1990—2021年中国60岁及以上老年人HIV/AIDS合并药物敏感结核病的疾病负担及变化趋势

doi:10.19982/j.issn.1000-6621.20250265

摘要/Abstract

摘要：

目的: 分析1990—2021年中国老年人 HIV/AIDS合并药物敏感结核病(drug-susceptible tuberculosis,DS-TB)的残疾调整生命年(disability-adjusted life years,DALYs)、死亡、发病及患病等疾病负担指标的变化趋势,为制定预防与控制策略提供参考依据。方法: 从全球疾病负担(Global Burden of Disease,GBD)数据库中获取1990—2021年间中国≥60岁老年人群中HIV/AIDS合并DS-TB的DALYs、死亡、发病和患病等数据,使用估计年度百分比变化(estimated annual percentage change,EAPC)及其95%置信区间(confidence interval,CI)详细描述各指标动态变化趋势。结果: 1990—2021年间,中国≥60岁老年人群HIV/AIDS合并DS-TB的患病率和发病率不断增长,其中,80~84岁组增幅最为突出,EAPC达3.77%(95%CI:2.33%~5.22%)。死亡率和DALYs指标呈现异质性变化,80岁以上高龄组死亡率呈负增长,而除90~94岁阶段外,各年龄段DALYs均呈绝对增长,70~74岁组DALYs增速最快(EAPC=1.71%,95%CI:0.27%~3.18%)。2021年数据显示,65~69岁组为疾病负担的峰值年龄段,DALYs、死亡、发病和患病数均居各年龄组之首;其中,男性依次为4567.57万人年、151.60万例、1107.40万例和2330.58万例,女性依次为1641.34万人年、52.64万例、425.74万例和905.10万例,各指标男性均明显高于女性。自该年龄段起,随年龄继续增长,上述四项指标均呈下降趋势。男性行为风险和不安全性行为的归因死亡率随年龄增长而升高,≥95岁组分别达到86.22/10万和83.38/10万;女性行为风险和不安全性行为的归因死亡率均>90/10万。结论: 中国老年人群HIV/AIDS合并DS-TB的疾病负担不断加重,病因涉及行为、药物及暴力等,未来需要特别关注高龄人群和不同性别群体差异。

关键词: 老年人, HIV感染, 结核, 共病现象, 疾病特征

Abstract:

Objective: To analyze the trends in disability-adjusted life years (DALYs), deaths, incidence, and prevalence of HIV/AIDS co-infected with drug-susceptible tuberculosis (DS-TB) among the elderly aged 60 above in China from 1990 to 2021, and to provide reference for the formulation of prevention and control strategies. Methods: Data on DALYs, deaths, incidence, and prevalence of HIV/AIDS co-infected with DS-TB among individuals aged ≥60 years in China from 1990 to 2021 were extracted from the Global Burden of Disease (GBD) database. The estimated annual percentage change (EAPC) and its 95% confidence interval (CI) were used to describe the dynamic trends of each indicator. Results: From 1990 to 2021, the prevalence and incidence of HIV/AIDS co-infected with DS-TB among the elderly in China continued to rise, with the most pronounced increase observed in the 80-84 age group, recording an EAPC of 3.77% (95%CI: 2.33%-5.22%). Mortality and DALYs showed heterogeneous trends: while mortality declined in those aged ≥80, DALYs increased in absolute terms across all age groups except the 90-94 cohort, with the fastest growth in the 70-74 age group (EAPC=1.71%, 95%CI: 0.27%-3.18%). In 2021, the 65-69 age group bore the heaviest disease burden, ranking highest across all indicators—DALYs, deaths, incidence, and prevalence. Among males, these were 45.6757 million person-years, 1.516 million deaths, 11.074 million incident cases, and 23.3058 million prevalent cases, respectively; among females, they were 16.4134 million person-years, 0.5264 million deaths, 4.2574 million incident cases, and 9.051 million prevalent cases. All indicators were significantly higher in males than in females. Beyond this age group, all four indicators declined with advancing age. Attributable mortality due to behavioral risks and unsafe sex among males increased with age, reaching 86.22/100000 and 83.38/100000, respectively, in those ≥95 years. Among females, attributable mortality from both behavioral risks and unsafe sex exceeded 90/100000. Conclusion: The disease burden of HIV/AIDS co-infected with DS-TB among the elderly in China is steadily increasing, with causes involving behavior, drugs, and violence. Greater attention should be paid to the very old and to sex-specific differences in future prevention and control efforts.

Key words: Aged, HIV infections, Tuberculosis, Comorbidity, Disease attributes

中图分类号:

R52
R211

朱庆东, 赵春艳, 黄爱春, 曾春梅, 龚春明, 许超艳, 简莎莎, 李维文, 宋畅. 1990—2021年中国60岁及以上老年人HIV/AIDS合并药物敏感结核病的疾病负担及变化趋势[J]. 中国防痨杂志, 2026, 48(1): 34-40. doi: 10.19982/j.issn.1000-6621.20250265

Zhu Qingdong, Zhao Chunyan, Huang Aichun, Zeng Chunmei, Gong Chunming, Xu Chaoyan, Jian Shasha, Li Weiwen, Song Chang. The disease burden and changing trends of HIV/AIDS-associated drug-susceptible tuberculosis in the elderly population aged 60 above of China from 1990 to 2021[J]. Chinese Journal of Antituberculosis, 2026, 48(1): 34-40. doi: 10.19982/j.issn.1000-6621.20250265

