Article(id=1320427710724293055, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320427658937225679, articleNumber=null, orderNo=null, doi=10.11847/zgggws1149270, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1762444800000, receivedDateStr=2025-11-07, revisedDate=1768492800000, revisedDateStr=2026-01-16, acceptedDate=1775232000000, acceptedDateStr=2026-04-04, onlineDate=1792744098597, onlineDateStr=2026-10-23, pubDate=1786291200000, pubDateStr=2026-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792744098597, onlineIssueDateStr=2026-10-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792744098597, creator=13701087609, updateTime=1792744098597, updator=13701087609, issue=Issue{id=1320427658937225679, tenantId=1146029695717560320, journalId=1319373219989389464, year='2026', volume='42', issue='8', pageStart='897', pageEnd='1024', issueExtLink='null', onlineDate='null', pubDate='1786291200000', pubDateStr='2026-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792744086250, creator='13701087609', updateTime=1792747993375, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1320444046678544663, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320427658937225679, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1320444046678544664, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320427658937225679, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=955, endPage=959, ext={EN=ArticleExt(id=1320427711026282944, articleId=1320427710724293055, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Competitive risks of survival outcomes among patients with COPD in Zhejiang province: an analysis based on the monitoring data from 2014 to 2023, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the competitive risks of survival outcomes among patients with chronic obstructive pulmonary disease (COPD) in Zhejiang province, thereby providing evidence-based reference for formulating management and intervention programs for this population.

Methods

Incidence cases of COPD from January 1, 2014 to December 31, 2023 were collected from the COPD Surveillance Database of Zhejiang Provincial Center for Disease Control and Prevention, and death data from January 1, 2014 to December 31, 2024 were collected from the Death Surveillance Database. Death outcomes were matched for COPD patients. With death from respiratory diseases as the target event and malignant tumors, cerebrovascular diseases, heart disease, and other diseases as competing events, sex- and age-specific competing risk analyses were performed based on the time and underlying cause of death.

Results

Among the 824 536 new COPD cases in Zhejiang province from 2014 to 2023, death outcome was observed in 211 586 cases. The 1-year, 5-year, and 10-year mortality probabilities were 0.089, 0.258, and 0.425, respectively. Respiratory diseases remained the primary risk of death (10-year cumulative risk: 0.150), followed by malignant tumors (10-year cumulative risk: 0.115, with lung cancer at 0.063 and other malignant tumors at 0.052). Cerebrovascular diseases had the lowest risk of death (10-year cumulative risk: 0.051). Stratified analysis showed that for male COPD patients, the malignant tumors had the highest cumulative risk within 3 years (3-year cumulative risk: 0.063), and respiratory diseases became the factor with the highest cumulative risk after 3 years (10-year cumulative risk: 0.162). For female patients, respiratory diseases consistently posed the highest cumulative risk (10-year cumulative risk: 0.120). For patients aged < 65 years, the risk of malignant tumors was the highest (10-year cumulative risk: 0.050); for those aged ≥65 years, the risk of respiratory diseases was the highest (10-year cumulative risk: 0.206). Other factors demonstrated similar risks, which were much lower than that of respiratory diseases.

Conclusions

COPD patients face complex mortality patterns, and their competitive risks show significant age and sex differences. This highlights the importance of developing personalized and multidisciplinary integrated intervention strategies for different patient subgroups to effectively improve the prognosis of COPD patients.

, authors=Pinyuan DAI, Xiaoyan ZHOU, Hao WANG, Weiwei GONG, Jin PAN, Yunqi GUAN, Na LI, Min YU, Jieming ZHONG, authorsList=Pinyuan DAI, Xiaoyan ZHOU, Hao WANG, Weiwei GONG, Jin PAN, Yunqi GUAN, Na LI, Min YU, Jieming ZHONG, authorCompany=null, correspAuthors=Jieming ZHONG, authorNote=null, correspAuthorsNote=
ZHONG Jieming, E-mail:
, copyrightStatement=Copyright © 2026 Chinese Journal of Public Health. All rights reserved., 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=1320427714801156571, articleId=1320427710724293055, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=浙江省慢性阻塞性肺疾病患者生存结局竞争风险:基于2014—2023年监测数据分析, columnId=1320427686770622717, journalTitle=中国公共卫生, columnName=调查报告与分析, runingTitle=null, highlight=null, articleAbstract=
目的

