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Article(id=1321170077601353959, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169992024961657, articleNumber=null, orderNo=null, doi=10.11847/zgggws1146346, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1730736000000, receivedDateStr=2024-11-05, revisedDate=1734969600000, revisedDateStr=2024-12-24, acceptedDate=1739721600000, acceptedDateStr=2025-02-17, onlineDate=1792921092652, onlineDateStr=2026-10-25, pubDate=1744214400000, pubDateStr=2025-04-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921092652, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921092652, creator=13701087609, updateTime=1792921092652, updator=13701087609, issue=Issue{id=1321169992024961657, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='4', pageStart='385', pageEnd='512', issueExtLink='null', onlineDate='null', pubDate='1744214400000', pubDateStr='2025-04-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921072250, creator='13701087609', updateTime=1792921072250, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=483, endPage=488, ext={EN=ArticleExt(id=1321170079367155944, articleId=1321170077601353959, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Trends in chronic obstructive pulmonary disease burden and attributable death risk factors in major Belt and Road Initiative participating countries, 1990–2021, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the changing trends in the burden of chronic obstructive pulmonary disease (COPD) and the main risk factors for death in major countries participating in the Belt and Road Initiative (BRI) from 1990 to 2021, and to provide a reference for formulating COPD prevention and control strategies for these countries.

Methods

Data on age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized disability-adjusted life years (DALY) rate, and the attributable fraction of COPD death risk factors from 1990 to 2021 were extracted from the Global Burden of Disease Study 2021 (GBD 2021) database for 13 major BRI participating countries: China, Egypt, Pakistan, Russia, the Philippines, Bangladesh, Myanmar, Thailand, Turkey, Iran, India, Indonesia, and Vietnam. Estimated annual percentage change (EAPC) was used to describe the trends in ASIR, ASMR, and age-standardized DALY rate in each country. Butterfly charts were used to compare the attributable fractions of COPD death risk factors by sex in 2021.

Results

From 1990 to 2021, the ASIR of COPD generally showed an upward trend in Egypt, Turkey, Iran, Indonesia, and Vietnam, increasing from 129.68/100 000, 199.53/100 000, 114.36/100 000, 155.06/100 000, and 159.48/100 000 in 1990 to 177.45/100 000, 225.79/100 000, 152.05/100 000, 176.01/100 000, and 179.64/100 000 in 2021, respectively. The corresponding EAPCs (95%CI) were 0.92% (0.90–0.95), 0.38% (0.34–0.42), 0.96% (0.94–0.98), 0.36% (0.33–0.38), and 0.28% (0.24–0.33). The ASIR of COPD generally showed a downward trend in China, Pakistan, Russia, the Philippines, Bangladesh, Myanmar, Thailand, and India, decreasing from 271.22/100 000, 243.66/100 000, 162.10/100 000, 191.76/100 000, 260.88/100 000, 241.21/100 000, 164.34/100 000, and 275.49/100 000 in 1990 to 215.62/100 000, 231.91/100 000, 144.19/100 000, 165.78/100 000, 238.94/100 000, 234.81/100 000, 125.47/100 000, and 262.45/100 000 in 2021, respectively. The corresponding EAPCs (95%CI) were –0.84% (–0.88– –0.81), –0.18% (–0.22– –0.14), –0.53% (–0.59– –0.46), –0.14% (–0.16– –0.12), –0.29% (–0.35– –0.23), –0.91% (–0.94– –0.88), –0.67% (–0.74– –0.59), and –0.18% (–0.19– –0.17). From 1990 to 2021, the ASMR of COPD generally showed a downward trend in China, Egypt, Pakistan, Russia, the Philippines, Bangladesh, Myanmar, Thailand, Turkey, Iran, Indonesia, and Vietnam, decreasing from 231.78/100 000, 48.30/100 000, 83.97/100 000, 29.81/100 000, 46.58/100 000, 101.94/100 000, 135.53/100 000, 55.13/100 000, 57.54/100 000, 21.01/100 000, 53.00/100 000, and 54.29/100 000 in 1990 to 73.23/100 000, 25.87/100 000, 73.80/100 000, 13.04/100 000, 32.81/100 000, 59.65/100 000, 104.53/100 000, 19.80/100 000, 40.77/100 000, 17.44/100 000, 49.53/100 000, and 43.96/100 000 in 2021, respectively. The corresponding EAPCs (95%CI) were –4.25% (–4.48– –4.02), –0.32% (–0.44– –0.19), –0.66% (–0.92– –0.40), –3.23% (–3.60– –2.86), –1.11% (–1.22– –1.00), –1.97% (–2.33– –1.61), –4.05% (–4.36– –3.75), –0.92% (–1.01– –0.84), –0.72% (–1.11– –0.33), –2.12% (–2.32– –1.92), –0.19% (–0.31– –0.06), and –0.66% (–0.76– –0.55). From 1990 to 2021, the age-standardized DALY rate of COPD generally showed a downward trend in all 13 major BRI participating countries. Attributable death risk factor analysis for COPD deaths showed significant sex differences in the proportions of deaths attributed to ambient particulate matter pollution, household air pollution from solid fuels, and occupational risks, with males generally having higher proportions than females.

Conclusions

From 1990 to 2021, the burden of COPD generally showed a downward trend in the 13 major BRI participating countries, with significant differences among countries. The proportions of COPD deaths attributed to ambient particulate matter pollution, household air pollution from solid fuels, and occupational risks were higher in males than in females.

