全球主要经济体子集替代全球整体数据。本研究采用了中国和G20国家下呼吸道感染在不同性别的全年龄人群中的发病率、死亡率、伤残调整生命年（DALYs）作为疾病负担的研究指标，各指标使用年龄标化率及其95%不确定性区间（Uncertainty Interval，UI）消除不同人群和不同时期可变年龄分布的影响，确保可比性[11]。数据提取流程如下：（1）登录GBD Results Tool（https://vizhub.healthdata.org/gbd-results/），选择“Lower respiratory infections”作为病因；（2）地理范围选择“China”和“G20”；（3）时间范围设定为2010—2023年；（4）指标选择发病率（Incidence）、死亡率（Mortality）和DALYs；（5）按性别（男性、女性、全体）和年龄组（5岁年龄组）分层提取；（6）输出年龄标准化率及其95%不确定性区间。危险因素归因数据通过GBD Compare工具提取，选择“Risk factors”模块获取各危险因素归因的DALYs数据。所有数据均以CSV格式导出，使用R软件进行后续整理与分析。
1.2　疾病定义
依据《国际疾病分类》第十版（ICD-10）的分类标准，下呼吸道感染主要涵盖以下三大类疾病：急性支气管炎（编码：J20~J22）、肺炎（编码：J12~J18）及流感相关下呼吸道感染（编码：J09~J11）[12-13]。GBD 2023研究基于上述诊断编码对下呼吸道感染进行系统性评估，以保障疾病定义的准确性与一致性。ICD-10分类系统对疾病亚型和临床表现的细致划分，有助于更精确地统计与分析不同类型下呼吸道感染的发病率和死亡率，从而更全面地评估其全球疾病负担。
1.3　危险因素
GBD 2023中下呼吸道感染相关危险因素共7个，包括：环境颗粒物污染、固体燃料导致的家庭空气污染（以下简称“固燃家庭污染”）、吸烟、二手烟暴露、儿童发育迟缓、儿童消瘦及非纯母乳喂养。本研究重点分析前4个环境和行为因素，理由是空气污染和烟草暴露是可干预的主要环境行为因素，具有明确的公共卫生政策指向性，而儿童发育迟缓、消瘦及非纯母乳喂养主要影响5岁以下儿童群体，而本研究关注全年龄人群的疾病负担。上述3个儿童营养相关因素在中国的归因比例较低且呈持续下降趋势，对总体疾病负担的贡献相对有限。为测量具体暴露数据，GBD 2023基于不同维度来划分危险因素暴露水平。根据每个不同危险因素的暴露数据（率）、相对危险度和理论最低暴露水平即可计算人群归因分值，最终归因于各危险因素的下呼吸道感染疾病负担就是相应的人群归因分值乘以总死亡人数或DALYs值[6]。
1.4　统计方法
所有统计分析和可视化均使用R软件（版本4.4.2）完成，检验水准α=0.05。图表绘制使用ggplot2包。所有率的计算均采用年龄标准化方法，以2010年世界标准人口作为参考人口，消除人口年龄结构差异的影响。
1.4.1　趋势分析
本研究使用GBD 2023数据库提供的估计年度百分比变化（EAPC）及其95%不确定性区间（UI）来评估2010—2023年间中国与G20国家下呼吸道感染疾病负担指标（年龄标准化发病率、年龄标准化死亡率和年龄标准化DALYs率）的长期变化趋势。EAPC基于对数线性回归模型计算，公式为EAPC=（e＾β-1）×100%，其中β为回归系数ln（Y）~Year中的斜率。EAPC的UI通过蒙特卡洛模拟计算，整合了多重不确定性来源。EAPC>0表示上升趋势，EAPC<0表示下降趋势[14]。
1.4.2　分解分析
采用分解分析方法将下呼吸道感染发病率和DALYs的变化归因于三个关键因素：人口增长、人口老龄化和流行病学变化。该方法基于Das Gupta分解技术，通过以下公式量化各因素的贡献：总变化=人口规模效应+年龄结构效应+年龄别发病率（或死亡率）效应（其中人口增长反映了总人口规模的影响，人口老龄化评估了年龄结构变化的影响），流行病学变化在调整人口规模和年龄后，捕捉了医疗干预和预防措施对疾病负担的影响[15]。该分析量化了各因素对发病数和DALYs变化的绝对和相对贡献，结果以绝对数和百分比形式呈现。贡献度计算公式为：贡献度（%）=（某因素导致的变化量/总变化量）×100%。正值表示该因素导致疾病负担增加，负值表示该因素有助于减轻疾病负担。
1.4.3　危险因素归因分析
本研究评估了与下呼吸道感染相关的主要环境和行为危险因素，包括吸烟、环境颗粒物污染、固燃家庭污染、二手烟暴露等。研究比较了全球和中国人群中各危险因素的归因比例及其时间趋势。危险因素归因分析基于GBD风险模型，采用比较风险评估框架进行。人群归因分值的计算公式为：PAF=Σ[P（x）×（RR（x）-1）]/[Σ（P（x）×（RR（x）-1））+1]，其中：P（x）为暴露水平x的人群比例，RR（x）为相对于理论最低暴露水平的相对危险度，归因的DALYs=总DALYs×PAF[6,16]。通过该方法，可以量化不同危险因素对下呼吸道感染疾病负担的具体贡献，为制定针对性预防控制策略提供科学依据。
2　结果
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2.1　中国与G20国家人群下呼吸道感染负担总体概况
