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Article(id=1321170605286732349, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321170520196895605, articleNumber=null, orderNo=null, doi=10.11847/zgggws1145608, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1722614400000, receivedDateStr=2024-08-03, revisedDate=1731168000000, revisedDateStr=2024-11-10, acceptedDate=1733241600000, acceptedDateStr=2024-12-04, onlineDate=1792921218462, onlineDateStr=2026-10-25, pubDate=1741536000000, pubDateStr=2025-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921218462, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921218462, creator=13701087609, updateTime=1792921218462, updator=13701087609, issue=Issue{id=1321170520196895605, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='3', pageStart='257', pageEnd='384', issueExtLink='null', onlineDate='null', pubDate='1741536000000', pubDateStr='2025-03-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921198175, creator='13701087609', updateTime=1792921198175, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=279, endPage=284, ext={EN=ArticleExt(id=1321170605483864638, articleId=1321170605286732349, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Age-period-cohort analysis of the incidence trend of chronic obstructive pulmonary disease among elderly residents in China from 1992 to 2021, columnId=1321170564291604713, journalTitle=Chinese Journal of Public Health, columnName=Special Report–Research on Disease Burden, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the incidence trends of chronic obstructive pulmonary disease (COPD) among elderly adults in China and to provide a reference for optimizing COPD prevention and control strategies in China.

Methods

Data related to the incidence of COPD among Chinese residents aged ≥60 years from 1992 to 2021 were collected from the Global Burden of Disease Study 2021 (GBD 2021) database. Descriptive analyses were conducted using indicators such as the number of incident cases, incidence rate, and age-standardized incidence rate. Joinpoint regression models were used to analyze the trends in COPD incidence among elderly adults in China and to calculate the annual percentage change (APC) and average annual percentage change (AAPC). Age-period-cohort (APC) models were applied to fit and estimate the age, period, and cohort effects on the risk of COPD incidence among elderly adults in China.

Results

The incidence rates of COPD among elderly adults in China overall, males, and females decreased from 1 374.91/1 000 001 359.40/100 000, and 1 389.29/100 000 in 1992 to 1 252.95/100 000, 1 207.43/100 000, and 1 179.24/100 000 in 2021, respectively. The age-standardized incidence rates decreased from 1 548.64/100 000, 1 590.77/100 000, and 1 515.03/100 000 in 1992 to 1 252.95/100 000, 1 331.37/100 000, and 1 190.16/100 000 in 2021, respectively. The AAPCs of the age-standardized incidence rates were –0.73%, –0.61%, and –0.83%, respectively (all P<0.05). The APC model analysis showed that the age effects on COPD incidence among elderly adults in China overall, males, and females all showed an increasing trend with age, with the age effect coefficients increasing from –0.817, –0.791, and –0.861 for ages 60-64 to 0.521, 0.611, and 0.504 for ages 90-94, respectively. The period effects on COPD incidence among elderly adults in China overall and females showed a trend of first decreasing and then increasing over time, with the period effect coefficients decreasing from 0.013 and 0.033 for the period 1992–1996 to –0.028 and –0.059 for the period 2007-2011, and then increasing to 0.013 and 0.024 for the period 2017–2021, respectively. The period effects on COPD incidence among elderly male adults showed an overall increasing trend over time, with the period effect coefficients increasing from –0.017 for the period 1992–1996 to 0.014 for the period 2017–2021. The birth cohort effects on COPD incidence among elderly adults in China overall, males, and females all showed a decreasing trend with birth year, decreasing from 0.255, 0.194, and 0.283 for the birth cohort 1902–1906 to –0.279, –0.307, and –0.258 for the birth cohort 1957–1961, respectively.

Conclusions

The age-standardized incidence rate of COPD among elderly adults in China showed an overall decreasing trend from 1992 to 2021, but the disease burden of COPD among males and elderly adults at advanced ages continues to increase.

, authors=Mengmeng PAN1, Xie ZHANG2, authorsList=Mengmeng PAN, Xie ZHANG, authorCompany=null, correspAuthors=Xie ZHANG, authorNote=null, correspAuthorsNote=
ZHANG Xie, E-mail:
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目的

了解中国老年居民慢性阻塞性肺疾病（COPD）的发病趋势，为我国COPD防治策略的优化提供参考依据。

方法

收集2021年全球疾病负担研究（GBD 2021）数据库中1992—2021年中国≥60岁老年居民COPD发病相关数据，采用发病数、发病率和标化发病率等指标进行描述性分析，采用Joinpoint回归模型分析中国老年居民COPD发病率的变化趋势并计算年度变化百分比（APC）和平均年度变化百分比（AAPC），并应用年龄–时期–队列（APC）模型拟合并估计中国老年居民COPD发病风险中的年龄效应、时期效应和队列效应。