, authors=Yaning WANG1, Yitong LIU1, Rujian LU2, Yaqin ZHONG1, authorsList=Yaning WANG, Yitong LIU, Rujian LU, Yaqin ZHONG, authorCompany=null, correspAuthors=Yaqin ZHONG, authorNote=null, correspAuthorsNote=
ZHONG Yaqin, E-mail:
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目的

了解1990—2021年“一带一路”共建主要国家慢性阻塞性肺疾病（COPD）疾病负担的变化趋势及其死亡的主要危险因素，为制定“一带一路”共建国家COPD的预防控制策略提供参考依据。

方法

从2021全球疾病负担研究（GBD 2021）数据库中提取1990—2021年中国、埃及、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国、土耳其、伊朗、印度、印度尼西亚和越南共13个“一带一路”共建主要国家COPD标化发病率、标化死亡率、标化伤残调整寿命年（DALY）率和COPD死亡危险因素归因占比等相关数据，采用年估计百分比变化（EAPC）描述各国标化发病率、标化死亡率和标化DALY率的变化趋势，并通过绘制蝴蝶图比较2021年各国不同性别人群COPD死亡危险因素的归因占比。

结果

1990—2021年13个“一带一路”共建主要国家中埃及、土耳其、伊朗、印度尼西亚和越南的COPD标化发病率总体均呈上升趋势，分别从1990年的129.68/10万、199.53/10万、114.36/10万、155.06/10万和159.48/10万上升到2021年的177.45/10万、225.79/10万、152.05/10万、176.01/10万和179.64/10万，EAPC（95%CI）分别为0.92%（0.90%～0.95%）、0.38%（0.34%～0.42%）、0.96%（0.94%～0.98%）、0.36%（0.33%～0.38%）和0.28%（0.24%～0.33%）；中国、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国和印度的COPD标化发病率总体均呈下降趋势，分别从1990年的271.22/10万、243.66/10万、162.10/10万、191.76/10万、260.88/10万、241.21/10万、164.34/10万和275.49/10万下降到2021年的215.62/10万、231.91/10万、144.19/10万、165.78/10万、238.94/10万、234.81/10万、125.47/10万和262.45/10万，EAPC（95%CI）分别为–0.84%（–0.88%～–0.81%）、–0.18%（–0.22%～–0.14%）、–0.53%（–0.59%～–0.46%）、–0.14%（–0.16%～–0.12%）、–0.29%（–0.35%～–0.23%）、–0.91%（–0.94%～–0.88%）、–0.67%（–0.74%～–0.59%）和–0.18%（–0.19%～–0.17%）。1990—2021年13个“一带一路”共建主要国家中中国、埃及、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国、土耳其、伊朗、印度尼西亚和越南COPD标化死亡率总体均呈下降趋势，分别从1990年的231.78/10万、48.30/10万、83.97/10万、29.81/10万、46.58/10万、101.94/10万、135.53/10万、55.13/10万、57.54/10万、21.01/10万、53.00/10万和54.29/10万下降到2021年的73.23/10万、25.87/10万、73.80/10万、13.04/10万、32.81/10万、59.65/10万、104.53/10万、19.80/10万、40.77/10万、17.44/10万、49.53/10万和43.96/10万，EAPC（95%CI）分别为–4.25%（–4.48%～–4.02%）、–0.32%（–0.44%～–0.19%）、–0.66%（–0.92%～–0.40%）、–3.23%（–3.60%～–2.86%）、–1.11%（–1.22%～–1.00%）、–1.97%（–2.33%～–1.61%）、–4.05%（–4.36%～–3.75%）、–0.92%（–1.01%～–0.84%）、–0.72%（–1.11%～–0.33%）、–2.12%（–2.32%～–1.92%）、–0.19%（–0.31%～–0.06%）和–0.66%（–0.76%～–0.55%）。1990—2021年13个“一带一路”共建主要国家中中国、埃及、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国、土耳其、伊朗、印度、印度尼西亚和越南的COPD标化DALY率总体均呈下降趋势，分别从1990年的3 852.57/10万、1 015.46/10万、1 783.98/10万、677.94/10万、961.37/10万、2 281.06/10万、2 710.62/10万、1 179.10/10万、1 199.96/10万、478.53/10万、2 508.84/10万、1 140.65/10万和1 054.72/10万下降到2021年的1 227.66/10万、602.17/10万、1 541.67/10万、352.01/10万、807.05/10万、1 301.68/10万、1 958.92/10万、461.07/10万、850.19/10万、424.08/10万、2 171.16/10万、1 040.41/10万和863.32/10万，EAPC（95%CI）分别为–4.19%（–4.38%～–3.99%）、–0.17%（–0.27%～–0.07%）、–0.68%（–0.91%～–0.45%）、–2.74%（–3.07%～–2.42%）、–1.32%（–1.44%～–1.21%）、–1.91%（–2.14%～–1.68%）、–3.70%（–3.96%～–3.43%）、–0.45%（–0.53%～–0.38%）、–0.90%（–1.16%～–0.63%）、–1.92%（–2.12%～–1.71%）、–0.36%（–0.47%～–0.25%）、–0.25%（–0.35%～–0.16%）和–0.60%（–0.68%～–0.52%）。COPD死亡危险因素归因分析结果显示，归因于烟雾烟草和职业风险的死亡占比存在明显性别差异，男性普遍高于女性；归因于空气污染的死亡占比性别差异较小。

