2011—2020年广州市肺结核死亡趋势及年龄-时期-队列模型分析

doi:10.19982/j.issn.1000-6621.20240323

摘要/Abstract

摘要：

目的：分析2011—2020年广州市肺结核患者的死亡情况和死亡率变化趋势,为制定防控策略和措施提供科学依据。方法：采用Joinpoint回归模型分析2011—2020年广州市全年龄段人群肺结核死亡率变化趋势,并计算年度变化百分比(annual percent change, APC)和平均年度变化百分比(average annual percent change, AAPC);使用年龄-时期-队列模型分析广州市20~85岁人群肺结核死亡风险的年龄、时期和队列效应。结果：广州市2011—2020年报告肺结核死亡患者2144例,年均报告标化死亡率为2.57/10万;男性肺结核标化死亡率为4.19/10万,约为女性标化死亡率(0.96/10万)的4.4倍。10年间广州市肺结核年龄标化死亡率总体呈现下降趋势,AAPC为―4.15%(95%CI:―6.41%~―1.85%,P=0.003);其中,女性肺结核死亡率下降速度高于男性,AAPC分别为―6.72%(95%CI:―10.38%~―2.92%,P=0.004)和―3.55%(95%CI:―6.19%~―0.85%,P=0.017)。在不同年龄段人群中,0~49岁和≥65岁年龄段人群肺结核死亡率均呈现明显下降趋势,AAPC分别为―7.05%(95%CI:―11.52%~―2.34%,P=0.009)和―3.94%(95%CI:―6.22%~―1.62%,P=0.005)。年龄-时期-队列模型的年龄效应显示,随着年龄的增长,肺结核死亡风险不断上升,≥65岁人群尤为显著,发病率由66~67岁年龄组的2.93/10万增长至84~85岁年龄组的6.10/10万。时期效应显示,肺结核死亡风险随着时期的变化总体呈现下降趋势,相对危险度(risk ratio, RR)从2011—2012年时期组的1.35下降至2019—2020年时期组的0.81。队列效应显示,越晚出生的人群肺结核死亡风险越低,RR值从1926—1927年出生队列的5.91降低至1998—1999年出生队列的0.16。结论：广州市肺结核死亡率总体呈不断下降的趋势,但男性和女性肺结核死亡率差距较大。需重点关注男性和≥65岁年龄段的老年人群,并实施针对性的防控和治疗措施。

关键词: 结核, 肺, 死亡率, 回归分析, 队列研究

Abstract:

Objective: Analyze pulmonary tuberculosis caused mortality rate and its changing trend in Guangzhou City from 2011 to 2020, in order to provide a scientific basis for formulating prevention and control strategies and measures. Methods: The Joinpoint regression model was used to analyze the change trend of tuberculosis mortality rates in all age groups in Guangzhou from 2011 to 2020. Annual percent change (APC) and average annual percent change (AAPC) were calculated. Age-period-cohort model was used to analyze the age, period and cohort effects on risk of pulmonary tuberculosis caused death in 20-85 years old populations in Guangzhou. Results: From 2011 to 2020, 2144 cases died of pulmonary tuberculosis were reported in Guangzhou, with an average annual standardized mortality rate of 2.57/100000. The standardized mortality rate of male was 4.19/100000, about 4.4 times of that of females (0.96/100000). The age-standardized mortality rates showed a decreasing trend in the past 10 years, AAPC was ―4.15% (95%CI: ―6.41%-―1.85%, P=0.003). The mortality rates decreased faster in females (AAPC=―6.72%, 95%CI: ―10.38%-―2.92%, P=0.004) than in males (―3.55%, 95%CI: ―6.19%-―0.85%, P=0.017). For different age groups, the mortality rates of pulmonary tuberculosis in 0-49 years old group and ≥65 years old group showed significant downward trends, their AAPC were ―7.05% (95%CI: ―11.52%-―2.34%, P=0.009) and ―3.94% (95%CI: ―6.22%-―1.62%, P=0.005) respectively. The age-period-cohort model showed that risk of tuberculosis death increased with age, particularly in people over 65 years old, from 2.93/100000 in the 66-67 age group to 6.10/100000 in the 84-85 age group. The period effect showed that the overall risk of tuberculosis death showed a downward trend with the change of period, risk ratio (RR) decreased from 1.35 in the 2011—2012 period group to 0.81 in the 2019—2020 period group. The cohort effect showed a lower risk of tuberculosis death for those born later, with RR decreasing from 5.91 in the 1926—1927 born cohort to 0.16 in the 1998—1999 born cohort. Conclusion: The mortality rate of pulmonary tuberculosis in Guangzhou showed a decreasing trend, but there was a large gap between male and female. It is necessary to focus on men and elderly people over 65 years old and implement targeted prevention and treatment measures.