结果

中国总体、男性和女性老年居民COPD发病率分别从1992年的1 374.91/10万、1 359.40/10万和1 389.29/10万下降至2021年的1 207.43/10万、1 237.97/10万和1 179.24/10万，标化发病率分别从1992年的1 548.64/10万、1 590.77/10万和1 515.03/10万下降至2021年的1 252.95/10万、1 331.37/10万和1 190.16/10万，标化发病率的AAPC值分别为–0.73%、–0.61%和–0.83%（均P<0.05）。APC模型分析结果显示，中国总体、男性和女性老年居民COPD发病率的年龄效应均随年龄的增长呈上升趋势，年龄效应系数分别从60～64岁的–0.817、–0.791和–0.861上升至90～94岁的0.521、0.611和0.504；中国总体和女性老年居民COPD发病率的时期效应均随时期的推移呈先下降后上升趋势，时期效应系数分别从1992—1996年的0.013和0.033下降至2007—2011年的–0.028和–0.059而后上升至2017—2021年的0.013和0.024，男性老年居民COPD发病率的时期效应均随时期的推移呈总体上升趋势，时期效应系数从1992—1996年的–0.017上升至2017—2021年的0.014；中国总体、男性和女性老年居民COPD发病率的出生队列效应系数均随出生年份的推移呈下降趋势，分别从1902—1906年的0.255、0.194和0.283下降至1957—1961年的–0.279、–0.307和–0.258。

结论

1992—2021年中国老年居民COPD标化发病率总体呈下降趋势，但男性和高龄老年居民COPD的疾病负担仍持续加重。

, authors=潘萌萌1, 张勰2, *, *, authorsList=潘萌萌, 张勰, authorCompany=null, correspAuthors=张勰, authorNote=

潘萌萌（2000—），硕士在读，研究方向：老年人健康服务与管理

, correspAuthorsNote=
张勰，E-mail：
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潘萌萌（2000—），硕士在读，研究方向：老年人健康服务与管理

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Canadian Respiratory Journal, 2016, 2016: 7518287., articleTitle=null, refAbstract=null), Reference(id=1321170832597045446, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170605286732349, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=23, rfOrder=22, authorNames=null, journalName=null, refType=null, unstructuredReference=陈晓英, 郑杨, 刘晓侠, 等. 美国慢性阻塞性肺疾病防控战略与行动及对中国的启示[J]. 中国慢性病预防与控制, 2019, 27(10): 790-795., articleTitle=null, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1321170824799834258, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170605286732349, xref=1, ext=[AuthorCompanyExt(id=1321170824808222867, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170605286732349, companyId=1321170824799834258, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1School of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, China), AuthorCompanyExt(id=1321170824816611476, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170605286732349, companyId=1321170824799834258, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1甘肃中医药大学公共卫生学院，兰州 730000)]), AuthorCompany(id=1321170824879526037, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170605286732349, xref=2, ext=[AuthorCompanyExt(id=1321170824887914646, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170605286732349, companyId=1321170824879526037, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2School of Health Management, Gansu University of Chinese Medicine, Lanzhou 730000, China), AuthorCompanyExt(id=1321170824908886167, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170605286732349, companyId=1321170824879526037, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2甘肃中医药大学卫生管理学院，兰州 730000)])], figs=[ArticleFig(id=1321170828893474988, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170605286732349, language=EN, label=Tab.1, caption=

Prevalence of COPD among elderly residents in China from 1992 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
年份总体男性女性
发病数/例发病率/（1/10万）标化发病率/（1/10万）发病数/例发病率/（1/10万）标化发病率/（1/10万）发病数/例发病率/（1/10万）标化发病率/（1/10万）
19921 461 7731 374.911 548.64695 4081 359.401 590.77766 3641 389.291 515.03
19931 506 3721 376.281 545.84723 4901 371.081 595.62782 8821 381.121 503.78
19941 551 2681 374.961 541.68751 3811 378.621 598.06799 8871 371.541 492.32
19951 594 6121 373.471 536.21778 0471 384.231 597.89816 5651 363.371 480.95
19961 635 3571 370.501 528.51802 7611 386.921 594.96832 5961 355.041 468.32
19971 673 2931 366.421 518.21825 8651 387.781 589.74847 4281 346.241 453.32
19981 707 9741 362.651 506.17847 0001 388.481 582.97860 9741 338.151 436.71
19991 741 3131 359.451 493.45868 1101 389.351 575.55873 2021 330.981 419.35
20001 774 4331 355.781 480.85888 8311 391.001 568.35885 6021 322.181 402.04
20011 804 8941 350.871 467.52908 3511 391.781 560.60896 5421 311.811 383.75
20021 833 4661 343.601 452.55927 1851 390.471 551.46906 2821 298.811 363.66
20031 860 8691 334.321 436.77945 3901 386.411 541.50915 4781 284.481 342.73
20041 887 1701 324.571 420.80962 5781 382.691 531.27924 5921 269.041 321.90
20051 918 1351 314.241 405.45982 2131 377.971 521.30935 9231 253.411 301.96
20061 959 5621 299.991 389.261 009 1361 370.811 511.36950 4251 232.381 279.94
20072 008 1691 283.461 371.591 041 7061 362.781 500.95966 4631 207.701 255.05
20082 055 3601 269.271 354.421 073 2911 356.171 490.20982 0681 186.191 231.28
20092 122 2671 247.471 339.541 113 6021 338.441 479.131 008 6641 160.411 212.67
20102 182 6101 238.421 328.861 143 8441 329.231 467.791 038 7661 151.781 203.14
20112 268 3081 229.851 323.171 180 6441 313.421 454.711 087 6641 150.391 205.78
20122 366 6951 226.181 320.891 217 2871 296.491 439.381 149 4081 159.571 217.61
20132 474 1291 221.111 320.001 254 8841 275.541 423.151 219 2461 169.741 232.97
20142 596 1061 218.601 318.261 299 9241 258.601 407.131 296 1821 180.961 246.09
20152 704 2261 209.231 313.421 340 9991 238.531 392.381 363 2271 181.731 251.18
20162 801 3961 199.761 301.771 383 0351 224.901 376.721 418 3611 176.211 243.15
20172 877 2251 189.061 285.021 418 7451 214.081 359.661 458 4801 165.691 226.28
20182 942 8191 182.811 268.871 451 4821 209.751 344.821 491 3371 157.721 208.50
20193 030 8931 189.371 259.111 494 3951 217.951 335.841 536 4981 162.831 197.77
20203 132 0521 199.891 257.011 541 5251 228.581 333.861 590 5271 173.321 195.71
20213 240 4111 207.431 252.951 594 3721 237.971 331.371 646 0391 179.241 190.16
), ArticleFig(id=1321170829015109805, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170605286732349, language=CN, label=表1, caption=