结论

1990—2021年13个“一带一路”共建主要国家的COPD疾病负担总体上均呈一定下降趋势，不同国家间存在明显差异；男性归因于烟雾烟草和职业风险的COPD死亡占比均高于女性。

, authors=王娅宁1, 刘奕彤1, 陆如建2, 仲亚琴1, *, *, authorsList=王娅宁, 刘奕彤, 陆如建, 仲亚琴, authorCompany=null, correspAuthors=仲亚琴, authorNote=

王娅宁（2000—），硕士在读，研究方向：社会医学与卫生事业管理

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仲亚琴，E-mail：
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王娅宁（2000—），硕士在读，研究方向：社会医学与卫生事业管理

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王娅宁（2000—），硕士在读，研究方向：社会医学与卫生事业管理

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Trends in standardized incidence rates of COPD (1/100 000) in major Belt and Road Initiative countries from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
国家1990年2021年EAPC/%95%CI/%
中国271.22215.62–0.84–0.88 ～ –0.81
埃及129.68177.450.920.90 ～ 0.95
巴基斯坦243.66231.91–0.18–0.22 ～ –0.14
俄罗斯162.10144.19–0.53–0.59 ～ –0.46
菲律宾191.76165.78–0.14–0.16 ～ –0.12
孟加拉国260.88238.94–0.29–0.35 ～ –0.23
缅甸241.21234.81–0.91–0.94 ～ –0.88
泰国164.34125.47–0.67–0.74 ～ –0.59
土耳其199.53225.790.380.34 ～ 0.42
伊朗114.36152.050.960.94 ～ 0.98
印度275.49262.45–0.18–0.19 ～ –0.17
印度尼西亚155.06176.010.360.33 ～ 0.38
越南159.48179.640.280.24 ～ 0.33
), ArticleFig(id=1321170084589064469, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170077601353959, language=CN, label=表1, caption=

1990—2021年“一带一路”共建主要国家COPD的标化发病率（1/10万）变化趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
国家1990年2021年EAPC/%95%CI/%
中国271.22215.62–0.84–0.88 ～ –0.81
埃及129.68177.450.920.90 ～ 0.95
巴基斯坦243.66231.91–0.18–0.22 ～ –0.14
俄罗斯162.10144.19–0.53–0.59 ～ –0.46
菲律宾191.76165.78–0.14–0.16 ～ –0.12
孟加拉国260.88238.94–0.29–0.35 ～ –0.23
缅甸241.21234.81–0.91–0.94 ～ –0.88
泰国164.34125.47–0.67–0.74 ～ –0.59
土耳其199.53225.790.380.34 ～ 0.42
伊朗114.36152.050.960.94 ～ 0.98
印度275.49262.45–0.18–0.19 ～ –0.17
印度尼西亚155.06176.010.360.33 ～ 0.38
越南159.48179.640.280.24 ～ 0.33
), ArticleFig(id=1321170084681339158, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170077601353959, language=EN, label=Tab.2, caption=

Trends in standardized death rates of COPD (1/100 000) in major Belt and Road Initiative countries from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
国家1990年2021年EAPC/%95%CI/%
中国231.7873.23–4.25–4.48 ～ –4.02
埃及48.3025.87–0.32–0.44 ～ –0.19
巴基斯坦83.9773.80–0.66–0.92 ～ –0.40
俄罗斯29.8113.04–3.23–3.60 ～ –2.86
菲律宾46.5832.81–1.11–1.22 ～ –1.00
孟加拉国101.9459.65–1.97–2.33 ～ –1.61
缅甸135.53104.53–4.05–4.36 ～ –3.75
泰国55.1319.80–0.92–1.01 ～ –0.84
土耳其57.5440.77–0.72–1.11 ～ –0.33
伊朗21.0117.44–2.12–2.32 ～ –1.92
印度119.72108.39–0.10–0.30 ～ 0.10
印度尼西亚53.0049.53–0.19–0.31 ～ –0.06
越南54.2943.96–0.66–0.76 ～ –0.55
), ArticleFig(id=1321170084773613847, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170077601353959, language=CN, label=表2, caption=

1990—2021年“一带一路”共建主要国家COPD的标化死亡率（1/10万）变化趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
国家1990年2021年EAPC/%95%CI/%
中国231.7873.23–4.25–4.48 ～ –4.02
埃及48.3025.87–0.32–0.44 ～ –0.19
巴基斯坦83.9773.80–0.66–0.92 ～ –0.40
俄罗斯29.8113.04–3.23–3.60 ～ –2.86
菲律宾46.5832.81–1.11–1.22 ～ –1.00
孟加拉国101.9459.65–1.97–2.33 ～ –1.61
缅甸135.53104.53–4.05–4.36 ～ –3.75
泰国55.1319.80–0.92–1.01 ～ –0.84
土耳其57.5440.77–0.72–1.11 ～ –0.33
伊朗21.0117.44–2.12–2.32 ～ –1.92
印度119.72108.39–0.10–0.30 ～ 0.10
印度尼西亚53.0049.53–0.19–0.31 ～ –0.06
越南54.2943.96–0.66–0.76 ～ –0.55
), ArticleFig(id=1321170084861694232, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170077601353959, language=EN, label=Tab.3, caption=

