现代预防医学

零假设	发病率	死亡率	DALYs率
净漂移=0	670.08	1	<0.001	220.95	1	<0.001	154.06	1	<0.001
总年龄偏差=0	31.84	2	<0.001	395.89	2	<0.001	231.71	2	<0.001
总时期偏差=0	37.83	4	<0.001	36.62	4	<0.001	23.33	4	<0.001
总出生队列偏差=0	51.30	7	<0.001	88.38	7	<0.001	68.76	7	<0.001
全时期RR值=1	948.13	5	<0.001	790.86	5	<0.001	479.58	5	<0.001
全出生队列RR值=1	979.06	8	<0.001	1 531.16	8	<0.001	797.25	8	<0.001
局部漂移=净漂移	50.42	4	<0.001	82.23	4	<0.001	63.77	4	<0.001

零假设	发病率	死亡率	DALYs率
净漂移=0	670.08	1	<0.001	220.95	1	<0.001	154.06	1	<0.001
总年龄偏差=0	31.84	2	<0.001	395.89	2	<0.001	231.71	2	<0.001
总时期偏差=0	37.83	4	<0.001	36.62	4	<0.001	23.33	4	<0.001
总出生队列偏差=0	51.30	7	<0.001	88.38	7	<0.001	68.76	7	<0.001
全时期RR值=1	948.13	5	<0.001	790.86	5	<0.001	479.58	5	<0.001
全出生队列RR值=1	979.06	8	<0.001	1 531.16	8	<0.001	797.25	8	<0.001
局部漂移=净漂移	50.42	4	<0.001	82.23	4	<0.001	63.77	4	<0.001

1990—2021年中国20岁以下人群肠道传染病疾病负担的年龄-时期-队列分析

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肖回回 , 赵锦 , 陈水连 , 邱劲松 , 周银柱 , 谢强明

现代预防医学 | 疾病预防控制 2026,53(6): 1119-1125

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现代预防医学 |疾病预防控制 2026 , 53 (6) : 1119 -1125

1990—2021年中国20岁以下人群肠道传染病疾病负担的年龄-时期-队列分析

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肖回回, 赵锦, 陈水连, 邱劲松, 周银柱, 谢强明

作者信息

长沙市疾病预防控制中心（长沙市卫生综合监督执法局）传染病防制科，湖南长沙 410004

通讯作者:

谢强明，E-mail: 375234093@qq.com

作者简介:

肖回回(1989—)，男，硕士，主管医师，研究方向：传染病防控

Age-period-cohort analysis on disease burden of enteric infectious diseases among the population under 20 years old, China, 1990 -2021

Hui-hui XIAO, Jin ZHAO, Shui-lian CHEN, Jin-song QIU, Yin-zhu ZHOU, Qiang-ming XIE

Affiliations

Division of Infectious Diseases Prevention and Control, Changsha Center for Disease Control and Prevention (Changsha Health Inspection Bureau), Changsha, Hunan 41004, China

出版时间: 2026-03-25 doi: 10.20043/j.cnki.MPM.202510331

文章导航

摘要

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目的

分析1990—2021年我国20岁以下人群肠道传染病流行水平及疾病负担的变化趋势，识别其严重程度和重点人群，为预防和干预政策的制定提供参考依据。

方法

数据来源全球疾病负担研究（GBD）2021数据库，利用Joinpoint回归模型分析1990—2021年我国20岁以下人群肠道传染病的发病率、死亡率和伤残调整寿命年（DALYs）率的时间变化趋势；采取年龄-时期-队列分析方法，分析年龄效应、时期效应和出生队列效应对我国20岁以下人群肠道传染病疾病负担变化趋势的影响。

结果

我国20岁以下人群肠道传染病发病率从1990年48 373.02/10万下降至2021年的8 811.07/10万，死亡率从1990年的17.55/10万下降至2021年的0.43/10万, DALYs从1990年的1 643.60/10万下降至52.31/10万。Joinpoint回归模型分析结果显示，1990—2021年我国20岁以下人群肠道传染病发病率平均每年下降5.34% （AAPC=-5.34%，95%CI: -5.50%~-5.18%），死亡率平均每年下降11.34%（AAPC=-11.34%，95% CI: -11.71%~-10.97%）, DALYs率平均每年下降10.56%（AAPC=-10.56%，95% CI: -11.03%~-10.10%）。年龄-时期-队列模型分析显示，0~4岁年龄组人群为高疾病负担人群，明显高于其他年龄组人群。随着时期推移，20岁以下人群肠道传染病发病率、死亡率和DALYs风险持续下降；与较早出生队列相比，较晚出生队列人群肠道传染病发病率、死亡率和DALYs风险更低。

