[Mortality trend of chronic respiratory diseases in China, 1990-2019].

Objective: To analyze mortality and its trend of chronic respiratory diseases (CRD) in China from 1990 to 2019. Methods: Based on the provincial results of China from the 2019 Global Burden of Disease (GBD) study, the average annual percent change (AAPC) of standardized mortality rates of different CRDs were analyzed by using Joinpoint 4.8.0.1, and the age-standardized mortality rate of CRD was calculated by using the GBD 2019 world standard population. Based on the comparative risk assessment theory of GBD, the attributable deaths due to 12 CRD risk factors were estimated, including smoking, indoor air pollution, occupational gas exposure, particulates and smog exposure, environmental particulate pollution, low temperature, passive smoking, ozone pollution, occupational exposure to silica, occupational asthma, high body mass index, high temperature and occupational exposure to asbestos. Results: From 1990 to 2019, the number of deaths and standardized mortality of chronic obstructive pulmonary disease (COPD) showed a downward trend (P<0.001). The number of COPD deaths decreased from 1 244 000 (912 000 - 1 395 000) in 1990 to 1 037 000 (889 000 - 1 266 000) in 2019. AAPC=-0.9% (95%CI: -1.5% - -0.3%), P<0.001; The standardized mortality rate decreased from 217.9/100 000 (163.3/100 000 - 242.0/100 000) in 1990 to 65.2/100 000 (55.5/100 000 - 80.1/100 000) in 2019. AAPC= -4.2% (95%CI:-5.2% - -3.2%), P<0.001. The number of deaths from asthma decreased from 40 000 (30 000 - 58 000) in 1990 to 25 000 (20 000 - 31 000) in 2019. AAPC=-2.0% (95%CI: -2.6% - -1.4%), P<0.001; The standardized mortality rate of asthma decreased from 6.4/100 000 (4.7/100 000 - 9.5/100 000) in 1990 to 1.5/100 000 (1.2/100 000 - 1.9/100 000) in 2019. AAPC=-5.1% (95%CI: -5.8% - -4.4%), P<0.001. The number of pneumoconiosis deaths decreased from 11 000 (8 000 - 14 000) in 1990 to 10 000 (8 000 - 14 000) in 2019, AAPC=-0.2%(95%CI:-0.4% - 0.1%), P=0.200; The standardized mortality rate of pneumoconiosis decreased from 1.4/100 000 (1.0/100 000 - 1.7/100 000) in 1990 to 0.5/100 000 (0.4/100 000 - 0.7/100 000) in 2019. AAPC=-3.1% (95%CI: -3.4% - -2.8%), P<0.001. The number of deaths from pulmonary interstitial diseases and pulmonary sarcoidosis increased from 3 000 (3 000 - 6 000) in 1990 to 8 000 (6 000 - 10 000) in 2019, AAPC=3.5% (95%CI: 2.7% - 4.2%), P<0.001; The corresponding standardized mortality rate changed little from 1990 to 2019, and AAPC was not statistically significant.The age-standardized mortality rates of