1992—2021年中国老年居民COPD发病情况

, figureFileSmall=null, figureFileBig=null, tableContent=
年份总体男性女性
发病数/例发病率/（1/10万）标化发病率/（1/10万）发病数/例发病率/（1/10万）标化发病率/（1/10万）发病数/例发病率/（1/10万）标化发病率/（1/10万）
19921 461 7731 374.911 548.64695 4081 359.401 590.77766 3641 389.291 515.03
19931 506 3721 376.281 545.84723 4901 371.081 595.62782 8821 381.121 503.78
19941 551 2681 374.961 541.68751 3811 378.621 598.06799 8871 371.541 492.32
19951 594 6121 373.471 536.21778 0471 384.231 597.89816 5651 363.371 480.95
19961 635 3571 370.501 528.51802 7611 386.921 594.96832 5961 355.041 468.32
19971 673 2931 366.421 518.21825 8651 387.781 589.74847 4281 346.241 453.32
19981 707 9741 362.651 506.17847 0001 388.481 582.97860 9741 338.151 436.71
19991 741 3131 359.451 493.45868 1101 389.351 575.55873 2021 330.981 419.35
20001 774 4331 355.781 480.85888 8311 391.001 568.35885 6021 322.181 402.04
20011 804 8941 350.871 467.52908 3511 391.781 560.60896 5421 311.811 383.75
20021 833 4661 343.601 452.55927 1851 390.471 551.46906 2821 298.811 363.66
20031 860 8691 334.321 436.77945 3901 386.411 541.50915 4781 284.481 342.73
20041 887 1701 324.571 420.80962 5781 382.691 531.27924 5921 269.041 321.90
20051 918 1351 314.241 405.45982 2131 377.971 521.30935 9231 253.411 301.96
20061 959 5621 299.991 389.261 009 1361 370.811 511.36950 4251 232.381 279.94
20072 008 1691 283.461 371.591 041 7061 362.781 500.95966 4631 207.701 255.05
20082 055 3601 269.271 354.421 073 2911 356.171 490.20982 0681 186.191 231.28
20092 122 2671 247.471 339.541 113 6021 338.441 479.131 008 6641 160.411 212.67
20102 182 6101 238.421 328.861 143 8441 329.231 467.791 038 7661 151.781 203.14
20112 268 3081 229.851 323.171 180 6441 313.421 454.711 087 6641 150.391 205.78
20122 366 6951 226.181 320.891 217 2871 296.491 439.381 149 4081 159.571 217.61
20132 474 1291 221.111 320.001 254 8841 275.541 423.151 219 2461 169.741 232.97
20142 596 1061 218.601 318.261 299 9241 258.601 407.131 296 1821 180.961 246.09
20152 704 2261 209.231 313.421 340 9991 238.531 392.381 363 2271 181.731 251.18
20162 801 3961 199.761 301.771 383 0351 224.901 376.721 418 3611 176.211 243.15
20172 877 2251 189.061 285.021 418 7451 214.081 359.661 458 4801 165.691 226.28
20182 942 8191 182.811 268.871 451 4821 209.751 344.821 491 3371 157.721 208.50
20193 030 8931 189.371 259.111 494 3951 217.951 335.841 536 4981 162.831 197.77
20203 132 0521 199.891 257.011 541 5251 228.581 333.861 590 5271 173.321 195.71
20213 240 4111 207.431 252.951 594 3721 237.971 331.371 646 0391 179.241 190.16
), ArticleFig(id=1321170829090607278, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170605286732349, language=EN, label=Tab.2, caption=