Key words: Tuberculosis, pulmonary, Mortality, Regression analysis, Cohort studies

中图分类号:

R183.3

李雪秋, 刘群, 唐科, 吴迪. 2011—2020年广州市肺结核死亡趋势及年龄-时期-队列模型分析[J]. 中国防痨杂志, 2025, 47(1): 44-50. doi: 10.19982/j.issn.1000-6621.20240323

Li Xueqiu, Liu Qun, Tang Ke, Wu Di. Analysis of mortality trend of pulmonary tuberculosis cases with an age-period-cohort model in Guangzhou City, 2011—2020[J]. Chinese Journal of Antituberculosis, 2025, 47(1): 44-50. doi: 10.19982/j.issn.1000-6621.20240323

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年份	男性
年份	报告死亡患者 (例)	人口 (100万)	粗报告死亡率 (/10万)	标化报告死亡率 (/10万)	报告死亡患者 (例)	人口 (100万)	粗报告死亡率 (/10万)	标化报告死亡率 (/10万)	报告死亡患者 (例)	人口 (100万)	粗报告死亡率 (/10万)	标化报告死亡率 (/10万)
2011	183	4.12	4.45	5.15	40	4.01	1.00	1.17	223	8.13	2.74	3.14
2012	184	4.15	4.44	4.97	52	4.05	1.28	1.44	236	8.20	2.88	3.21
2013	148	4.19	3.53	3.86	42	4.11	1.02	1.15	190	8.30	2.29	2.50
2014	177	4.23	4.18	4.54	49	4.17	1.18	1.16	226	8.40	2.69	2.86
2015	180	4.30	4.19	4.41	39	4.25	0.92	0.97	219	8.55	2.56	2.69
2016	153	4.37	3.50	3.69	29	4.34	0.67	0.67	182	8.71	2.09	2.19
2017	207	4.49	4.61	4.85	31	4.48	0.69	0.71	238	8.97	2.65	2.79
2018	180	4.63	3.89	4.01	43	4.65	0.93	0.96	223	9.28	2.40	2.48
2019	168	4.75	3.54	3.55	38	4.79	0.79	0.80	206	9.54	2.16	2.17
2020	163	4.89	3.33	3.37	38	4.96	0.77	0.71	201	9.85	2.04	2.03
合计	1743	44.12	3.95	4.19	401	43.81	0.92	0.96	2144	87.93	2.44	2.57

分类	时间区段	AAPC(%,95%CI)	t值	P值
性别
总人群	2011—2020	―4.15(―6.41~―1.85)	―4.112	0.003
男性	2011—2020	―3.55(―6.19~―0.85)	―3.014	0.017
女性	2011—2020	―6.72(―10.38~―2.92)	―4.013	0.004
0~49岁
总人群	2011—2020	―7.05(―11.52~―2.34)	―3.412	0.009
男性	2011—2020	―5.65(―10.20~―0.87)	―2.712	0.027
女性	2011—2020	―11.61(―19.13~―3.39)	―3.201	0.013
50~64岁
总人群	2011—2020	―3.47(―7.93~1.21)	―1.719	0.124
男性	2011—2020	―2.08(―6.88~2.98)	―0.962	0.364
女性	2011—2020	―11.68(―19.69~―2.88)	―3.016	0.017
≥65岁
总人群	2011—2020	―3.94(―6.22~―1.62)	―3.876	0.005
男性	2011—2020	―3.84(―6.57~―1.03)	―3.132	0.014
女性	2011—2020	―4.56(―9.53~0.67)	―2.018	0.078