了解浙江省慢性阻塞性肺疾病(简称“慢阻肺”)患者的生存结局竞争风险,为慢阻肺患者管理和干预方案的制定提供参考依据。

方法

收集浙江省疾病预防控制中心慢阻肺发病报告监测数据库中2014年1月1日—2023年12月31日慢阻肺发病数据和全死因监测数据库中2014年1月1日—2024年12月31日死亡数据,为慢阻肺患者匹配上相应的死亡结局,以“呼吸系统疾病死亡”为目标事件,以“恶性肿瘤”“脑血管疾病”“心脏病”和“其他疾病”为竞争事件,根据死亡时间和根本死因进行分性别和年龄的竞争风险分析。

结果

2014—2023年浙江省824 536例慢阻肺新发患者共观察到211 586例死亡结局,1年死亡概率为0.089,5年死亡概率为0.258,10年死亡概率为0.425。呼吸系统疾病仍是慢阻肺患者最主要的死亡风险(10年累计死亡风险为0.150);其次为恶性肿瘤(10年累计死亡风险为0.115),其中肺癌10年累计死亡风险为0.063,其他恶性肿瘤10年累计死亡风险为0.052;脑血管疾病的死亡风险最低(10年累计死亡风险为0.051)。分层分析结果显示,男性慢阻肺患者在3年内累计死亡风险恶性肿瘤最高(3年累计死亡风险为0.063),3年后则转变为呼吸系统疾病最高(10年累计死亡风险为0.162);女性慢阻肺患者则始终以呼吸系统疾病导致的累计死亡风险最高(10年累计死亡风险为0.120);<65岁慢阻肺患者以恶性肿瘤累计死亡风险最高(10年累计死亡风险为0.050);≥65岁慢阻肺患者以呼吸系统疾病累计死亡风险最高(10年累计死亡风险为0.206),其他死亡原因风险较为一致,远低于呼吸系统疾病。

结论

慢阻肺患者面临复杂的死亡模式,其竞争风险存在显著的年龄和性别差异,应制定个性化、多学科的综合干预策略以有效改善慢阻肺患者的预后。

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戴品远(1995—),主管医师,硕士,研究方向:流行病与卫生统计学

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钟节鸣,E-mail:
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戴品远(1995—),主管医师,硕士,研究方向:流行病与卫生统计学

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BMJ, 2018, 361: k1651., articleTitle=null, refAbstract=null), Reference(id=1320427722837443118, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427710724293055, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=22, rfOrder=21, authorNames=null, journalName=null, refType=null, unstructuredReference=Chen W J, Thomas J, Sadatsafavi M, et al. Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis[J]. The Lancet Respiratory Medicine, 2015, 3(8): 631-639., articleTitle=null, refAbstract=null), Reference(id=1320427722904551983, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427710724293055, 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=GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. The Lancet, 2018, 392(10159): 1923-1994., articleTitle=null, refAbstract=null), Reference(id=1320427722967466544, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427710724293055, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=24, rfOrder=23, authorNames=null, journalName=null, refType=null, unstructuredReference=Perrotta F, D’Agnano V, Scialò F, et al. Evolving concepts in COPD and lung cancer: a narrative review[J]. Minerva Medica, 2022, 113(3): 436-448., articleTitle=null, refAbstract=null), Reference(id=1320427723038769713, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427710724293055, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=25, rfOrder=24, authorNames=null, journalName=null, refType=null, unstructuredReference=Barreiro E, Bustamante V, Curull V, et al. Relationships between chronic obstructive pulmonary disease and lung cancer: biological insights[J]. Journal of Thoracic Disease, 2016, 8(10): E1122-E1135., articleTitle=null, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1320427715010871772, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427710724293055, xref=null, ext=[AuthorCompanyExt(id=1320427715023454685, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427710724293055, companyId=1320427715010871772, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Chronic and Non-communicable Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China), AuthorCompanyExt(id=1320427715040231902, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427710724293055, companyId=1320427715010871772, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=浙江省疾病预防控制中心慢性非传染性疾病预防与控制所,杭州 310051)])], figs=[ArticleFig(id=1320427719498777111, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427710724293055, language=EN, label=Tab.1, caption=

Causes of death and their proportions among COPD patients in different age groups in Zhejiang province