Trends in standardized DALY rates (1/100 000) of COPD in major Belt and Road Initiative countries from 1990 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
国家1990年2021年EAPC/%95%CI/%
中国3 852.571 227.66–4.19–4.38 ～ –3.99
埃及1 015.46602.17–0.17–0.27 ～ –0.07
巴基斯坦1 783.981 541.67–0.68–0.91 ～ –0.45
俄罗斯677.94352.01–2.74–3.07 ～ –2.42
菲律宾961.37807.05–1.32–1.44 ～ –1.21
孟加拉国2 281.061 301.68–1.91–2.14 ～ –1.68
缅甸2 710.621 958.92–3.70–3.96 ～ –3.43
泰国1 179.10461.07–0.45–0.53 ～ –0.38
土耳其1 199.96850.19–0.90–1.16 ～ –0.63
伊朗478.53424.08–1.92–2.12 ～ –1.71
印度2 508.842 171.16–0.36–0.47 ～ –0.25
印度尼西亚1 140.651 040.41–0.25–0.35 ～ –0.16
越南1 054.72863.32–0.60–0.68 ～ –0.52
), ArticleFig(id=1321170084932997401, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170077601353959, language=CN, label=表3, caption=

1990—2021年“一带一路”共建主要国家COPD的标化DALY率（1/10万）变化趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
国家1990年2021年EAPC/%95%CI/%
中国3 852.571 227.66–4.19–4.38 ～ –3.99
埃及1 015.46602.17–0.17–0.27 ～ –0.07
巴基斯坦1 783.981 541.67–0.68–0.91 ～ –0.45
俄罗斯677.94352.01–2.74–3.07 ～ –2.42
菲律宾961.37807.05–1.32–1.44 ～ –1.21
孟加拉国2 281.061 301.68–1.91–2.14 ～ –1.68
缅甸2 710.621 958.92–3.70–3.96 ～ –3.43
泰国1 179.10461.07–0.45–0.53 ～ –0.38
土耳其1 199.96850.19–0.90–1.16 ～ –0.63
伊朗478.53424.08–1.92–2.12 ～ –1.71
印度2 508.842 171.16–0.36–0.47 ～ –0.25
印度尼西亚1 140.651 040.41–0.25–0.35 ～ –0.16
越南1 054.72863.32–0.60–0.68 ～ –0.52
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1990—2021年“一带一路”共建主要国家慢性阻塞性肺疾病疾病负担变化趋势及其死亡危险因素归因分析
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王娅宁 1 , 刘奕彤 1 , 陆如建 2 , 仲亚琴 1, *, *
中国公共卫生 | 调查报告与分析 2025,41(4): 483-488
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中国公共卫生 |调查报告与分析 2025 , 41 (4) : 483 -488
1990—2021年“一带一路”共建主要国家慢性阻塞性肺疾病疾病负担变化趋势及其死亡危险因素归因分析
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王娅宁1, 刘奕彤1, 陆如建2, 仲亚琴1, *, *
作者信息
  • 1南通大学公共卫生学院，南通 226019
  • 2南通市第三人民医院心胸外科，南通 226006
通讯作者:
仲亚琴，E-mail：
作者简介:

王娅宁（2000—），硕士在读，研究方向：社会医学与卫生事业管理

Trends in chronic obstructive pulmonary disease burden and attributable death risk factors in major Belt and Road Initiative participating countries, 1990–2021
Yaning WANG1, Yitong LIU1, Rujian LU2, Yaqin ZHONG1
Affiliations
  • 1School of Public Health, Nantong University, Nantong 226019, China
  • 2Department of Cardiothoracic Surgery, Nantong Third People’s Hospital, Nantong 226006, China
    • Corresponding Author:
    ZHONG Yaqin, E-mail:
出版时间: 2025-04-10 doi: 10.11847/zgggws1146346
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摘要
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目的

了解1990—2021年“一带一路”共建主要国家慢性阻塞性肺疾病（COPD）疾病负担的变化趋势及其死亡的主要危险因素，为制定“一带一路”共建国家COPD的预防控制策略提供参考依据。

方法

从2021全球疾病负担研究（GBD 2021）数据库中提取1990—2021年中国、埃及、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国、土耳其、伊朗、印度、印度尼西亚和越南共13个“一带一路”共建主要国家COPD标化发病率、标化死亡率、标化伤残调整寿命年（DALY）率和COPD死亡危险因素归因占比等相关数据，采用年估计百分比变化（EAPC）描述各国标化发病率、标化死亡率和标化DALY率的变化趋势，并通过绘制蝴蝶图比较2021年各国不同性别人群COPD死亡危险因素的归因占比。