Age-period-cohort model analysis of COPD incidence among elderly residents in China from 1992 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类总体男性女性
效应系数95%CI效应系数95%CI效应系数95%CI
年龄效应/岁60～64–0.817–0.819 ～–0.814–0.791–0.795 ～–0.788–0.861–0.864 ～–0.859
65～69–0.369–0.371 ～–0.368–0.354–0.357 ～–0.351–0.402–0.405 ～–0.400
70～74–0.094–0.095 ～–0.093–0.114–0.116 ～–0.112–0.087–0.089 ～–0.086
75～790.0540.053～0.0560.0080.005～0.0100.0880.086～0.090
80～840.2820.280～0.2840.2360.230～0.2350.3190.317～0.322
85～890.4220.419～0.4240.4080.404～0.4120.4400.437～0.443
90～940.5210.518～0.5250.6110.604～0.6170.5040.500～0.508
时期效应/年份1992—19960.0130.011～0.015–0.017–0.021 ～–0.0140.0330.031～0.035
1997—20010.0110.010～0.013–0.001–0.004～0.0010.0170.015～0.019
2002—2006–0.008–0.010 ～–0.007–0.001–0.003～0.001–0.019–0.021 ～–0.017
2007—2011–0.028–0.030 ～–0.0270.0030.002～0.005–0.059–0.061 ～–0.057
2012—2016–0.001–0.002～0.0010.002–0.001～0.0040.0050.003～0.007
2017—20210.0130.011～0.0150.0140.011～0.0180.0240.021～0.026
出生队列效应/年份1902—19060.2550.244～0.2670.1940.172～0.2160.2830.269～0.297
1907—19110.1700.163～0.1760.1650.153～0.1770.1790.171～0.187
1912—19160.1150.110～0.1200.1300.122～0.1380.1170.111～0.123
1917—19210.0820.078～0.0860.0970.090～0.1040.0850.080～0.090
1922—19260.0580.055～0.0610.0690.063～0.0740.0630.059～0.067
1927—19310.0330.031～0.0360.0450.041～0.0490.0320.029～0.035
1932—1936–0.001–0.003～0.0010.0170.014～0.020–0.014–0.017 ～–0.012
1937—1941–0.034–0.035 ～–0.032–0.013–0.016 ～–0.011–0.058–0.060 ～–0.056
1942—1946–0.068–0.069 ～–0.067–0.054–0.056 ～–0.052–0.091–0.093 ～–0.089
1947—1951–0.126–0.128 ～–0.125–0.123–0.126 ～–0.121–0.139–0.141 ～–0.136
1952—1956–0.206–0.208 ～–0.203–0.218–0.222 ～–0.215–0.199–0.202 ～–0.196
1957—1961–0.279–0.283 ～–0.276–0.307–0.313 ～–0.302–0.258–0.263 ～–0.253
), ArticleFig(id=1321170829182881967, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170605286732349, language=CN, label=表2, caption=

1992—2021年中国老年居民COPD发病率的APC模型分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类总体男性女性
效应系数95%CI效应系数95%CI效应系数95%CI
年龄效应/岁60～64–0.817–0.819 ～–0.814–0.791–0.795 ～–0.788–0.861–0.864 ～–0.859
65～69–0.369–0.371 ～–0.368–0.354–0.357 ～–0.351–0.402–0.405 ～–0.400
70～74–0.094–0.095 ～–0.093–0.114–0.116 ～–0.112–0.087–0.089 ～–0.086
75～790.0540.053～0.0560.0080.005～0.0100.0880.086～0.090
80～840.2820.280～0.2840.2360.230～0.2350.3190.317～0.322
85～890.4220.419～0.4240.4080.404～0.4120.4400.437～0.443
90～940.5210.518～0.5250.6110.604～0.6170.5040.500～0.508
时期效应/年份1992—19960.0130.011～0.015–0.017–0.021 ～–0.0140.0330.031～0.035
1997—20010.0110.010～0.013–0.001–0.004～0.0010.0170.015～0.019
2002—2006–0.008–0.010 ～–0.007–0.001–0.003～0.001–0.019–0.021 ～–0.017
2007—2011–0.028–0.030 ～–0.0270.0030.002～0.005–0.059–0.061 ～–0.057
2012—2016–0.001–0.002～0.0010.002–0.001～0.0040.0050.003～0.007
2017—20210.0130.011～0.0150.0140.011～0.0180.0240.021～0.026
出生队列效应/年份1902—19060.2550.244～0.2670.1940.172～0.2160.2830.269～0.297
1907—19110.1700.163～0.1760.1650.153～0.1770.1790.171～0.187
1912—19160.1150.110～0.1200.1300.122～0.1380.1170.111～0.123
1917—19210.0820.078～0.0860.0970.090～0.1040.0850.080～0.090
1922—19260.0580.055～0.0610.0690.063～0.0740.0630.059～0.067
1927—19310.0330.031～0.0360.0450.041～0.0490.0320.029～0.035
1932—1936–0.001–0.003～0.0010.0170.014～0.020–0.014–0.017 ～–0.012
1937—1941–0.034–0.035 ～–0.032–0.013–0.016 ～–0.011–0.058–0.060 ～–0.056
1942—1946–0.068–0.069 ～–0.067–0.054–0.056 ～–0.052–0.091–0.093 ～–0.089
1947—1951–0.126–0.128 ～–0.125–0.123–0.126 ～–0.121–0.139–0.141 ～–0.136
1952—1956–0.206–0.208 ～–0.203–0.218–0.222 ～–0.215–0.199–0.202 ～–0.196
1957—1961–0.279–0.283 ～–0.276–0.307–0.313 ～–0.302–0.258–0.263 ～–0.253
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1992—2021年中国老年居民慢性阻塞性肺疾病发病趋势年龄–时期–队列分析
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潘萌萌 1 , 张勰 2, *, *
中国公共卫生 | 专题报道——疾病负担研究 2025,41(3): 279-284
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中国公共卫生 |专题报道——疾病负担研究 2025 , 41 (3) : 279 -284
1992—2021年中国老年居民慢性阻塞性肺疾病发病趋势年龄–时期–队列分析
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潘萌萌1, 张勰2, *, *
作者信息
  • 1甘肃中医药大学公共卫生学院，兰州 730000
  • 2甘肃中医药大学卫生管理学院，兰州 730000
通讯作者:
张勰，E-mail：
作者简介:

潘萌萌（2000—），硕士在读，研究方向：老年人健康服务与管理

Age-period-cohort analysis of the incidence trend of chronic obstructive pulmonary disease among elderly residents in China from 1992 to 2021
Mengmeng PAN1, Xie ZHANG2
Affiliations
  • 1School of Public Health, Gansu University of Chinese Medicine, Lanzhou 730000, China
  • 2School of Health Management, Gansu University of Chinese Medicine, Lanzhou 730000, China
    • Corresponding Author:
    ZHANG Xie, E-mail:
出版时间: 2025-03-10 doi: 10.11847/zgggws1145608
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摘要
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目的

了解中国老年居民慢性阻塞性肺疾病（COPD）的发病趋势，为我国COPD防治策略的优化提供参考依据。

方法

收集2021年全球疾病负担研究（GBD 2021）数据库中1992—2021年中国≥60岁老年居民COPD发病相关数据，采用发病数、发病率和标化发病率等指标进行描述性分析，采用Joinpoint回归模型分析中国老年居民COPD发病率的变化趋势并计算年度变化百分比（APC）和平均年度变化百分比（AAPC），并应用年龄–时期–队列（APC）模型拟合并估计中国老年居民COPD发病风险中的年龄效应、时期效应和队列效应。

结果

中国总体、男性和女性老年居民COPD发病率分别从1992年的1 374.91/10万、1 359.40/10万和1 389.29/10万下降至2021年的1 207.43/10万、1 237.97/10万和1 179.24/10万，标化发病率分别从1992年的1 548.64/10万、1 590.77/10万和1 515.03/10万下降至2021年的1 252.95/10万、1 331.37/10万和1 190.16/10万，标化发病率的AAPC值分别为–0.73%、–0.61%和–0.83%（均P<0.05）。APC模型分析结果显示，中国总体、男性和女性老年居民COPD发病率的年龄效应均随年龄的增长呈上升趋势，年龄效应系数分别从60～64岁的–0.817、–0.791和–0.861上升至90～94岁的0.521、0.611和0.504；中国总体和女性老年居民COPD发病率的时期效应均随时期的推移呈先下降后上升趋势，时期效应系数分别从1992—1996年的0.013和0.033下降至2007—2011年的–0.028和–0.059而后上升至2017—2021年的0.013和0.024，男性老年居民COPD发病率的时期效应均随时期的推移呈总体上升趋势，时期效应系数从1992—1996年的–0.017上升至2017—2021年的0.014；中国总体、男性和女性老年居民COPD发病率的出生队列效应系数均随出生年份的推移呈下降趋势，分别从1902—1906年的0.255、0.194和0.283下降至1957—1961年的–0.279、–0.307和–0.258。

结论

1992—2021年中国老年居民COPD标化发病率总体呈下降趋势，但男性和高龄老年居民COPD的疾病负担仍持续加重。

慢性阻塞性肺疾病（COPD）  /  发病趋势  /  年龄–时期–队列（APC）模型  /  老年居民  /  中国
Objective

To understand the incidence trends of chronic obstructive pulmonary disease (COPD) among elderly adults in China and to provide a reference for optimizing COPD prevention and control strategies in China.

Methods

Data related to the incidence of COPD among Chinese residents aged ≥60 years from 1992 to 2021 were collected from the Global Burden of Disease Study 2021 (GBD 2021) database. Descriptive analyses were conducted using indicators such as the number of incident cases, incidence rate, and age-standardized incidence rate. Joinpoint regression models were used to analyze the trends in COPD incidence among elderly adults in China and to calculate the annual percentage change (APC) and average annual percentage change (AAPC). Age-period-cohort (APC) models were applied to fit and estimate the age, period, and cohort effects on the risk of COPD incidence among elderly adults in China.