从2010年至2023年，中国与G20国家下呼吸道感染负担均呈显著下降趋势，但下降幅度存在差异（见表1）。中国各项指标的绝对水平始终低于G20国家：2023年中国男性发病率、死亡率和DALYs分别为2 235.28/10万、11.70/10万和286.22/10万，均显著低于G20国家的2 825.97/10万、26.80/10万和961.72/10万。女性趋势类似（见表1，图1）。就全体人群而言，中国发病率、死亡率和DALYs的EAPC分别为-2.51、-5.29和-8.66，而G20国家分别为-2.54、-3.17和-4.07。值得注意的是，中国在死亡率和DALYs的下降速度明显快于G20国家，反映出中国在下呼吸道感染防控方面取得的显著成效。
2.2　中国与G20国家人群下呼吸道感染负担的性别与年龄别比较
从2010年至2023年，中国和G20国家的下呼吸道感染发病率均呈持续下降趋势，但中国的发病率水平始终低于G20国家平均水平。具体而言，中国男性和女性的发病率在研究期间均保持相对稳定的下降态势，而G20国家则在2016—2017年期间出现明显波动（图1）。无论是在中国还是G20国家，下呼吸道感染的发病数和DALYs负担均呈现“两端高”的年龄分布特征，且高年龄组男性负担常高于女性。2023年，中国发病数在<5岁年龄组最高，而发病率在75~79岁年龄组达峰值；G20国家发病数峰值出现在70~74岁年龄组，发病率同样在75~79岁达最高（图2A、2B）。在DALYs分布方面，中国和G20国家5岁以下儿童组DALYs绝对数均最高，但老年组DALYs率更为突出，75~79岁年龄组达峰值（图2C、2D）。总体而言，DALYs负担集中于儿童和老年人群。
2.3　中国与G20国家人群下呼吸道感染负担的分解分析
2010至2023年期间，分解分析显示流行病学变化是减轻疾病负担的核心驱动因素（图3）。在发病数方面，G20国家总体呈负向变化，流行病学变化的负向贡献有效抵消了人口老龄化和人口增长的正向影响；中国发病数虽呈小幅正向变化，但流行病学变化同样表现为负向贡献，反映出相似的防控成效（图3A）。在DALYs方面，中国和G20国家总体变化均为负值，流行病学变化发挥了最主要的负向作用，而人口老龄化和人口增长的正向贡献相对有限，表明医疗干预措施和预防策略的改善对减轻疾病负担发挥了关键作用（图3B）。
2.4　中国与G20国家人群下呼吸道感染DALYs风险因素的差异及时间趋势
图4显示，空气污染和烟草暴露是中国与G20国家下呼吸道感染DALYs的主要危险因素，但归因比例存在显著差异。2023年，空气污染在中国和G20国家的归因比例分别为22.05%和27.14%。其中，中国环境颗粒物污染归因比例（19.05%）高于G20国家（13.85%），而固燃家庭污染归因比例（3.18%）显著低于G20国家（13.31%），反映出我国在清洁能源推广方面取得的成效。烟草暴露在中国的归因比例（23.62%）高于G20国家（14.48%）。
从时间趋势来看（图5），2010—2023年间中国环境颗粒物污染归因比例从15.86%上升至19.05%，吸烟归因比例从6.03%上升至11.14%，均呈显著上升趋势；而固燃家庭污染归因比例从16.92%大幅降至3.18%。G20国家各项指标则相对稳定。上述结果提示，环境颗粒物污染和吸烟暴露对中国下呼吸道感染负担的影响日益显著。
3　讨论
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基于GBD 2023数据库，本研究系统评估了2010—2023年中国与G20国家下呼吸道感染疾病负担的演变特征。研究结果显示，中国与G20国家下呼吸道感染负担均呈明显下降态势，但中国降幅更为显著，这与既往研究发现一致。Wang等[5]研究发现，1990—2021年间中国下呼吸道感染年龄标准化死亡率的AAPC为-4.77（95%CI：-5.14，-4.39），显著快于全球水平（-2.47）。Li等[3]研究同样显示，中国下呼吸道感染全年龄死亡率从1990年的40.37/10万下降至2021年的14.54/10万，降幅达60.85%。中国下呼吸道感染负担的快速下降与医药卫生体制改革、疫苗接种覆盖率提升及公共卫生综合干预措施强化等因素相关[17-19]。本研究通过比较分析揭示了单独研究难以发现的重要发现：中国死亡率和DALYs下降速度显著快于G20平均水平，验证了防控策略的有效性；同时，中国烟草暴露归因比例远高于G20国家，且人口老龄化效应更突出，提示应优先控烟并应对老龄化挑战。
本研究结果显示中国与G20国家下呼吸道感染负担在性别及年龄分布上呈现相似规律。从性别差异来看，男性死亡率与DALY率均高于女性，这可能与男性吸烟率较高、职业粉尘暴露风险增加以及就医行为相对滞后等因素密切相关[3]。Li等[3]的研究显示，2021年中国男性下呼吸道感染死亡率为16.35/10万，高于女性的12.65/10万；在烟草归因方面，男性归因于烟草的DALYs比例从1990年的19.84%（95%UI：8.79~30.20%）上升至2021年的32.72%（95%UI：22.78~41.77%），增幅达64.92%，而女性同期仅下降5.89%，这一显著的性别差异与男性更高的吸烟率密切相关。年龄分布分析表明，儿童（<5岁）与老年人（≥75岁）是疾病负担的主要承载人群，这与儿童免疫功能尚未成熟[20]、老年人慢性基础疾病共病率较高[21]的特征相符。值得注意的是，中国老年人群DALY率增速更为陡峭，可能与我国人口老龄化进程加速相关。因此，未来防控策略应聚焦这两大重点人群，提升疫苗接种覆盖率，强化健康监测与慢性病管理。