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年龄组 (岁)	1990年		2021年		EAPC (%,95%CI)
年龄组 (岁)	死亡数 (万例,95%CI)	死亡率 (/10万,95%CI)	死亡数 (万例,95%CI)	死亡率 (/10万,95%CI)	EAPC (%,95%CI)
60~64	45(1~75)	0.13(0~0.21)	159(93~240)	0.22(0.13~0.33)	0.78(-0.35~1.92)
65~69	34(1~57)	0.13(0~0.21)	204(118~316)	0.27(0.15~0.41)	0.57(-0.63~1.79)
70~74	19(1~32)	0.10(0~0.17)	141(82~216)	0.26(0.15~0.41)	1.30(-0.26~2.89)
75~79	25(6~38)	0.22(0.05~0.33)	92(53~142)	0.28(0.16~0.43)	1.05(0.08~2.02)
80~84	4(1~13)	0.08(0.02~0.24)	41(23~63)	0.21(0.12~0.32)	-0.97(-2.68~0.78)
85~89	1(0~4)	0.08(0.02~0.26)	19(11~30)	0.20(0.12~0.31)	-0.76(-2.41~0.93)
90~94	0(0~1)	0.07(0.02~0.22)	4(2~7)	0.14(0.08~0.22)	-1.62(-3.22~0.02)
≥95	0(0~0)	0.05(0.02~0.14)	1(0~1)	0.11(0.07~0.18)	-1.66(-3.22~-0.07)

年龄组 (岁)	1990年		2021年		EAPC (%,95%CI)
年龄组 (岁)	DALYs (人年,95%CI)	DALYs率 (/10万,95%CI)	DALYs (人年,95%CI)	DALYs率 (1/10万,95%CI)	EAPC (%,95%CI)
60~64	1522(220~2418)	4.31(0.62~6.84)	5600(3581~8132)	7.67(4.91~11.14)	1.02(-0.02~2.08)
65~69	992(153~1565)	3.64(0.56~5.73)	6209(3971~9026)	8.09(5.18~11.77)	0.94(-0.16~2.06)
70~74	485(93~768)	2.58(0.49~4.08)	3647(2397~5252)	6.84(4.50~9.85)	1.71(0.27~3.18)
75~79	639(375~800)	5.62(3.29~7.03)	2037(1312~2884)	6.15(3.96~8.71)	1.15(0.33~1.98)
80~84	65(22~205)	1.22(0.42~3.87)	805(535~1117)	4.07(2.70~5.64)	0.17(-1.39~1.75)
85~89	17(6~57)	1.00(0.33~3.37)	313(212~436)	3.29(2.22~4.58)	0.37(-1.12~1.88)
90~94	2(1~8)	0.81(0.27~2.60)	70(48~95)	2.39(1.64~3.25)	-0.02(-1.47~1.44)
≥95	0(0~1)	0.61(0.22~1.74)	12(8~16)	1.88(1.31~2.51)	0.13(-1.24~1.52)

年龄组 (岁)	1990年		2021年		EAPC (%,95%CI)
年龄组 (岁)	患病数 (万例,95%CI)	患病率 (/10万,95%CI)	患病数 (万例,95%CI)	患病率 (/10万,95%CI)	EAPC (%,95%CI)
60~64	574(399~694)	1.62(1.13~1.96)	2591(2122~3001)	3.55(2.91~4.11)	2.65(2.07~3.25)
65~69	391(266~470)	1.43(0.98~1.72)	3236(2640~3751)	4.22(3.44~4.89)	2.98(2.21~3.77)
70~74	272(173~339)	1.45(0.92~1.80)	2159(1765~2508)	4.05(3.31~4.71)	3.51(2.26~4.77)
75~79	604(326~995)	5.30(2.87~8.75)	1515(1240~1761)	4.57(3.74~5.32)	1.72(0.73~2.72)
80~84	36(7~119)	0.67(0.13~2.26)	793(652~920)	4.01(3.29~4.65)	3.77(2.33~5.22)
85~89	10(2~34)	0.61(0.12~2.01)	320(263~371)	3.36(2.76~3.89)	3.54(2.14~4.95)
90~94	2(0~6)	0.56(0.11~1.85)	84(69~97)	2.87(2.35~3.32)	3.21(1.83~4.60)
≥95	0(0~1)	0.52(0.11~1.62)	15(12~18)	2.36(1.94~2.74)	2.92(1.57~4.29)

年龄组 (岁)	1990年		2021年		EAPC (%,95%CI)
年龄组 (岁)	发病数 (万例,95%CI)	发病率 (/10万,95%CI)	发病数 (万例,95%CI)	发病率 (/10万,95%CI)	EAPC (%,95%CI)
60~64	380(278~449)	1.07(0.79~1.27)	1243(1052~1414)	1.70(1.44~1.94)	1.58(1.17~2.00)
65~69	260(174~306)	0.95(0.64~1.12)	1533(1302~1743)	2.00(1.70~2.27)	1.89(1.28~2.50)
70~74	182(140~217)	0.97(0.74~1.15)	1024(869~1164)	1.92(1.63~2.18)	2.37(1.30~3.44)
75~79	458(303~614)	4.03(2.67~5.40)	717(607~816)	2.17(1.83~2.46)	0.41(-0.57~1.41)
80~84	25(7~68)	0.46(0.13~1.28)	377(320~429)	1.91(1.61~2.17)	2.15(0.52~3.80)
85~89	7(2~19)	0.42(0.12~1.14)	153(130~174)	1.61(1.36~1.83)	1.92(0.35~3.52)
90~94	1(0~3)	0.40(0.11~1.07)	40(34~46)	1.38(1.17~1.56)	1.58(0.03~3.14)
≥95	0(0~0)	0.38(0.12~0.94)	7(6~8)	1.15(0.98~1.31)	1.38(-0.09~2.87)