摘要:
目的 分析1990—2021年老年人群高血压疾病负担并预测未来趋势，为我国应对老年高血压疾病负担的公共卫生决策提供参考。方法 提取全球疾病负担（GlobalBurden of Disease，GBD） 2021数据库中全球、中国及5个社会人口学指数（sociodemographicindex，SDI）地区年龄≥60岁人群的高血压相关死亡和伤残调整生命年（disability adjustedlife years，DALYs）数据。计算老年人群的高血压年龄标化死亡率和标化DALYs率，并采用Joinpoint回归分析疾病负担变化趋势，结果以平均年度变化百分比（average annualpercentage change，AAPC）表示。此外，基于不同年龄组和性别进行亚组分析，采用三因素分解法分析老龄化、人口增长和流行病学变化3个因素对疾病负担的影响。基于贝叶斯模型预测2022—2040年老年人群的高血压疾病负担。结果 1990—2021年全球和中国老年人群高血压的年龄标化死亡率和标化DALYs率整体均呈下降趋势（AAPC均为负值，P均＜0.001），但2021年全球和中国老年人群高血压死亡人数较1990年分别增加了68.37%和157.86%，而DALYs数分别增加了61.74%和125.98%。同时，除高SDI地区外，2021年其余4个SDI地区的高血压死亡人数和DALYs数较1990年均明显增加。此外，中国老年人群男性的高血压疾病负担整体高于女性，且2021年中国老年人群中70～74岁年龄组的高血压DALYs数最高，而死亡人数则主要集中于80～84岁年龄组。分解分析表明，人口增长是导致全球和中国老年人群高血压死亡人数及DALYs数增加的主要因素。预测分析发现，中国2022—2040年老年人群总体、男性和女性的高血压疾病负担将继续增加。结论 尽管过去近30年中国老年人群高血压的年龄标化死亡率和标化DALYs率总体呈下降趋势，但高血压的绝对疾病负担依然沉重，迫切需进一步制定和实施更加科学有效的公共卫生政策和临床干预策略，以积极应对这一严重的公共卫生问题。
Abstract:
Objective To analyze the disease burden of hypertension in the elderly population from 1990 to 2021 and to predict future trends, thereby providing insights for public health decision-making regarding older adults with hypertension in China. Methods Data on hypertension-related deaths and disability-adjusted life years (DALYs) for individuals aged ≥60 years was extracted from the Global Burden of Disease (GBD 2021) database for the world, China, and five sociodemographic index (SDI) regions. Age-standardized mortality and DALY rates for hypertension in the elderly population were calculated, and Joinpoint regression was used to assess trend changes of disease burden, with results reported as average annual percentage change (AAPC). Additionally, subgroup analyses were conducted based on age and sex. The impact of aging, population growth, and epidemiological changes on disease burden was analyzed using a threefactor decomposition method. Future projections for the disease burden from 2022 to 2040 were performed using a Bayesian model. Results From 1990 to 2021, both age-standardized mortality and DALYs rates for hypertension in the elderly population demonstrated a significant downward trend globally and in China (both AAPC values were negative, all P<0.001). However, in 2021, the number of deaths attributed to hypertension among the elderly increased by 68.37% globally and by 157.86% in China compared to 1990, while DALYs rose by 61.74% globally and 125.98% in China. Notably, except for the high SDI region, the other four SDI regions witnessed significant increases in deaths and DALYs due to hypertension in 2021 compared to 1990. Furthermore, the burden of hypertension was generally higher among elderly males than females in China. In 2021, the highest number of DALYs due to hypertension was observed in the 70-74 years group, while deaths were predominantly concentrated in the 80-84 years group. Decomposition analysis indicated that population growth was the primary factor contributing to the increases in deaths and DALYs due to hypertension among the elderly globally and in China. Predictive analysis suggested that the disease burden of hypertension among the elderly in China, encompassing overall, male, and female populations, is expected to continue rising from 2022 to 2040. Conclusion Although age-standardized mortality and DALY rates for hypertension among the elderly in China have shown a downward trend over the past three decades, the absolute burden remains substantial. There is an urgent need for the formulation and implementation of more effective public health policies and clinical interventions to address this critical public health challenge.
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