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项目年龄/岁呼吸系统疾病其他恶性肿瘤肺癌心脏病脑血管疾病其他
死亡例数占比/%死亡例数占比/%死亡例数占比/%死亡例数占比/%死亡例数占比/%死亡例数占比/%
男性<455528.804221.992915.18199.9594.713719.37
45~4922133.9511617.8211117.05507.68416.3011217.20
50~5466132.9235617.7347223.511567.77743.6928914.39
55~591 29729.7181218.601 21527.832826.462024.6355812.78
60~642 73529.611 66918.072 68129.026336.855025.431 01711.01
65~69488629.752 91517.75459127.961 1517.011 1396.941 73910.59
70~74723030.82389116.59559723.8620568.772 1299.082 55210.88
75~7910 82934.44449414.29531316.90349211.11356911.35374411.91
80~8413 38336.43441112.01391410.65535614.58486513.24481013.09
85~89955138.182 4109.631 5726.28418516.73349913.99380115.19
90~943 27739.476147.392923.521 57318.941 06312.801 48417.87
≥9553239.76725.38201.4925819.2817012.7128621.38
女性<451923.172226.831821.9522.4433.661821.95
45~496131.943819.902814.662211.5284.193417.80
50~5413230.998219.257317.145212.21235.406415.02
55~5920127.6914119.4214119.427510.33395.3712917.77
60~6456135.0427717.3021713.5518011.241056.5626116.30
65~691 03334.3446415.4340713.5334211.372899.6147315.72
70~741 78433.5875014.125059.5072613.6668012.8086816.34
75~792 94332.3499510.936887.561 55617.101 33014.611 58917.46
80~84465232.351 1808.207425.162 87219.972 32716.182 60918.14
85~89396232.906965.784223.502 70322.451 87115.542 38819.83
90~941 53932.872284.871032.201 08223.1165213.931 07823.02
≥9528933.45232.66101.1619622.6910612.2724027.78
合计<457427.116423.444717.22217.69124.405520.15
45~4928233.4915418.2913916.51728.55495.8214617.34
50~5479332.5843818.0054522.392088.55973.9935314.50
55~591 49829.4295318.721 35626.633577.012414.7368713.49
60~643 29630.411 94617.962 89826.748137.506075.601 27811.79
65~69591930.463 37917.39499825.721 4937.681 4287.352 21211.39
70~74901431.33464116.136 10221.212 7829.672 8099.763 42011.89
75~7913 77233.975 48913.546 00114.805 04812.454 89912.085 33313.15
80~8418 03535.285 59110.944 6569.118 22816.107 19214.077 41914.51
85~8913 51336.463 1068.381 9945.386 88818.595 37014.496 18916.70
90~94481637.098426.483953.042 65520.451 71513.212 56219.73
≥9582137.28954.31301.3645420.6227612.5352623.89
), ArticleFig(id=1320427719586857496, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320427710724293055, language=CN, label=表1, caption=