本研究采用分解分析法定量评估人口增长、人口老龄化及流行病学转变对疾病负担的差异化贡献。结果表明，流行病学转变是减轻疾病负担的核心驱动因素，在中国与G20国家DALYs降幅中均占主导地位，印证了医疗技术进步和公共卫生干预措施优化的关键作用[22]。尽管如此，人口老龄化与人口增长仍产生正向影响。在中国，人口老龄化效应尤为突出，随着老年人口占比持续攀升，即便标化率下降，疾病负担绝对数仍可能上升，对医疗卫生体系构成新挑战[23]。相较而言，G20国家人口增长的正向贡献更大，而老龄化效应相对温和。这提示在制定防控策略时，应充分考量各国人口学特征的异质性，因地制宜地实施针对性干预措施。
危险因素分析表明空气污染和烟草暴露是中国和G20国家疾病负担的主要归因因素，但两者在归因比例及时间演变趋势上存在显著差异。在中国，2023年空气污染归因比例为22.05%，其中环境颗粒物污染占比从2010年的15.86%上升至19.05%，而固燃家庭污染占比大幅降至3.18%，反映出我国在清洁能源推广方面的成效，但也揭示了环境颗粒物污染问题日益凸显[24]。烟草暴露在中国的归因比例（23.62%）高于G20国家（14.48%），与我国较高的吸烟率密切相关。上述发现与既往研究结论一致。Li等[3]报告显示，1990—2021年间中国归因于环境颗粒物污染的DALYs比例从7.44%（95%UI：1.26~15.72%）大幅上升至22.14%（95%UI：3.28~38.41%），烟草归因比例从19.06%（95%UI：7.84~29.48%）上升至26.53%（95%UI：16.31~35.55%）。相比之下，G20国家空气污染归因比例（27.14%）高于中国，但其构成存在差异，固燃家庭污染占比（13.31%）显著高于中国。这可能与部分中低收入G20成员国仍广泛使用生物质燃料有关[25]。
基于上述研究发现，本研究提出如下政策建议：（1）持续推进大气污染防治工作。建议相关部门进一步收紧工业排放限值，优化能源结构，加快淘汰高污染产能，从源头削减颗粒物等大气污染物的排放强度；（2）深化控烟干预策略。在提高烟草制品税率的基础上，建议采取分类施策原则，针对儿童及老年人活动密集的公共场所划定禁烟区域或限定吸烟时段，同时完善戒烟门诊等服务网络；（3）强化重点人群防护措施。建议扩大儿童及老年人群流感疫苗、肺炎疫苗等免疫接种覆盖面，建立健康档案，实施动态监测与健康管理。
本研究尚存在以下不足之处：其一，研究数据取自GBD数据库，其中部分指标系通过统计学模型推算所得，与实际调查数据可能存在偏差；其二，受数据可及性限制，本研究未能获得省级或更细粒度的区域数据，因而无法深入分析我国不同地区间下呼吸道感染疾病负担的异质性；其三，本研究危险因素归因分析基于现有循证医学证据，对于近年来新识别或尚未充分证实的潜在危险因素，可能存在纳入不足的情况。
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  • 张家港市青年科技项目(ZJGQNKJ202523)
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2026年第53卷第8期
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doi: 10.20043/j.cnki.MPM.202511313
  • 接收时间：2025-11-20
  • 首发时间：2026-11-02
  • 出版时间：2026-04-25
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  • 收稿日期：2025-11-20
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张家港市青年科技项目(ZJGQNKJ202523)
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    1.张家港市第五人民医院公共卫生科，江苏　张家港　215600
    2.张家港市第五人民医院呼吸与危重症医学科
    3.张家港市第五人民医院科教科
    4.张家港市疾病预防控制中心中心部

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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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