结果

1990—2021年13个“一带一路”共建主要国家中埃及、土耳其、伊朗、印度尼西亚和越南的COPD标化发病率总体均呈上升趋势，分别从1990年的129.68/10万、199.53/10万、114.36/10万、155.06/10万和159.48/10万上升到2021年的177.45/10万、225.79/10万、152.05/10万、176.01/10万和179.64/10万，EAPC（95%CI）分别为0.92%（0.90%～0.95%）、0.38%（0.34%～0.42%）、0.96%（0.94%～0.98%）、0.36%（0.33%～0.38%）和0.28%（0.24%～0.33%）；中国、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国和印度的COPD标化发病率总体均呈下降趋势，分别从1990年的271.22/10万、243.66/10万、162.10/10万、191.76/10万、260.88/10万、241.21/10万、164.34/10万和275.49/10万下降到2021年的215.62/10万、231.91/10万、144.19/10万、165.78/10万、238.94/10万、234.81/10万、125.47/10万和262.45/10万，EAPC（95%CI）分别为–0.84%（–0.88%～–0.81%）、–0.18%（–0.22%～–0.14%）、–0.53%（–0.59%～–0.46%）、–0.14%（–0.16%～–0.12%）、–0.29%（–0.35%～–0.23%）、–0.91%（–0.94%～–0.88%）、–0.67%（–0.74%～–0.59%）和–0.18%（–0.19%～–0.17%）。1990—2021年13个“一带一路”共建主要国家中中国、埃及、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国、土耳其、伊朗、印度尼西亚和越南COPD标化死亡率总体均呈下降趋势，分别从1990年的231.78/10万、48.30/10万、83.97/10万、29.81/10万、46.58/10万、101.94/10万、135.53/10万、55.13/10万、57.54/10万、21.01/10万、53.00/10万和54.29/10万下降到2021年的73.23/10万、25.87/10万、73.80/10万、13.04/10万、32.81/10万、59.65/10万、104.53/10万、19.80/10万、40.77/10万、17.44/10万、49.53/10万和43.96/10万，EAPC（95%CI）分别为–4.25%（–4.48%～–4.02%）、–0.32%（–0.44%～–0.19%）、–0.66%（–0.92%～–0.40%）、–3.23%（–3.60%～–2.86%）、–1.11%（–1.22%～–1.00%）、–1.97%（–2.33%～–1.61%）、–4.05%（–4.36%～–3.75%）、–0.92%（–1.01%～–0.84%）、–0.72%（–1.11%～–0.33%）、–2.12%（–2.32%～–1.92%）、–0.19%（–0.31%～–0.06%）和–0.66%（–0.76%～–0.55%）。1990—2021年13个“一带一路”共建主要国家中中国、埃及、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国、土耳其、伊朗、印度、印度尼西亚和越南的COPD标化DALY率总体均呈下降趋势，分别从1990年的3 852.57/10万、1 015.46/10万、1 783.98/10万、677.94/10万、961.37/10万、2 281.06/10万、2 710.62/10万、1 179.10/10万、1 199.96/10万、478.53/10万、2 508.84/10万、1 140.65/10万和1 054.72/10万下降到2021年的1 227.66/10万、602.17/10万、1 541.67/10万、352.01/10万、807.05/10万、1 301.68/10万、1 958.92/10万、461.07/10万、850.19/10万、424.08/10万、2 171.16/10万、1 040.41/10万和863.32/10万，EAPC（95%CI）分别为–4.19%（–4.38%～–3.99%）、–0.17%（–0.27%～–0.07%）、–0.68%（–0.91%～–0.45%）、–2.74%（–3.07%～–2.42%）、–1.32%（–1.44%～–1.21%）、–1.91%（–2.14%～–1.68%）、–3.70%（–3.96%～–3.43%）、–0.45%（–0.53%～–0.38%）、–0.90%（–1.16%～–0.63%）、–1.92%（–2.12%～–1.71%）、–0.36%（–0.47%～–0.25%）、–0.25%（–0.35%～–0.16%）和–0.60%（–0.68%～–0.52%）。COPD死亡危险因素归因分析结果显示，归因于烟雾烟草和职业风险的死亡占比存在明显性别差异，男性普遍高于女性；归因于空气污染的死亡占比性别差异较小。

结论

1990—2021年13个“一带一路”共建主要国家的COPD疾病负担总体上均呈一定下降趋势，不同国家间存在明显差异；男性归因于烟雾烟草和职业风险的COPD死亡占比均高于女性。

慢性阻塞性肺疾病（COPD）  /  疾病负担  /  变化趋势  /  死亡危险因素  /  归因分析  /  “一带一路”共建
Objective

To understand the changing trends in the burden of chronic obstructive pulmonary disease (COPD) and the main risk factors for death in major countries participating in the Belt and Road Initiative (BRI) from 1990 to 2021, and to provide a reference for formulating COPD prevention and control strategies for these countries.

Methods

Data on age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized disability-adjusted life years (DALY) rate, and the attributable fraction of COPD death risk factors from 1990 to 2021 were extracted from the Global Burden of Disease Study 2021 (GBD 2021) database for 13 major BRI participating countries: China, Egypt, Pakistan, Russia, the Philippines, Bangladesh, Myanmar, Thailand, Turkey, Iran, India, Indonesia, and Vietnam. Estimated annual percentage change (EAPC) was used to describe the trends in ASIR, ASMR, and age-standardized DALY rate in each country. Butterfly charts were used to compare the attributable fractions of COPD death risk factors by sex in 2021.