结论

1990—2021年我国20岁以下人群肠道传染病的发病率、死亡率和DALYs率呈明显下降趋势，5岁以下年龄组人群仍是我国肠道传染病的重点人群，应采取综合防治手段进一步降低该人群疾病负担。

关键词

肠道传染病 / Joinpiont回归 / 疾病负担 / 年龄-时期-队列模型

Abstract

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Objective

To analyze the trends in the prevalence and disease burden of enteric infectious diseases among the population under 20 years old in China from 1990 to 2021, to identify the severity and key affected populations, and to provide a reference basis for formulating prevention and intervention policies.

Methods

Data were sourced from the Global Burden of Disease Study (GBD) 2021 database. The Joinpoint regression model was used to analyze the temporal trends in the incidence, mortality, and disability-adjusted life years (DALYs) rates of enteric infectious diseases among the population under 20 in China from 1990 to 2021. The age-period-cohort analysis method was employed to assess the effects of age, period, and birth cohort on the trends in the disease burden.

Results

The incidence rate of enteric infectious diseases in the population under 20 in China decreased from 48 373.02 per 100 000 in 1990 to 8 811.07 per 100 000 in 2021. The mortality rate decreased from 17.55 per 100 000 in 1990 to 0.43 per 100 000 in 2021. The DALYs rate decreased from 1 643.60 per 100 000 in 1990 to 52.31 per 100 000 in 2021. Joinpoint regression analysis showed that from 1990 to 2021, the incidence rate decreased by an average of 5.34% annually (AAPC=-5.34%, 95% CI: -5.50% to -5.18%), the mortality rate decreased by an average of 11.34% annually (AAPC=-11.34%, 95% CI: -11.71% to -10.97%), and the DALYs rate decreased by an average of 10.56% annually (AAPC=-10.56%, 95% CI: -11.03% to -10.10%). Age-period-cohort model analysis revealed that the 0-4 age group had a higher disease burden, significantly exceeding other age groups. With the progression of time periods, the risks of incidence, mortality, and DALYs for enteric infectious diseases in the population under 20 continued to decline. Compared to earlier birth cohorts, later birth cohorts had lower risks of incidence, mortality, and DALYs.

Conclusion

From 1990 to 2021, the incidence, mortality, and DALYs rates of enteric infectious diseases among the population under 20 years old in China showed a significant downward trend. However, for enteric infectious diseases children under 5 remain the key population, and comprehensive prevention and control measures should be implemented to further reduce the disease burden for this age group.

Key words

Enteric infectious diseases / Joinpoint regression / Disease burden / Age-period-cohort model

引用本文

肖回回, 赵锦, 陈水连, 邱劲松, 周银柱, 谢强明. 1990—2021年中国20岁以下人群肠道传染病疾病负担的年龄-时期-队列分析. 现代预防医学, 2026 , 53 (6) : 1119 -1125 . DOI: 10.20043/j.cnki.MPM.202510331

Hui-hui XIAO, Jin ZHAO, Shui-lian CHEN, Jin-song QIU, Yin-zhu ZHOU, Qiang-ming XIE. Age-period-cohort analysis on disease burden of enteric infectious diseases among the population under 20 years old, China, 1990 -2021[J]. Modern Preventive Medicine, 2026 , 53 (6) : 1119 -1125 . DOI: 10.20043/j.cnki.MPM.202510331

正文

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肠道传染病（Enteric infections diseases）是由多种细菌、病毒、寄生虫感染引起的以消化道症状为主的传染性疾病，主要包括腹泻性疾病（Diarrheal diseases）、伤寒与副伤寒（Typhoid and paratyphoid fever）、侵袭性非伤寒沙门氏菌感染（Invasive non-typhoidal Salmonella, iNTS）等，常见病原体包括诺如病毒、轮状病毒、沙门氏菌、伤寒沙门氏菌等^[1-2]。根据世界卫生组织评估肠道传染病是全球重大疾病负担，位列全球十大死因之一，每年导致5.5亿人患病^[3-4]，尤其在发展中国家，是儿童和青少年人群中重要的公共卫生问题，导致该人群死亡和健康寿命损失的主要原因之一^[5]。随着社会经济的快速发展，近三十年我国肠道传染病防治取得了巨大成就，但依据全国法定传染病疾病监测数据统计，肠道传染病发病数仍长期居高位^[6]。儿童及青少年正处于生长发育的关键阶段，且集体生活环境（如托幼机构、学校）密集，使得他们成为肠道传染病感染和暴发的高风险人群，然而，我国针对20岁以下人群肠道传染病负担相关研究尚缺乏。本研究利用全球疾病负担研究（GBD 2021）数据库，分析1990—2021年中国20岁以下人群肠道传染病的疾病负担时间变化趋势，利用年龄-时期-队列模型探索潜在影响因素，为今后防控工作制定提供科学参考。