浙江省不同年龄组慢阻肺患者各类死亡原因及占比

, figureFileSmall=null, figureFileBig=null, tableContent=
项目年龄/岁呼吸系统疾病其他恶性肿瘤肺癌心脏病脑血管疾病其他
死亡例数占比/%死亡例数占比/%死亡例数占比/%死亡例数占比/%死亡例数占比/%死亡例数占比/%
男性<455528.804221.992915.18199.9594.713719.37
45~4922133.9511617.8211117.05507.68416.3011217.20
50~5466132.9235617.7347223.511567.77743.6928914.39
55~591 29729.7181218.601 21527.832826.462024.6355812.78
60~642 73529.611 66918.072 68129.026336.855025.431 01711.01
65~69488629.752 91517.75459127.961 1517.011 1396.941 73910.59
70~74723030.82389116.59559723.8620568.772 1299.082 55210.88
75~7910 82934.44449414.29531316.90349211.11356911.35374411.91
80~8413 38336.43441112.01391410.65535614.58486513.24481013.09
85~89955138.182 4109.631 5726.28418516.73349913.99380115.19
90~943 27739.476147.392923.521 57318.941 06312.801 48417.87
≥9553239.76725.38201.4925819.2817012.7128621.38
女性<451923.172226.831821.9522.4433.661821.95
45~496131.943819.902814.662211.5284.193417.80
50~5413230.998219.257317.145212.21235.406415.02
55~5920127.6914119.4214119.427510.33395.3712917.77
60~6456135.0427717.3021713.5518011.241056.5626116.30
65~691 03334.3446415.4340713.5334211.372899.6147315.72
70~741 78433.5875014.125059.5072613.6668012.8086816.34
75~792 94332.3499510.936887.561 55617.101 33014.611 58917.46
80~84465232.351 1808.207425.162 87219.972 32716.182 60918.14
85~89396232.906965.784223.502 70322.451 87115.542 38819.83
90~941 53932.872284.871032.201 08223.1165213.931 07823.02
≥9528933.45232.66101.1619622.6910612.2724027.78
合计<457427.116423.444717.22217.69124.405520.15
45~4928233.4915418.2913916.51728.55495.8214617.34
50~5479332.5843818.0054522.392088.55973.9935314.50
55~591 49829.4295318.721 35626.633577.012414.7368713.49
60~643 29630.411 94617.962 89826.748137.506075.601 27811.79
65~69591930.463 37917.39499825.721 4937.681 4287.352 21211.39
70~74901431.33464116.136 10221.212 7829.672 8099.763 42011.89
75~7913 77233.975 48913.546 00114.805 04812.454 89912.085 33313.15
80~8418 03535.285 59110.944 6569.118 22816.107 19214.077 41914.51
85~8913 51336.463 1068.381 9945.386 88818.595 37014.496 18916.70
90~94481637.098426.483953.042 65520.451 71513.212 56219.73
≥9582137.28954.31301.3645420.6227612.5352623.89
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浙江省慢性阻塞性肺疾病患者生存结局竞争风险:基于2014—2023年监测数据分析
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戴品远 , 周晓燕 , 王浩 , 龚巍巍 , 潘劲 , 关云琦 , 李娜 , 俞敏 , 钟节鸣 *, *
中国公共卫生 | 调查报告与分析 2026,42(8): 955-959
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中国公共卫生 |调查报告与分析 2026 , 42 (8) : 955 -959
浙江省慢性阻塞性肺疾病患者生存结局竞争风险:基于2014—2023年监测数据分析
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戴品远, 周晓燕, 王浩, 龚巍巍, 潘劲, 关云琦, 李娜, 俞敏, 钟节鸣*, *
作者信息
  • 浙江省疾病预防控制中心慢性非传染性疾病预防与控制所,杭州 310051
通讯作者:
钟节鸣,E-mail:
作者简介:

戴品远(1995—),主管医师,硕士,研究方向:流行病与卫生统计学

Competitive risks of survival outcomes among patients with COPD in Zhejiang province: an analysis based on the monitoring data from 2014 to 2023
Pinyuan DAI, Xiaoyan ZHOU, Hao WANG, Weiwei GONG, Jin PAN, Yunqi GUAN, Na LI, Min YU, Jieming ZHONG
Affiliations
  • Department of Chronic and Non-communicable Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
  • Corresponding Author:
    ZHONG Jieming, E-mail:
出版时间: 2026-08-10 doi: 10.11847/zgggws1149270
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目的

了解浙江省慢性阻塞性肺疾病(简称“慢阻肺”)患者的生存结局竞争风险,为慢阻肺患者管理和干预方案的制定提供参考依据。

方法

收集浙江省疾病预防控制中心慢阻肺发病报告监测数据库中2014年1月1日—2023年12月31日慢阻肺发病数据和全死因监测数据库中2014年1月1日—2024年12月31日死亡数据,为慢阻肺患者匹配上相应的死亡结局,以“呼吸系统疾病死亡”为目标事件,以“恶性肿瘤”“脑血管疾病”“心脏病”和“其他疾病”为竞争事件,根据死亡时间和根本死因进行分性别和年龄的竞争风险分析。

结果

2014—2023年浙江省824 536例慢阻肺新发患者共观察到211 586例死亡结局,1年死亡概率为0.089,5年死亡概率为0.258,10年死亡概率为0.425。呼吸系统疾病仍是慢阻肺患者最主要的死亡风险(10年累计死亡风险为0.150);其次为恶性肿瘤(10年累计死亡风险为0.115),其中肺癌10年累计死亡风险为0.063,其他恶性肿瘤10年累计死亡风险为0.052;脑血管疾病的死亡风险最低(10年累计死亡风险为0.051)。分层分析结果显示,男性慢阻肺患者在3年内累计死亡风险恶性肿瘤最高(3年累计死亡风险为0.063),3年后则转变为呼吸系统疾病最高(10年累计死亡风险为0.162);女性慢阻肺患者则始终以呼吸系统疾病导致的累计死亡风险最高(10年累计死亡风险为0.120);<65岁慢阻肺患者以恶性肿瘤累计死亡风险最高(10年累计死亡风险为0.050);≥65岁慢阻肺患者以呼吸系统疾病累计死亡风险最高(10年累计死亡风险为0.206),其他死亡原因风险较为一致,远低于呼吸系统疾病。