Results

The incidence rates of COPD among elderly adults in China overall, males, and females decreased from 1 374.91/1 000 001 359.40/100 000, and 1 389.29/100 000 in 1992 to 1 252.95/100 000, 1 207.43/100 000, and 1 179.24/100 000 in 2021, respectively. The age-standardized incidence rates decreased from 1 548.64/100 000, 1 590.77/100 000, and 1 515.03/100 000 in 1992 to 1 252.95/100 000, 1 331.37/100 000, and 1 190.16/100 000 in 2021, respectively. The AAPCs of the age-standardized incidence rates were –0.73%, –0.61%, and –0.83%, respectively (all P<0.05). The APC model analysis showed that the age effects on COPD incidence among elderly adults in China overall, males, and females all showed an increasing trend with age, with the age effect coefficients increasing from –0.817, –0.791, and –0.861 for ages 60-64 to 0.521, 0.611, and 0.504 for ages 90-94, respectively. The period effects on COPD incidence among elderly adults in China overall and females showed a trend of first decreasing and then increasing over time, with the period effect coefficients decreasing from 0.013 and 0.033 for the period 1992–1996 to –0.028 and –0.059 for the period 2007-2011, and then increasing to 0.013 and 0.024 for the period 2017–2021, respectively. The period effects on COPD incidence among elderly male adults showed an overall increasing trend over time, with the period effect coefficients increasing from –0.017 for the period 1992–1996 to 0.014 for the period 2017–2021. The birth cohort effects on COPD incidence among elderly adults in China overall, males, and females all showed a decreasing trend with birth year, decreasing from 0.255, 0.194, and 0.283 for the birth cohort 1902–1906 to –0.279, –0.307, and –0.258 for the birth cohort 1957–1961, respectively.

Conclusions

The age-standardized incidence rate of COPD among elderly adults in China showed an overall decreasing trend from 1992 to 2021, but the disease burden of COPD among males and elderly adults at advanced ages continues to increase.