1　资料与方法

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1.1　资料来源

本研究数据来源于由健康指标与评估研究所（Institute for Health Metrics and Evaluatio，IHME）发布（网址：https://vizhub.healthdata.org/gbd-results）的GBD2021数据库。该数据库提供了1980—2021年全球204个国家或地区，按照年龄、性别等分组的371种疾病和损伤、288种死亡原因以及88种风险因素的疾病负担数据。GBD的数据整合与估算遵循严格、标准化流程，数据源于各国官方疾病监测网络、全国健康调查、同行评审文献等多源异构数据^[7]。采用贝叶斯元回归模型（DisMod-MR 2.1模型）对疾病各项指标参数进行标准化合成和校正，实现不同地区、时间和人群间的可比性及一致性^[8]。本研究对GBD2021数据进行筛选，指标为“Incidence, Deaths, DALYs”，发病原因为“Enteric infections”，地区为“China”，年龄为<5岁、5~9岁、10~14岁、15~19岁，性别为“Both”，年份为“1990—2021年”，从而获取1990—2021年我国20岁以下人群肠道传染病发病率、死亡率和伤残调整生命年（DALYs）数据。参照《国际疾病分类》第十版（ICD-10），肠道传染病的编码范围为A00~A09^[9]。

1.2　统计学方法

1.2.1　Joinpoint回归模型

利用Joinpoint 5.3.0软件^[10]对1990—2021年中国20岁以下人群肠道传染病的发病率、死亡率和DALYs率的变化趋势进行分析，计算发病率、死亡率及DALYs率的年度变化百分比（annual percent change, APC）、平均年度变化百分比（average annual percent change, AAPC）及其95%CI。APC>0，表示发病率/死亡率逐年递增；APC<0，提示发病率/死亡率逐年递减；当无连接点时，即APC=AAPC时，发病率/死亡率呈单调递增/单调递减趋势。

1.2.2　年龄-时期-队列模型分析

该模型从年龄效应、时期效应和出生队列效应3个维度探讨疾病趋势变化^[11]，本研究使用Holford 提出的估计函数法计算系列参数进行模型解释^[12-13]，其中年龄效应代表疾病随年龄增长相关风险变化，时期效应代表疾病在不同时期中相关风险变化，队列效应代表具有相同出生年份的队列间疾病相关风险变化。该模型的估计函数主要包括净漂移（整个人群年龄标准化率的年均变化百分比，反映时期和队列效应的综合结果）、局部漂移（各年龄组的年均变化百分比）、纵向年龄曲线（校正时期效应后，在出生队列对照组中估算的年龄别粗率，代表年龄效应）、时期效应RR值（各时期组与时期对照组的年龄别粗率比值，代表时期效应）及队列效应RR值（各出生队列组与出生队列对照组的年龄别粗率比值，代表出生队列效应）。通过对上述估计函数的假设检验，确定相应效应的显著性。本研究将年龄从0~19岁以连续5年为一组进行划分，1992—2021年的发病率、死亡率和DALYs率以连续5年为一个时期进行划分，共划分为6个时期。设置中心年龄组、时期和出生队列作为参照组，计算各组的RR值及95% CI。采用Wald χ²检验参数估计，双侧检验，检验水准α=0.05。

2　结果

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2.1　肠道传染病年发病率、死亡率和DALYs率变化趋势

1990—2021年中国20岁以下人群肠道传染病发病率、死亡率和DALYs率总体呈现下降趋势。发病率从1990年48 373.02/10万下降至2021年的8 811.07/10万，Joinpoint回归模型结果显示，AAPC=-5.34% (95% CI: -5.50%~-5.18%, t=-62.50, P<0.001)。死亡率从1990年的17.55/10万下降至2021年的0.43/10万，Joinpoint回归模型结果显示AAPC=-11.34%(95% CI: -11.71%~-10.97%, t=-56.87, P<0.001)。DALYs率从1990年的1 643.60/10万下降至52.31/10万，Joinpoint回归模型结果显示AAPC=-10.56%(95% CI:-11.03%~-10.10%, t=-42.08, P<0.001)。