Results

From 1990 to 2021, the ASIR of COPD generally showed an upward trend in Egypt, Turkey, Iran, Indonesia, and Vietnam, increasing from 129.68/100 000, 199.53/100 000, 114.36/100 000, 155.06/100 000, and 159.48/100 000 in 1990 to 177.45/100 000, 225.79/100 000, 152.05/100 000, 176.01/100 000, and 179.64/100 000 in 2021, respectively. The corresponding EAPCs (95%CI) were 0.92% (0.90–0.95), 0.38% (0.34–0.42), 0.96% (0.94–0.98), 0.36% (0.33–0.38), and 0.28% (0.24–0.33). The ASIR of COPD generally showed a downward trend in China, Pakistan, Russia, the Philippines, Bangladesh, Myanmar, Thailand, and India, decreasing from 271.22/100 000, 243.66/100 000, 162.10/100 000, 191.76/100 000, 260.88/100 000, 241.21/100 000, 164.34/100 000, and 275.49/100 000 in 1990 to 215.62/100 000, 231.91/100 000, 144.19/100 000, 165.78/100 000, 238.94/100 000, 234.81/100 000, 125.47/100 000, and 262.45/100 000 in 2021, respectively. The corresponding EAPCs (95%CI) were –0.84% (–0.88– –0.81), –0.18% (–0.22– –0.14), –0.53% (–0.59– –0.46), –0.14% (–0.16– –0.12), –0.29% (–0.35– –0.23), –0.91% (–0.94– –0.88), –0.67% (–0.74– –0.59), and –0.18% (–0.19– –0.17). From 1990 to 2021, the ASMR of COPD generally showed a downward trend in China, Egypt, Pakistan, Russia, the Philippines, Bangladesh, Myanmar, Thailand, Turkey, Iran, Indonesia, and Vietnam, decreasing from 231.78/100 000, 48.30/100 000, 83.97/100 000, 29.81/100 000, 46.58/100 000, 101.94/100 000, 135.53/100 000, 55.13/100 000, 57.54/100 000, 21.01/100 000, 53.00/100 000, and 54.29/100 000 in 1990 to 73.23/100 000, 25.87/100 000, 73.80/100 000, 13.04/100 000, 32.81/100 000, 59.65/100 000, 104.53/100 000, 19.80/100 000, 40.77/100 000, 17.44/100 000, 49.53/100 000, and 43.96/100 000 in 2021, respectively. The corresponding EAPCs (95%CI) were –4.25% (–4.48– –4.02), –0.32% (–0.44– –0.19), –0.66% (–0.92– –0.40), –3.23% (–3.60– –2.86), –1.11% (–1.22– –1.00), –1.97% (–2.33– –1.61), –4.05% (–4.36– –3.75), –0.92% (–1.01– –0.84), –0.72% (–1.11– –0.33), –2.12% (–2.32– –1.92), –0.19% (–0.31– –0.06), and –0.66% (–0.76– –0.55). From 1990 to 2021, the age-standardized DALY rate of COPD generally showed a downward trend in all 13 major BRI participating countries. Attributable death risk factor analysis for COPD deaths showed significant sex differences in the proportions of deaths attributed to ambient particulate matter pollution, household air pollution from solid fuels, and occupational risks, with males generally having higher proportions than females.

Conclusions

From 1990 to 2021, the burden of COPD generally showed a downward trend in the 13 major BRI participating countries, with significant differences among countries. The proportions of COPD deaths attributed to ambient particulate matter pollution, household air pollution from solid fuels, and occupational risks were higher in males than in females.