结论

慢阻肺患者面临复杂的死亡模式,其竞争风险存在显著的年龄和性别差异,应制定个性化、多学科的综合干预策略以有效改善慢阻肺患者的预后。

慢性阻塞性肺疾病患者  /  生存结局  /  竞争风险  /  监测数据  /  浙江省
Objective

To understand the competitive risks of survival outcomes among patients with chronic obstructive pulmonary disease (COPD) in Zhejiang province, thereby providing evidence-based reference for formulating management and intervention programs for this population.

Methods

Incidence cases of COPD from January 1, 2014 to December 31, 2023 were collected from the COPD Surveillance Database of Zhejiang Provincial Center for Disease Control and Prevention, and death data from January 1, 2014 to December 31, 2024 were collected from the Death Surveillance Database. Death outcomes were matched for COPD patients. With death from respiratory diseases as the target event and malignant tumors, cerebrovascular diseases, heart disease, and other diseases as competing events, sex- and age-specific competing risk analyses were performed based on the time and underlying cause of death.

Results

Among the 824 536 new COPD cases in Zhejiang province from 2014 to 2023, death outcome was observed in 211 586 cases. The 1-year, 5-year, and 10-year mortality probabilities were 0.089, 0.258, and 0.425, respectively. Respiratory diseases remained the primary risk of death (10-year cumulative risk: 0.150), followed by malignant tumors (10-year cumulative risk: 0.115, with lung cancer at 0.063 and other malignant tumors at 0.052). Cerebrovascular diseases had the lowest risk of death (10-year cumulative risk: 0.051). Stratified analysis showed that for male COPD patients, the malignant tumors had the highest cumulative risk within 3 years (3-year cumulative risk: 0.063), and respiratory diseases became the factor with the highest cumulative risk after 3 years (10-year cumulative risk: 0.162). For female patients, respiratory diseases consistently posed the highest cumulative risk (10-year cumulative risk: 0.120). For patients aged < 65 years, the risk of malignant tumors was the highest (10-year cumulative risk: 0.050); for those aged ≥65 years, the risk of respiratory diseases was the highest (10-year cumulative risk: 0.206). Other factors demonstrated similar risks, which were much lower than that of respiratory diseases.

Conclusions

COPD patients face complex mortality patterns, and their competitive risks show significant age and sex differences. This highlights the importance of developing personalized and multidisciplinary integrated intervention strategies for different patient subgroups to effectively improve the prognosis of COPD patients.