chronic obstructive pulmonary disease (COPD)  /  incidence trend  /  age-period-cohort (APC) model  /  elderly residents  /  China
潘萌萌, 张勰. 1992—2021年中国老年居民慢性阻塞性肺疾病发病趋势年龄–时期–队列分析. 中国公共卫生, 2025 , 41 (3) : 279 -284 . DOI: 10.11847/zgggws1145608
Mengmeng PAN, Xie ZHANG. Age-period-cohort analysis of the incidence trend of chronic obstructive pulmonary disease among elderly residents in China from 1992 to 2021[J]. Chinese Journal of Public Health, 2025 , 41 (3) : 279 -284 . DOI: 10.11847/zgggws1145608
正文
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随着城市化和老龄化进程的加快以及环境和生活方式的变化，慢性非传染性疾病对全球生命健康和经济社会发展的威胁愈加严重，其中慢性呼吸系统疾病已演变成为导致发展中国家人口死亡的第三大因素[1]。作为慢性呼吸系统疾病的主要类型之一，慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）是一种慢性炎症性呼吸道疾病[2]，困扰全球>3.8亿的人口[3]。同时，COPD也是一种常见的可预防和治疗的疾病，其特征为发病率高、死亡率高、病程长和治疗费用高[4]，主要临床症状包括慢性咳嗽、咳嗽、气短、呼吸困难、喘息、胸闷、疲劳和体重减轻等。肺活量测定是诊断和评估COPD的金标准，能够准确、可靠和客观地测量气流受限情况[5]。研究表明，中国COPD患者占全球COPD患者的1/4，COPD不仅对中国居民造成沉重的健康损失，还产生了巨大的直接和间接经济负担[3, 6]。鉴于人口增长和老龄化以及日益严重的环境污染[5]，预计未来COPD住院人数将明显增加，COPD住院的负担亦将持续增加[2,7]。为了解中国老年居民COPD的发病趋势，为我国COPD防治策略的优化提供参考依据，本研究收集2021年全球疾病负担研究（The Global Burden of Disease Study 2021, GBD 2021）数据库中1992—2021年中国≥60岁老年居民COPD发病相关数据，采用发病数、发病率和标化发病率等指标进行描述性分析，采用Joinpoint联结点回归模型分析中国老年居民COPD发病率的变化趋势并计算年度变化百分比（annual percentage rate change，APC）和平均年度变化百分比（average annual percentage change，AAPC），并应用年龄–时期–队列（age-period-cohort，APC）模型拟合并估计中国老年居民COPD发病风险中的年龄效应、时期效应和队列效应。结果报告如下。
1　资料与方法
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1.1　资料来源
资料来源于GBD 2021, 本研究数据从全球健康数据交换数据库（the Global Health Data Exchange, GHDx）中获取，网址为：https://vizhub.healthdata.org/gbd-results/。GBD 2021通过人口普查、医疗数据、科研成果、官方死亡统计数据等多种渠道，采用科学、合理、标准的方法测算了全球204个国家、地区288种死因和371种疾病或伤害的疾病负担和导致这些疾病的88种危险因素，具有全面性、准确性、一致性、内部可比性等优点[8]。本研究收集GBD 2021中1992—2021年中国全人群、分性别老年居民COPD发病数、发病率和标化发病率等相关数据进行分析，其中标化发病率通过GBD 2021全球人口年龄标准进行计算，能比较不同年龄结构人群、年份或时期之间的比率[9]。本研究中COPD根据《国际疾病与相关健康问题统计分类第十版（The International Statistical Classification of Diseases and Related Health Problems 10th Revision， ICD-10）》[10]编码进行分类和编码，编码为J41～J44和J47。
1.2　统计分析
采用Excel 2016软件建立数据库进行一般描述性分析；应用R 4.4.0统计软件进行Joinpoint联结点回归分析，拟合得到最优联结点个数，计算得出COPD标化发病率的APC和AAPC值，分析中国老年居民COPD发病的变化趋势。应用Stata 16.0软件构建APC模型拟合并估计中国老年居民COPD发病风险中的年龄效应、时期效应和出生队列效应，基于这3个维度，APC模型能够相对系统、全面且有针对性地分析老年居民COPD的发病风险[11–12]，基本公式为：Inincidence=μ+αa+βb+γc+εabc；其中，Inincidence代表老年居民COPD发病率的自然对数，μ代表截距，αa代表第a个年龄组的年龄效应，βb代表第b个时期的时期效应，γc代表第c个队列的队列效应，εabc代表误差项或残差项。APC模型中，根据老年人口定义选择60～94岁人群研究，其中年龄以5年为间隔分为7组（60～64岁、65～69岁、$\cdots $、90～94岁），时期以5年为间隔分为6组（1992—1996年、1997—2001年、$\cdots $、2017—2021年），出生队列由时期减去年龄得到，划分为12个出生队列（1902—1906年、1907—1911年、$\cdots $、1957—1961年）。检验水准为双侧检验α=0.05。
2　结　果
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2.1　1992—2021年中国老年居民COPD发病趋势（表1）
中国总体老年居民COPD发病率从1992年的1 374.91/10万下降至2021年的1 207.43/10万，标化发病率从1992年的1 548.64/10万下降至2021年的1 252.95/10万，平均每年降低0.73%（AAPC= –0.73%，t= –54.46，P<0.05）；中国男性老年居民COPD发病率从1992年的1 359.40/10万下降至2021年的1 237.97/10万，标化发病率从1992年的1 590.77/10万下降至2021年的1 331.37/10万，平均每年降低0.61%（AAPC= –0.61%，t= –77.02，P<0.05）；中国女性老年居民COPD发病率从1992年的1 389.29/10万下降至2021年的1 179.24/10万，标化发病率从1992年的1 515.03/10万下降至2021年的1 190.16/10万，平均每年降低0.83%（AAPC= –0.83%，t= –36.43，P<0.05）。
2.2　1992—2021年中国老年居民COPD标化发病率Joinpoint联结点回归分析