chronic obstructive pulmonary disease (COPD)  /  disease burden  /  changing trends  /  death risk factors  /  attribution analysis  /  Belt and Road Initiative
王娅宁, 刘奕彤, 陆如建, 仲亚琴. 1990—2021年“一带一路”共建主要国家慢性阻塞性肺疾病疾病负担变化趋势及其死亡危险因素归因分析. 中国公共卫生, 2025 , 41 (4) : 483 -488 . DOI: 10.11847/zgggws1146346
Yaning WANG, Yitong LIU, Rujian LU, Yaqin ZHONG. Trends in chronic obstructive pulmonary disease burden and attributable death risk factors in major Belt and Road Initiative participating countries, 1990–2021[J]. Chinese Journal of Public Health, 2025 , 41 (4) : 483 -488 . DOI: 10.11847/zgggws1146346
正文
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在2024年全球慢性阻塞性肺疾病倡议（global initiative for chronic obstructive lung disease, GOLD）中，慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）被定义为一种异质性的肺部状态，以由气道和/或肺泡异常所致的慢性呼吸道症状为特征，进而引起持续进行性加重的气流受限[1]。由于人口老龄化和空气污染等因素的影响，COPD的发病率和死亡率均逐年增长，其防治形势十分严峻，已成为世界最主要的公共卫生问题之一。研究表明，COPD为全球居民的主要死亡原因之一，预计到2050年，全球COPD患者将接近6亿[2]，在低收入和中等收入国家中其所造成的疾病负担尤为沉重[3]。“一带一路”共建国家多为中低收入的发展中国家，加之人口老龄化日益严重、健康教育缺乏、诊断评估不充分以及患者高昂的治疗成本等，导致COPD的疾病负担不断扩大，给不同国家的卫生和医疗保健系统带来巨大的社会和经济压力[4]。由于各国经济发展水平、医疗卫生条件、遗传特征和环境因素等均存在明显差异[5]，因此开展COPD预防、诊断和治疗等方面的跨国、跨区域合作，对于“健康丝绸之路”的建设具有重要意义。为了解1990—2021年“一带一路”共建国家COPD疾病负担的变化趋势及其死亡的主要危险因素，为制定“一带一路”共建国家COPD的预防控制策略提供参考依据，本研究从2021全球疾病负担研究（global burden of disease study 2021，GBD 2021）数据库中提取1990—2021年中国、埃及、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国、土耳其、伊朗、印度、印度尼西亚和越南共13个“一带一路”共建主要国家COPD标化发病率、标化死亡率、标化伤残调整寿命年（disability adjusted life year, DALY）率和COPD死亡危险因素归因占比等相关数据，采用年估计百分比变化（estimated annual percentage change, EAPC）描述各国标化发病率、标化死亡率和标化DALY率的变化趋势，并通过绘制蝴蝶图比较2021年各国不同性别人群COPD死亡危险因素的归因占比。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研究，所有数据均可在全球健康数据交换网站（http://ghdx.healthdata.org/gbd-results-tool）查询下载。GBD 2021由华盛顿大学健康测量与评价研究中心主导，采用标准的、可复制的方法评估全球204个国家或地区的369种疾病和伤害以及87种危险因素负担，并按国家和地区、年份、性别和年龄组分别报告[6]。本研究收集了1990—2021年13个人口总数>5 000万“一带一路”共建主要国家（中国、埃及、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国、土耳其、伊朗、印度、印度尼西亚、越南）的COPD相关数据，包括标化发病率、标化死亡率和标化DALY率等，各标化率采用GBD 2021全球标准人口年龄构成[7]进行计算。GBD 2021将与COPD有病因关联的可改变危险因素分为4个级别，本研究主要涉及二级危险因素，包括空气污染、烟雾烟草和职业风险[8]。COPD按《疾病和有关健康问题的国际统计分类（第十次修订本）》[9]编码进行分类，编码为J44。
1.2　统计分析
采用Excel 2021建立数据库，应用R 4.4.1软件进行统计分析。采用GBD 2021中的标化发病率、标化死亡率和标化DALY率对13个“一带一路”共建主要国家的疾病负担情况进行描述，并计算各标化率的EAPC分析其变化趋势；当EAPC值95%CI的上限和下限均>0时表示该指标在此时间段内呈上升趋势，当EAPC值95%CI的上限和下限均<0时表示该指标在此时间段内呈下降趋势，当EAPC值95%CI包含0时则表示该指标在此时间段内处于平稳状态[10]。通过绘制蝴蝶图比较不同性别人群COPD死亡危险因素的归因占比。
2　结　果
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2.1　1990—2021年“一带一路”共建主要国家COPD疾病负担变化趋势
2.1.1　COPD标化发病率变化趋势（表1）
1990—2021年13个“一带一路”共建主要国家中埃及、土耳其、伊朗、印度尼西亚和越南的COPD标化发病率总体均呈上升趋势，EAPC值分别为0.92%、0.38%、0.96%、0.36%和0.28%；中国、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国和印度的COPD标化发病率总体均呈下降趋势，EAPC值分别为–0.84%、–0.18%、–0.53%、–0.14%、–0.29%、–0.91%、–0.67%和–0.18%。
2.1.2　COPD标化死亡率变化趋势（表2）
1990—2021年13个“一带一路”共建主要国家中中国、埃及、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国、土耳其、伊朗、印度尼西亚和越南COPD标化死亡率总体均呈下降趋势，EAPC值分别为–4.25%、–0.32%、–0.66%、–3.23%、–1.11%、–1.97%、–4.05%、–0.92%、–0.72%、–2.12%、–0.19%和–0.66%，而印度COPD标化死亡率的下降趋势不显著。
2.1.3　COPD标化DALY率变化趋势（表3）
1990—2021年13个“一带一路”共建主要国家的COPD标化DALY率总体均呈下降趋势，中国、埃及、巴基斯坦、俄罗斯、菲律宾、孟加拉国、缅甸、泰国、土耳其、伊朗、印度、印度尼西亚和越南的EAPC值分别为–4.19%、–0.17%、–0.68%、–2.74%、–1.32%、–1.91%、–3.70%、–0.45%、–0.90%、–1.92%、–0.36%、–0.25%和–0.60%。
2.2　2021年“一带一路”共建主要国家COPD死亡危险因素归因分析（图1）