2.2　肠道传染病发病率、死亡率和DALYs率的年龄-时期-队列分析

中国20岁以下人群肠道传染病发病率、死亡率和DALYs率的年龄效应、时期效应及出生队列效应均有统计学意义（P<0.001），见表1。

2.2.1　净漂移和局部漂移

1992—2021年中国20岁以下人群肠道传染病的发病率净漂移为-6.05%（95% CI:-6.50%~-5.61%），死亡率的净漂移为-8.12%（95% CI: -9.135%~-7.08%），DALYs率的净漂移为-7.68%（95% CI:-8.83%~-6.50%）。发病率、死亡率及DALYs率的所有年龄组局部漂移值均<0，其中0~4岁年龄组的年度变化百分比均最小，见图2。

2.2.2　年龄效应

肠道传染病发病率、死亡率和DALYs率随着年龄增长均呈现下降趋势，0~4岁是发病率、死亡率和DALYs率明显高于其他年龄组，发病率为69 763.26/10万（95% CI:64 543. 26/10万~75 405.45/10万），死亡率为26.52/10万（95% CI:23.33/10万~30.15/10万），DALYs率为2 511.39/10万（95% CI:2 166.80/10万~2 910.79/10万），见图3。

2.2.3　时期效应

以2002—2006年时期为对照组，发病风险从1992—1996年的1.66（95% CI: 1.50 ~1.83）下降至2012—2016年最低时期组，为0.39（95% CI: 0.34 ~0.46），死亡风险从1992—1996年的4.29（95% CI:3.46~5.34）下降至2012—2016年的0.46（95% CI: 0.33~0.65），DALYs风险从1992—1996年的3.51（95% CI:2.77~4.46）下降至2012—2016年的0.42（95% CI: 0.29~0.62）。2017—2021年时期，三项指标风险均出现微幅上升，见图4。

2.2.4　队列效应

以1997—2001出生队列组为对照组，发病风险从1977—1981年出生队列组的2.11（95% CI:1.65~2.71）下降至2017—2021年的0.15（95% CI: 0.12~0.19），死亡风险从1977—1981年出现队列组的1.89（95% CI:1.08~3.34）下降至2017—2021年的0.04（95% CI:0.03~0.05），DALYs风险从1977—1981年出生队列组1.56（95% CI: 0.81~3.01）下降至2017—2021年的0.04（95% CI: 0.03~0.06），见图5。

3　讨论

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本研究结果显示，1990—2021年中国20岁以下人群肠道传染病的发病率、死亡率和DALYs率均呈现明显下降趋势，年均下降5%~11%，反应我国该年龄段人群肠道传染病流行水平和疾病负担明显下降。这得益于近几十年我国社会经济的快速发展和城市化进程，驱动着卫生系统强化，从而显著降低了肠道传染病的感染风险^[14-16]，例如2009年的医疗改革，使得细菌性痢疾和其他感染性腹泻等肠道传染病发病率显著下降^[17]。我国20世纪90年代以来开展的爱国卫生运动，改水改厕等专项卫生活动的持续推进，使得城乡环境卫生、卫生设施和饮用水状况显著改善，使得我国安全饮用水覆盖率和卫生厕所覆盖率明显提高，截至2020年分别达到了94%和92%^[18]，也极大降低我国肠道传染病发病水平，环境卫生改善对儿童群体肠道传染病降低尤其有效^[19]。同时在2003年后我国又加强传染病防控体系，各项防控措施得以全面提升，其中包括霍乱、细菌性痢疾、手足口病和病毒感染性腹泻等肠道传染病的主动监测和响应能力^[20]。

中国20岁以下人群肠道传染病的疾病负担主要仍为低年龄组人群，为0~4岁年龄组，该年龄组人群发病率、死亡率和DALYs率都显著高于其他年龄组。这主要是低年龄人群免疫系统尚未完全发育，肠道免疫屏障功能不成熟有关，增加了感染的发病率和严重程度，如轮状病毒、诺如病毒在5岁以下儿童中的阳性检测率显著高于其他年龄组^[21]，其中轮状病毒是导致低年龄人群高疾病负担的关键病原体^[22-23]。儿童在幼儿期频繁暴露肠道病原体，如致泻性大肠杆菌、沙门氏菌和志贺氏菌，这些病原体在日常环境（如托儿所或家庭）中传播率高^[24]，易反复感染，引起感染性腹泻，从而加剧了疾病负担，表现为高DALYs率。本研究发现近三十年疾病负担下降最快也是0~4岁年龄组人群，其主要原因为手足口疫苗和轮状病毒疫苗的推广接种，显著降低了接种婴幼儿肠道传染病的发病例，有研究显示，轮状病毒疫苗接种可预防40%~50%的轮状病毒腹泻病例和70%~90%的重症病例^[25-26]。再者，1990—2021年间，中国人均GPD增长超过20倍，极大地提高了家庭就医能力和医疗服务的可及性，这些提高对疾病负担的降低起到了重要作用，使得患病幼儿能够早期诊断和及时治疗，从而有效减少疾病传播和并发症的发生^[27-28]。同时也证明近三十年我国在肠道传染病5岁以下重点人群防治措施取得显著成效。