Joinpoint联结点回归模型分析结果显示，中国总体、男性和女性老年居民COPD标化发病率均呈下降趋势（均P<0.05）。其中，总体老年居民Joinpoint最优模型5个联结点将1992—2021年划分为1992—1996年、1996—2001年、2001—2010年、2010—2015年、2015—2019年和2019—2021年6个时间段，各时间段的APC值依次为–0.32%、–0.81%、–1.13%、–0.18%、–1.10%和–0.16%，除2019—2021年外其他时间段的APC值差异均有统计学意义（均P<0.05），我国总体老年居民COPD标化发病率呈持续下降趋势；男性老年居民Joinpoint最优模型4个联结点将1992—2021年划分为1992—1995年、1995—2001年、2001—2010年、2010—2019年和2019—2021年5个时间段，各时间段的APC值依次为0.19%、–0.40%、–0.68%、–1.08%和–0.03%，除2019—2021年外其他时间段的APC值差异均有统计学意义（均P<0.05），我国男性老年居民COPD标化发病率呈先缓慢上升再缓慢下降而后快速降低趋势；女性老年居民Joinpoint最优模型5个联结点将1992—2021年划分为1992—1997年、1997—2002年、2002—2010年、2010—2015年、2015—2019年和2019—2021年6个时间段，各时间段的APC值依次为–0.81%、–1.27%、–1.64%、0.97%、–1.17%和–0.26%，除2019—2021年外其他时间段的APC值差异均有统计学意义（均P<0.05），我国女性老年居民COPD标化发病率呈先快速下降再快速上升而后快速降低趋势。
2.3　1992—2021年中国老年居民COPD发病率APC模型分析（表2）
APC模型分析结果显示，1992—2021年中国老年居民COPD发病率的年龄效应随年龄增长呈总体上升趋势，总体、男性和女性老年居民COPD发病率的年龄效应系数分别从60～64岁的–0.817、–0.791和–0.861上升至90～94岁的0.521、0.611和0.504；中国总体和女性老年居民1992—2021年COPD发病率的时期效应均随时间推移呈先下降而后上升趋势，COPD发病率的时期效应系数分别从1992—1996年的0.013和0.033下降至2007—2011年的–0.028和–0.059而后上升至2017—2021年的0.013和0.024；男性老年居民1992—2021年COPD发病率的时期效应呈总体上升趋势，COPD发病率的时期效应系数从1992—1996年的–0.017上升至2017—2021年的0.014；1992—2021年中国老年居民COPD发病率的出生队列效应均呈总体下降趋势，总体、男性和女性老年居民COPD发病率的出生队列效应系数分别从1902—1906年的0.255、0.194和0.283下降至1957—1961年的–0.279、–0.307和–0.258。
3　讨　论
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本研究结果显示，中国总体、男性和女性老年居民COPD标化发病率分别从1992年的1 548.64/10万、1 590.77/10万和1 515.03/10万下降至2021年的1 252.95/10万、1 331.37/10万和1 190.16/10万，标化发病率的AAPC值分别为–0.73%、–0.61%和–0.83%（均P<0.05），表明1992—2021年中国老年居民COPD的标化发病率呈总体下降趋势，与既往研究[13 – 15]结果一致。这进一步说明，中国COPD的预防控制力度逐步加大，同时药物治疗效果也在逐步显现，苏彦萍等[16]研究表明减轻老年居民COPD疾病负担的有效途径之一是通过预防来降低COPD发病率。研究表明，人口老龄化、预期寿命延长、相对较高的吸烟率和严重的空气污染等是COPD的主要危险因素[4]，低教育程度和低收入水平亦与COPD较高的患病率相关[3]。此外，社会人口指数对老年居民COPD的发病率也存在着一定影响，在社会人口指数较低的地区，老年居民COPD的发病率逐渐增加，其发病人数和死亡比例亦有所上升，这可能与社会人口指数越高地区的医疗保健水平越高，使得该地区居民更注重维护自己的健康有关[17–18]。对老年男性居民而言，吸烟是导致COPD死亡率和疾病负担升高的主要危险因素，而其他危险因素如家庭和环境颗粒物污染则对老年女性居民有重大影响[6,17]。
年龄效应、时期效应和出生队列效应的意义不同，年龄效应是个体内部衰老的全生命周期反映，时期效应能够反映出影响不同年龄组老年居民COPD疾病分布的人为因素，出生队列效应则以同一年代的人群组成一个出生队列，反映年龄与时期交互所产生的作用[19–20]。本研究结果显示，1992—2021年中国老年居民COPD发病率的年龄效应随年龄增长呈总体上升趋势，因此需保障老年人健康素养宣教工作的有序开展，鼓励其养成良好行为生活习惯，有计划地控制未来因中国老年居民COPD疾病负担加重所产生的诸多问题；中国总体和女性老年居民1992—2021年COPD发病率的时期效应均随时间推移呈先下降而后上升趋势，男性老年居民1992—2021年COPD发病率的时期效应呈总体上升趋势，提示男性老年居民COPD的疾病负担持续增加；1992—2021年中国老年居民COPD发病率的出生队列效应均呈总体下降趋势，这可能与我国政府为进一步加强COPD防控并降低患者死亡风险实施了减少煤炭和石油消耗、开发清洁能源、加强森林保护和推广秸秆覆盖等诸多相关措施有关[13]。
综上所述，1992—2021年中国老年居民COPD标化发病率总体呈下降趋势，但男性和高龄老年居民COPD的疾病负担仍持续增加。COPD标化发病率的降低可能与2000年后我国公共卫生事业及基层医疗卫生事业开始蓬勃发展，居民卫生医疗意识逐渐提高，对于慢性呼吸系统相关疾病发生的关注度有所提升有关[21]；而男性和高龄老年居民COPD疾病负担持续加重则提示应加强对男性和高龄老年居民COPD的早期筛查与干预，同时将重点转移至“治未病”，通过三级预防控制COPD发病和患病危险因素来减轻老年居民COPD的疾病负担[21–23]，不断提高老年居民的健康保障水平，从而改善老年居民的健康生活质量。
总体而言，本研究通过Joinpoint联结点回归模型分析1992—2021年中国老年居民COPD发病率趋势，又通过构建APC模型分析我国老年居民COPD发病率的年龄效应、时期效应和出生队列效应，能够为强化全社会全人群公共卫生意识、降低老年居民COPD危险因素、促进COPD早期诊断和治疗、减轻COPD危险因素造成的疾病负担以及提高我国老年居民COPD筛查、预防和治疗的效果提供理论依据。但本研究仍存在一定的局限性：一方面，本研究使用GBD 2021数据进行分析，无法避免数据偏差，对结果的准确性存在一定影响；另一方面，APC模型仅考虑了年龄、时期和出生队列的影响，未进一步分析其他危险因素对COPD发病的影响。因此，在今后的研究中可改进研究方法以提高数据分析的准确性，同时还可基于比较风险评估理论对引发老年居民COPD的危险因素进行归因疾病负担评估，以及时采取干预措施有效减轻我国老年居民COPD发病的疾病负担。

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doi: 10.11847/zgggws1145608
  • 接收时间：2024-08-03
  • 首发时间：2026-10-25
  • 出版时间：2025-03-10
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  • 收稿日期：2024-08-03
  • 修回日期：2024-11-10
  • 录用日期：2024-12-04
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    1甘肃中医药大学公共卫生学院，兰州 730000
    2甘肃中医药大学卫生管理学院，兰州 730000

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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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