2021年在13个“一带一路”共建主要国家中，男性人群因烟雾烟草而导致的COPD死亡占比均高于女性人群；其中，埃及男性人群和土耳其女性人群因烟雾烟草导致的COPD死亡占比最高，孟加拉国男性人群和印度尼西亚女性人群因烟雾烟草导致的COPD死亡占比最低。由职业风险导致的COPD死亡占比中，13个主要国家男性人群均高于女性人群；其中，菲律宾男性人群和埃及女性人群因职业风险导致的COPD死亡占比最高，印度尼西亚男性人群和孟加拉国女性人群因职业风险导致的COPD死亡占比最低。由空气污染导致的COPD死亡占比中，男性和女性人群的差异不明显，但各国间的差异显著；其中，孟加拉国男性和女性人群因空气污染导致的COPD死亡占比均最高，俄罗斯男性和女性人群因空气污染导致的COPD死亡占比均最低。
3　讨　论
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世界卫生组织发布的《2021年全球主要死因报告》显示，COPD已成为全球第四大死亡原因，COPD死亡人数约占总死亡人数的5%[11]。研究表明，COPD在≥40岁人群中呈现出更为普遍的流行趋势[12]，全球范围老龄人口的增加将引发一场COPD危机，给个人、国家及全球经济均带来严重损失[13]。本研究结果显示，1990—2021年中国COPD的标化发病率、标化死亡率和标化DALY率均呈下降趋势，分别从1990年的271.22/10万、231.78/10万和3 852.57/10万下降到2021年的215.62/10万、73.23/10万和1 227.66/10万，EAPC（95%CI）分别为–0.84%（–0.88%～–0.81%）、–4.25%（–4.48%～–4.02%）和–4.19%（–4.38%～–3.99%），这可能得益于医疗技术水平的提高与人均期望寿命的增加[14–16]。加强初级卫生保健系统以早期诊断和管理 COPD 可以改善患者的结局[17]，中国通过扩大基本医疗保险的覆盖面、加强初级卫生保健服务的能力以及实施国家慢性病预防和控制计划，显著提高了慢性病（包括COPD）的护理质量[18]。这项全面的卫生系统改革提高了医疗服务的效率和可及性，为国际社会提供了一个有价值的范例。
在13个“一带一路”共建主要国家中，1990—2021年俄罗斯COPD的标化发病率、标化死亡率和标化DALY率下降趋势较为显著，分别从1990年的162.10/10万、29.81/10万和677.94/10万下降到2021年的144.19/10万、13.04/10万和352.01/10万，EAPC（95%CI）分别为–0.53%（–0.59%～ –0.46%）、–3.23%（–3.60%～–2.86%）和–2.74%（–3.07%～–2.42%），这可能与该国对疾病的重视程度有关，包括为所有公民均提供了免费医疗[19]。此外，2020年俄罗斯总理签署了《2025年前俄罗斯联邦卫生发展战略实施行动计划》[20]，计划指出要形成有效的疾病预防体系，组成实体的国家权力机构和公共卫生保护领域地方自治机构的责任，确保所有公民至少每年进行1次预防性医学检查，这在一定程度上保证了COPD的早期诊断。1990—2021年伊朗的COPD标化发病率上升趋势最为明显，从114.36/10万上升至152.05/10万，EAPC（95%CI）为0.96%（0.94%～0.98%）。一项关于伊朗西南部COPD患者的前瞻性流行病学研究表明，大多数COPD患者使用煤气给房子供暖和烹饪食物[21]，然而固体燃料造成的室内空气污染也是COPD的主要危险因素[22]，因此这可能是造成伊朗COPD标化发病率上升的主要原因。此外，埃及的COPD标化发病率亦有明显上升趋势，从1990年的129.68/10万上升至2021年的177.45/10万，EAPC（95%CI）为0.92%（0.90%～0.95%），这与Safiri S等[23]1990—2019年COPD的疾病负担研究结果相似。有研究表明，许多发展中国家的电网供电不足且不稳定导致了许多场所依赖可造成严重空气污染的柴油发电机，使得固体燃料在能源消费中占据相当一大部分的比例[24]，因此，为了减轻COPD的疾病负担，伊朗和埃及等发展中国家应当采取综合性的防治措施，包括减少固体燃料的使用、加强空气污染治理和控制风险因素等[25]。
引起COPD的个体因素（如年龄、遗传因素等）是无法控制的，但是生活方式和环境因素可以干预。吸烟是目前世界上公认的COPD重要危险因素之一[4]，本研究结果显示，男性人群因烟雾烟草造成的COPD死亡占比远高于女性人群，与侯珊珊等[8]研究结果相似，这可能与男性人群吸烟率普遍高于女性人群有关[26]。因职业风险导致的COPD死亡占比中，男性人群普遍高于女性人群，这可能与男性人群更多从事高风险职业有关，其在职业选择上可能更倾向于从事一些易接触烟尘、蒸汽和化学烟雾的工作，如采矿、建筑业和化工产业等[27]。因此，在“一带一路”共建国家中，应加强控烟措施、改善空气质量，并提高职业健康标准，以减轻COPD的疾病负担[28]。
综上所述，1990—2021年除越南外其他12个“一带一路”共建主要国家的COPD疾病负担均呈下降趋势，且不同国家间存在明显差异；男性归因于烟雾烟草和职业风险的COPD死亡占比均高于女性。因此建议在加强COPD卫生合作方面，中国可通过“一带一路”国家合作机制加强与其他国家在COPD诊断、干预治疗和预后管理等方面的交流；在COPD重点预防治疗方面，随着“一带一路”国家人口期望寿命的增加和人口老龄化程度的不断加深，COPD疾病所致伤残或失能比例显著增加，应着重关注该人群；在控制COPD危险因素方面，中国与其他“一带一路”国家应加强在控烟和空气污染治理等领域的法律制度交流与合作，结合各自国家的实际情况，加强学习和借鉴其他国家的有效干预措施，共同应对这一全球性健康挑战。此外，本研究仍存在一定的局限性：第一，GBD 2021公布的数据是美国医疗支出专门委员会根据调查数据进行估算的，因此本研究在纳入发病率和死亡率等指标进行结果外推时可能会存在偏倚；第二，本研究对COPD死亡危险因素归因分析的结果未综合多个因素的合并归因分值，且涉及的危险因素相对较少，可能会低估或忽视其他因素的影响。因此，在今后的研究中应尽可能收集多源数据与GBD 2021数据进行对比验证，在外推时进行敏感性分析，并纳入更多COPD死亡相关危险因素计算合并归因分值以全面评估各危险因素对COPD死亡的影响。

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2025年第41卷第4期
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doi: 10.11847/zgggws1146346
  • 接收时间：2024-11-05
  • 首发时间：2026-10-25
  • 出版时间：2025-04-10
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  • 收稿日期：2024-11-05
  • 修回日期：2024-12-24
  • 录用日期：2025-02-17
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    1南通大学公共卫生学院，南通 226019
    2南通市第三人民医院心胸外科，南通 226006

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仲亚琴，E-mail：
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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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