chronic obstructive pulmonary disease patients  /  survival outcome  /  competitive risk  /  surveillance data  /  Zhejiang province
戴品远, 周晓燕, 王浩, 龚巍巍, 潘劲, 关云琦, 李娜, 俞敏, 钟节鸣. 浙江省慢性阻塞性肺疾病患者生存结局竞争风险:基于2014—2023年监测数据分析. 中国公共卫生, 2026 , 42 (8) : 955 -959 . DOI: 10.11847/zgggws1149270
Pinyuan DAI, Xiaoyan ZHOU, Hao WANG, Weiwei GONG, Jin PAN, Yunqi GUAN, Na LI, Min YU, Jieming ZHONG. Competitive risks of survival outcomes among patients with COPD in Zhejiang province: an analysis based on the monitoring data from 2014 to 2023[J]. Chinese Journal of Public Health, 2026 , 42 (8) : 955 -959 . DOI: 10.11847/zgggws1149270
慢性阻塞性肺疾病(简称“慢阻肺”)为全球第三大致死性疾病,其特征为持续性呼吸道症状和气流受限[1]。研究表明,慢阻肺患者的死亡原因除急性加重的呼吸衰竭和肺炎外,还有包括肺癌在内的恶性肿瘤、心血管疾病和脑血管疾病等[2],这些疾病与慢阻肺本身存在着复杂的作用,可能是慢阻肺患者的独立死亡原因,也可能互相加重,加速慢阻肺的病程[3]。因此,在分析慢阻肺患者的预后和死亡风险时,必须充分考虑这些竞争风险的存在,并将其作为重要的结局事件。尽管目前已有研究统计过慢阻肺患者的死亡率[4],但仍存在一定的局限性:一方面Kaplan-Meier法和Cox比例风险模型等传统的生存分析方法主要适用于单一结局事件的研究,未能充分考虑竞争风险事件的存在[5];另一方面许多已发表的慢阻肺生存研究往往基于相对较小的样本量[6],其结果的外推性可能受限,难以全面反映真实世界中慢阻肺患者群体的异质性和复杂性。为此,本研究收集浙江省疾病预防控制中心慢阻肺发病报告监测数据库中2014年1月1日—2023年12月31日慢阻肺发病数据和全死因监测数据库中2014年1月1日—2024年12月31日死亡数据,为慢阻肺患者匹配上相应的死亡结局,以“呼吸系统疾病死亡”为目标事件,以“恶性肿瘤”“脑血管疾病”“心脏病”和“其他疾病”为竞争事件,根据死亡时间和根本死因进行分性别和年龄的竞争风险分析,旨在评估真实世界背景下慢阻肺患者的生存状况及其死亡风险分布,为制定更具差异化的慢阻肺患者管理和干预方案提供参考依据。结果报告如下。
资料来源于浙江省疾病预防控制中心维护的慢阻肺发病报告监测数据库和全死因监测数据库2个核心数据库。(1)慢阻肺发病报告监测数据库:该数据库收录了全省二级及以上医疗机构严格遵循《慢性阻塞性肺疾病全球倡议(GOLD)》[7]中临床诊断指南确诊的所有慢阻肺病例。本研究收集其中2014年1月1日—2023年12月31日所有慢阻肺新发患者相关数据进行分析。(2)全死因监测数据库:该数据库涵盖了2014年1月1日—2024年12月31日全省户籍人口以及发生在浙江省的所有死亡个案。死因编码严格依据《疾病和有关健康问题的国际统计分类第十次修订本》(International Statistical Classification of Diseases and Related Health Problems 10th Revision, ICD-10)[8]标准进行标准化审核。通过身份证号进行跨库精准匹配,构建包括人口学特征(性别、出生日期)、确诊时间及死亡信息(死亡日期、根本死因)的纵向队列。死亡结局依据ICD-10编码归类为呼吸系统疾病(J00~J99)、恶性肿瘤(C00~C97)、脑血管疾病(I60~I69)、心脏病(I05~I09,I11,I20~I27,I30~I52)和其他疾病5类,以“呼吸系统疾病死亡”为目标事件,其他4类疾病为竞争事件。本研究经浙江省疾病预防控制中心伦理委员会审查批准,批号为:2024–041–01。
应用R V4.2软件进行统计分析,检验水准为双侧检验α = 0.05。首先采用Cox回归模型对慢阻肺患者的死亡结局进行生存分析,计算风险比(hazard ratio, HR)。然后分析各类死亡原因的占比,先采用基于Wald统计量的Z检验比较第10年不同死亡风险的统计学差异,再使用Fine-Gray比例风险模型[9–10],使用累计风险函数(cumulative incidence function, CIF)来计算所有结局事件的累计发生概率:
$ {\lambda }_{j}(t,{X}_{i})={\lambda }_{0}(t)\mathrm{exp} \left(\displaystyle \sum \limits_{j=1}^{p}{\beta }_{ij}{X}_{i}\right) $