different CRDs were higher in men than those in women. In 1990 and 2019, the mortality rates of COPD, asthma, pneumoconiosis and interstitial pulmonary disease and pulmonary sarcoidosis increased with age. In 2019, the population attributable fractions (PAFs) for smoking, environmental particulate pollution, occupational gas exposure, particulate and smog exposure, low temperature exposure and passive smoking were 71.1% (68.0% - 74.3%), 24.7% (20.1% - 30.0%), 19.3% (13.0% - 25.4%), 15.7% (13.6% - 18.3%) and 8.8% (4.5% - 13.1%) respectively in men, and the PAFs for environmental particulate pollution, smoking, low temperature exposure, occupational gas exposure, particulate and smog exposure, and passive smoking were 24.1% (19.6% - 29.3%), 21.9% (18.7% - 25.2%), 16.4% (14.0% - 19.2%), 15.6% (10.2% - 21.1%) and 14.7% (7.9% - 21.3%) respectively in women. Conclusions: During 1990-2019, the overall death level of CRD decreased significantly in China, but it is still at high level in the world. Active prevention and control measures should be taken to reduce the death level caused by CRD.目的： 分析1990-2019年我国慢性呼吸系统疾病（CRD）死亡情况及其变化趋势。 方法： 利用2019年全球疾病负担（GBD）中国分省研究结果，采用GBD2019世界标准人口对CRD死亡率进行标化，应用Joinpoint 4.8.0.1软件计算各类CRD死亡人数及标化死亡率的平均年度变化百分比（AAPC），基于GBD比较风险评估理论估计吸烟、室内空气污染、职业性气体、微粒和烟雾、环境颗粒物污染、低温、被动吸烟、臭氧污染、职业性接触二氧化硅、职业性哮喘、高体质指数（BMI）、高温和职业性接触石棉12个CRD危险因素的归因死亡数。 结果： 1990-2019年慢性阻塞性肺病（COPD）死亡人数和标化死亡率呈下降趋势（P<0.001），死亡人数从1990年的124.4万（91.2万~139.5万）例降至2019年的103.7万（88.9万~126.6万）例，AAPC=-0.9%（95%CI：-1.5%~-0.3%），P<0.001；标化死亡率从1990年的217.9/10万（163.3/10万~242.0/10万）降至2019年的65.2/10万（55.5/10万~80.1/10万），AAPC=-4.2%（95%CI：-5.2%~-3.2%），P<0.001。支气管哮喘死亡人数从1990年的4.0万（3.0万~5.8万）例降至2019年的2.5万（2.0万~3.1万）例，AAPC=-2.0%（95%CI：-2.6%~-1.4%），P<0.001；标化死亡率从1990年的6.4/10万（4.7/10万~9.5/10万）降至2019年的1.5/10万（1.2/10万~1.9/10万），AAPC=-5.1%（95%CI：-5.8%~-4.4%），P<0.001。尘肺死亡人数从1990年的1.1万（0.8万~1.4万）例降至2019年的1.0万（0.8万~1.4万）例，AAPC=-0.2%（95%CI：-0.4%~0.1%），P=0.200；标化死亡率从1990年的1.4/10万（1.0/10万~1.7/10万）降至2019年的0.5/10万（0.4/10万~0.7/10万），AAPC=-3.1%（95%CI：-3.4%~-2.8%），P<0.001；肺间质性疾病和肺结节病死亡人数从1990年的0.3万（0.3万~0.6万）例增至2019年的0.8万（0.6万~1.0万）例，AAPC=3.5%（95%CI：2.7%~4.2%），P<0.001；标化死亡率在1990-2019年变化不大，AAPC无统计学意义。不同种类CRD标化死亡率均为男性高于女性。1990年与2019年，COPD、支气管哮喘、尘肺、肺间质性疾病和肺结节病的死亡率均随年龄的增加呈上升趋势。2019年我国男性CRD死亡可归因于吸烟、环境颗粒物污染、职业性气体、微粒和烟雾、低温和被动吸烟的人群归因分值（PAF）分别为71.1%（68.0%~74.3%）、24.7%（20.1%~30.0%）、19.3%（13.0%~25.4%）、15.7%（13.6%~18.3%）和8.8%（4.5%~13.1%），女性可归因于环境颗粒物污染、吸烟、低温、职业性气体、微粒和烟雾和被动吸烟的PAF分别为24.1%（19.6%~29.3%）、21.9%（18.7%~25.2%）、16.4%（14.0%~19.2%）、15.6%（10.2%~21.1%）和14.7%（7.9%~21.3%）。 结论： 1990-2019年中国CRD的总体死亡水平明显降低，但在全球仍处于较高水平，需采取积极防控措施降低CRD的死亡水平。.