从时期效应和出生队列效应分析结果看，1990—2021年我国20岁以下人群肠道传染病的疾病负担总体呈现下降的趋势，这应该是强大的时期效应和出生队列效应的共同作用的结果。可大致分为三个阶段：第一阶段1990—2000年基础卫生设施的普及和初级卫生保健系统的建立，早在20世纪70年代，我国腹泻病的减少就被证实与卫生条件的改善和饮用水质量的提高密切相关^[29]。进入1990年代后，全国范围内的爱国卫生运动，农村改水改厕工程以及城市供水系统的现代化，从根本上切断了粪-口传播这一肠道传染病的主要途径^[30]，这时期肠道传染病发病风险呈现快速下降；第二阶段为2001—2015医疗资源普及和国家免疫规划深入，2009年我国启动新一轮深化医药卫生改革，推动基层医疗机构下沉普及^[31]，使得儿童患病后能够更及时地获得诊断和治疗。同期国家免疫规划通过垂直整合基层医疗体系不断完善深化，免疫服务有效覆盖全国儿童^[32]，使得儿童传染病死亡率的持续下降^[33]。第三阶段为2016—2021年精准防控与综合干预，随着我国公共卫生开展多种症候群监测，COVID-19期间建立传染病联防联控机制，使传染病防控逐渐迈入进入多系统、多部门、多层级监测预警以及综合防治策略^[34]，提升肠道传染病综合干预能力。时期效应显示在2017—2021年这时期，肠道传染病的发病率、死亡率及DALYs略微上升，其主要原因可能与我国公共卫生领域持续性投入，病原体检测能力的进一步提升密切相，虽然有这种小幅上升，但是并没有改变我国近三十年肠道传染病下降的总体大趋势。

本研究存在一些局限性。其一，GBD数据库中流行病学数据基于统计学模型的计算，与我国实际监测数据存在一些偏差；其二，肠道传染病的不同病原体在我国存在地区差异^[24]，而GBD不包含中国省份数据，仍需要进一步深入探究各省份的具体情况。

综上所述，1990—2021年中国20岁以下人群的肠道传染病疾病负担呈明显下降趋势。年龄-时期-队列分析显示，0~4岁年龄组是疾病负担最高，发病率、死亡率及DALYs都明显高其他年龄组人群；时期及出生队列效应表明，随着时间推移及较晚出生队列，肠道传染病的疾病风险呈下降趋势。因此，应继续攻坚我国5岁以下年龄组人群的肠道传染病发病率和死亡率，采取多途径的综合防治措施，进一步降低该人群疾病负担。

基金

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湖南省自然科学基金(2025JJ80516)
湖南省自然科学基金(2025JJ80519)

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2026年第53卷第6期

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doi: 10.20043/j.cnki.MPM.202510331

接收时间：2025-10-28
首发时间：2026-11-02
出版时间：2026-03-25

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收稿日期：2025-10-28

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湖南省自然科学基金(2025JJ80516)

湖南省自然科学基金(2025JJ80519)

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长沙市疾病预防控制中心（长沙市卫生综合监督执法局）传染病防制科，湖南长沙 410004

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谢强明，E-mail: 375234093@qq.com

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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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零假设	发病率			死亡率			DALYs率
零假设	χ²值	自由度	P值	χ²值	自由度	P值	χ²值	自由度	P值
净漂移=0	670.08	1	<0.001	220.95	1	<0.001	154.06	1	<0.001
总年龄偏差=0	31.84	2	<0.001	395.89	2	<0.001	231.71	2	<0.001
总时期偏差=0	37.83	4	<0.001	36.62	4	<0.001	23.33	4	<0.001
总出生队列偏差=0	51.30	7	<0.001	88.38	7	<0.001	68.76	7	<0.001
全时期RR值=1	948.13	5	<0.001	790.86	5	<0.001	479.58	5	<0.001
全出生队列RR值=1	979.06	8	<0.001	1 531.16	8	<0.001	797.25	8	<0.001
局部漂移=净漂移	50.42	4	<0.001	82.23	4	<0.001	63.77	4	<0.001