其中,$ {\lambda }_{0}(t) $为事件j的基线累计风险函数;$ {X}_{i} $代表协变量i;$ {\beta }_{ij} $对应协变量i在事件j的回归系数。$ \mathrm{exp} \left(\displaystyle\sum \limits_{j=1}^{p}{\beta }_{ij}{X}_{i}\right) $为部分分布风险函数(sub-distribution hazard function),其β通过以下公式来估计:
$ L\left(\beta \right)=\displaystyle\prod \limits_{j=1}^{n}\dfrac{\mathrm{exp} \left(\displaystyle\sum \limits_{j=1}^{p}{\beta }_{ij}{X}_{i}\right)}{\displaystyle\sum \limits_{j\in {R}_{j}}{\omega }_{ij}\mathrm{exp} \left(\displaystyle\sum \limits_{j=1}^{p}{\beta }_{ij}{X}_{i}\right)}$
其中,风险集$ {R}_{j} $为在时间t前未发生感兴趣事件结局的个体以及在时间t前发生其他竞争风险事件的个体构成;权重$ {\omega }_{ij} $为在时间t前未发生竞争事件的个体,在时间t发生感兴趣事件的权重$ {\omega }_{ij} $为1,对于在时间t前发生了竞争事件的个体,则权重$ {\omega }_{ij} $为$ G(t) $与$ G({t}_{i}) $的比值,$ G(t) $是Kaplan-Meier法估计的生存函数。最后将性别和年龄作为协变量,探讨这2个因素对结局事件的影响。
2014—2023年浙江省824 536例慢阻肺患者中,男性588 745例 (71.40%),女性235 791例(28.60%);年龄<65岁273 791例(33.21%),≥65岁550 745例(66.79%)。
2014—2023年浙江省824 536例慢阻肺患者中,共211 586例观察到死亡结局。生存分析结果显示,新发慢阻肺患者1年死亡概率为0.089,5年死亡概率为0.258,10年死亡概率为0.425;男性和女性慢阻肺患者10年死亡概率分别为0.448和0.370,女性慢阻肺患者死亡风险低于男性慢阻肺患者(HR=0.77,95%CI=0.76~0.78);<65岁和≥65岁慢阻肺患者10年死亡概率分别为0.125和0.582,≥65岁慢阻肺患者死亡风险高于<65岁慢阻肺患者(HR=6.35,95%CI=6.25~6.44)。
2014—2023年浙江省824 536例新发不同年龄慢阻肺患者在70岁之前,慢阻肺患者的主要死亡原因为包括肺癌在内的恶性肿瘤,其次是呼吸系统疾病;而在70岁之后,呼吸系统疾病成为最主要的死亡原因,其次是恶性肿瘤;当患者年龄>85岁,心脏病则成为仅次于呼吸系统疾病的第二大死亡原因。
分析结果显示,呼吸系统疾病仍是浙江省慢阻肺患者最主要的死亡风险(10年累计死亡风险为0.150);其次为恶性肿瘤(10年累计死亡风险为0.115),其中肺癌的10年累计死亡风险为0.063,其他恶性肿瘤的10年累计死亡风险为0.052;再次为其他疾病(10年累计死亡风险为0.063)和心脏病(10年累计死亡风险为0.059);脑血管疾病的死亡风险最低(10年累计死亡风险为0.051)。按性别和年龄进行分层后,竞争风险分析结果显示,男性慢阻肺患者在3年内累计死亡风险以恶性肿瘤为最高(3年累计死亡风险为0.063),但3年后则转变为呼吸系统疾病累计死亡风险为最高(10年累计死亡风险为0.162),其中肺癌的10年累计死亡风险为0.062;女性慢阻肺患者则始终以呼吸系统疾病的累计死亡风险为最高(10年累计死亡风险为0.120),其次为其他疾病(10年累计死亡风险为0.072)和心脏病(10年累计死亡风险为0.069)导致的死亡风险,肺癌的死亡风险最低(10年累计死亡风险为0.021);<65岁慢阻肺患者的恶性肿瘤死亡风险为最高(10年累计死亡风险为0.050),前4年仅肺癌累计死亡风险就达0.016;而≥65岁慢阻肺患者则以呼吸系统疾病的死亡风险为最高(10年累计死亡风险为0.206)。
本研究基于浙江省监测数据对慢阻肺患者的死亡风险和不同死因的竞争风险进行分析,为深入理解该疾病的负担及其随时间推移的趋势提供了重要依据。研究结果显示,女性慢阻肺患者死亡风险低于男性慢阻肺患者(HR=0.77,95%CI= 0.76~0.78),与Ntritsos G等[11]研究中慢阻肺死亡率的性别差异结果一致,这可能与不同性别人群在吸烟、职业等危险因素暴露、激素影响、遗传易感性、免疫反应和在医疗保健寻求行为等方面均存在着差异有关[12–13];≥65岁慢阻肺患者死亡风险高于<65岁慢阻肺患者(HR=6.35,95%CI=6.25~6.44),与相关研究[14–15]结果一致,即年龄升高是导致慢阻肺患者死亡的重要危险因素,这一发现强调了老年慢阻肺患者群体的脆弱性与死亡的危险性。
