背景 在全球老龄化不断深化的背景下,慢性病患者不断增加,多病共存现象愈加严重.在普遍认知中,心血管疾病与 2 型糖尿病大多属于老年病,但随着居民生活节奏与饮食等行为方式的改变,很多疾病呈现年轻化趋势.现也有研究表明,与一般人群相比,年轻时患糖尿病的患者的心血管疾病风险及死亡率会相对增加.目的 探究 1990-2019 年中国成年人归因于糖尿病的心血管疾病负担情况,为共病预防提供依据.方法 基于 2019 年全球疾病负担研究(GBD)数据,主要采用死亡率、伤残调整寿命年(DALY)率和计算获取的年估计变化百分比(EAPC)等指标评估我国心血管疾病(包括缺血性心脏病、脑卒中和外周动脉疾病 3 类)归因于糖尿病的疾病负担情况,并对年龄段(25~49 岁、50~69 岁、≥70 岁)及性别进行分层分析,最后对疾病负担的时间趋势进行分析.结果 中国 25岁及以上人群归因于糖尿病的心血管疾病死亡数从1990年的29.805万例上升到2019年的70.034万例.男性归因于糖尿病的心血管疾病标化死亡率较 1990 年升高,而女性标化死亡率有所降低,且男性标化死亡率始终高于女性.2019年归因于糖尿病的心血管疾病DALY为 1 358.585 万人年,按年龄划分的死亡率和DALY率随年龄增长而增加.女性标化DALY率下降趋势较男性明显(女性:EAPC=-0.32%,95%CI=-0.49%~-0.11%;男性:EAPC=-0.01%,95%CI=-0.26%~0.29%).2019 年归因于糖尿病的缺血性心脏病、外周动脉疾病患者 3 个年龄段的死亡率和DALY率较 1990年大部分上升,而 2019 年归因于糖尿病的脑卒中患者 3 个年龄段的死亡率较 1990 年下降.1990-2019 年心血管疾病中 3 类心血管疾病归因于糖尿病的标化DALY率占比呈波动性变化,但在 2019 年归因于糖尿病的 3 类心血管疾病标化DALY率占比均高于 1990 年.结论 1990-2019 年我国成年人归因于糖尿病的心血管疾病的死亡率和DALY率总体呈现上升趋势,人群糖尿病及心血管疾病共病风险较大,应注重在糖尿病患者中筛查心血管疾病或患心血管疾病风险高的个体,重点关注男性、高龄人群以及不良生活习惯较多的年轻人,对其进行早期的健康干预,减少共病疾病负担.
Background Against the backdrop of global aging,the number of patients with chronic diseases is increasing,and the multimorbidity is becoming more severe.Traditionally,cardiovascular diseases and type 2 diabetes are mostly considered diseases of the elderly.However,with changes in lifestyle patterns such as the pace of life and diet,many diseases are showing a trend of rejuvenation.Recent studies have also shown that individuals who develop diabetes at a young age have an increased relative risk of developing cardiovascular diseases and higher mortality rates compared to the general population.Objective To investigate the burden of cardiovascular diseases attributed to diabetes among Chinese adults from 1990 to 2019,so as to provide evidence for comorbidity prevention.Methods Based on the 2019 Global Burden of Disease(GBD)study data,indicators such as mortality rates,disability-adjusted life years(DALY)rates,and estimated annual percentage change(EAPC)were used to assess the burden of cardiovascular diseases in China(including ischemic heart disease,stroke,and peripheral arterial disease)attributed to diabetes.The analysis was stratified by age group(25-49 years,50-69 years,≥70 years)and gender,and the temporal trends in disease burden were finally analyzed.Results The number of cardiovascular disease deaths attributable to diabetes increased from 298 050 in 1990 to 700 340 in 2019 among people aged 25 years and older in China.The age-standardized mortality rate for CVD attributed to diabetes increased for males compared to 1990,while it decreased for females,with males consistently having higher rates than females.In 2019,the DALY for CVD attributed to diabetes was 13 585 850 person-years.The age-specific mortality rate and DALY rate increased with age.The downward trend in standardized DALY rate was more pronounced in females(EAPC=-0.32%,95%CI=-0.49%to-0.11%)than in males(EAPC=-0.01%,95%CI=-0.26%to 0.29%).The mortality and DALY rates for ischemic heart disease and peripheral arterial disease attributed to diabetes increased in the three age groups from 1990 to 2019,while the mortality rates for stroke attributed to diabetes declined in all three age groups in 2019 compared to 1990.The percentage of standardized DALY rates attributable to diabetes for the 3 cardiovascular diseases in cardiovascular disease fluctuated from 1990 to 2019.However,the percentage of standardized DALY rates for all 3 cardiovascular diseases attributable to diabetes was higher in 2019 than in 1990.Conclusion From 1990 to 2019,there has been an overall increasing trend in the mortality and DALY rates of cardiovascular diseases attributed to diabetes among adults in China.Population is at greater risk for comorbidities of diabetes and CVD,emphasizing the need to focus on screening for CVD among individuals with diabetes or those at high risk of developing CVD.Emphasis should be placed on males,the elderly,and younger individuals with unhealthy lifestyle habits for early health interventions to reduce the burden of comorbidities.