通过对不同年龄组慢阻肺患者各类死因的占比进行分析,本研究发现慢阻肺患者的死因谱在不同年龄组间呈现动态转变。在70岁之前,恶性肿瘤是慢阻肺患者的主要死因(10年累计死亡风险为0.115),其中肺癌的10年累计死亡风险为0.063。研究表明,慢阻肺本身就是多种恶性肿瘤(尤其是肺癌)的独立危险因素,这不仅因为两者共同存在吸烟等危险因素的暴露史,还因为慢阻肺患者肺部长期存在的慢性炎症、氧化应激以及反复损伤和修复过程为肿瘤的发生提供了有利的微环境[16–17];此外,慢阻肺患者普遍存在的免疫功能紊乱也可能削弱机体对癌细胞的清除能力[18]。因此,对于相对年轻的慢阻肺患者而言,他们可能更长时间地暴露于致癌环境中,或者慢阻肺导致的生物学改变可能加速了肿瘤的发生和进展,这提示临床医生在管理相对年轻的慢阻肺患者时应做好恶性肿瘤的及时筛查和早期干预,将其作为重要的可能结局进行考量。当患者年龄进入70岁之后,呼吸系统疾病逐渐成为慢阻肺患者死亡的首要原因,这反映了随着年龄增长和慢阻肺病程的自然进展,肺功能持续下降,急性加重事件的频率和严重性随之增加;对于那些未在疾病早期因其他共病(如恶性肿瘤)死亡的患者,慢阻肺本身的肺部病理改变和功能障碍累积到临界点,最终使得呼吸衰竭成为其最主要且直接的致死原因,其对生存的威胁超越了其他竞争性死因[19]。在这些老年患者中,肺部结构和功能的不可逆损伤已达到最高点,使得呼吸系统本身成为死亡的根本原因[20]。在85岁之后,心脏病的危害日益突出,成为仅次于呼吸系统疾病的第二大死因,这可能是因为慢阻肺通过慢性缺氧、系统性炎症和肺动脉高压等机制直接损害心脏功能,增加了心血管事件的发生风险[21]。因此,随着患者年龄的增长,心血管系统本身的老化和长期慢性疾病对心脏的负担,使心脏病成为老年慢阻肺患者不可忽视的死亡原因[22]。
此外,本研究分性别的竞争风险分析进一步揭示了不同死因风险的差异:男性在3年内累计死亡风险以恶性肿瘤为最高(3年累计死亡风险为0.063),但3年后则转变为呼吸系统疾病死亡风险为最高(10年累计死亡风险为0.162),而肺癌则一直保持较高的死亡风险(10年累计死亡风险为0.062),这可能与男性普遍较高的吸烟率和长期致癌物暴露史[23]导致部分患者在疾病早期就已累积了较高的癌症风险,甚至可能存在未被发现的早期肿瘤有关。而慢阻肺的慢性炎症微环境则被认为是肺癌发生和发展的重要驱动因素,因此,部分男性患者在确诊慢阻肺后,很快就发现癌症诊断并进展至终末期[24];且随着生存期的延长,反复的急性加重、肺部结构破坏以及随之而来的肺动脉高压和右心功能不全等并发症最终会使呼吸系统本身成为主要致死因素[25]。相比之下,女性慢阻肺患者则始终以呼吸系统疾病的死亡风险为最高(10年累计死亡风险为0.120),表明呼吸系统疾病在女性慢阻肺病程中的重要程度,提示对于女性慢阻肺患者而言,持续且积极的呼吸系统疾病进展管理至关重要。
综上所述,慢阻肺患者面临复杂的死亡模式,其竞争风险存在显著的年龄和性别差异,应制定个性化、多学科的综合干预策略以有效改善慢阻肺患者的预后。本研究虽然基于大样本的真实世界数据,但仍存在一定的局限性。首先,数据主要来源于浙江省的医疗机构收集,不同医疗机构的医生对于慢阻肺的诊断可能存在着主观上的区别;其次,虽然本研究控制了性别和年龄的影响,但是由于数据收集的困难,未能纳入吸烟史、职业暴露、社会经济地位和医疗服务可及性等潜在的混杂因素。因此,在未来的研究中应进一步获取更全面的临床数据以进行更精细的风险因素调整。

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2026年第42卷第8期
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doi: 10.11847/zgggws1149270
  • 接收时间:2025-11-07
  • 首发时间:2026-10-23
  • 出版时间:2026-08-10
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  • 收稿日期:2025-11-07
  • 修回日期:2026-01-16
  • 录用日期:2026-04-04
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    浙江省疾病预防控制中心慢性非传染性疾病预防与控制所,杭州 310051

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2种不同金属材料的力学参数
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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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