1990~2021年中国60岁及以上人群尿石症疾病负担变化趋势及预测分析

Trends and Projections of the Burden of Urolithiasis among Adults Aged 60 Years and Older in China, 1990~2021

摘要: 目的：分析1990~2021年中国60岁及以上人群尿石症的历史变化并预测未来趋势，评估防控效果及长期风险。方法：基于全球疾病负担研究(Global Burden of Disease, GBD)数据库，采用时间序列模型对发病率、患病率、伤残调整寿命年(Disability-Adjusted Life Years, DALYs)率及死亡率进行时序分析；通过分解分析探讨疾病负担变化驱动因素；运用自回归积分滑动平均(Autoregressive Integrated Moving Average, ARIMA)模型对未来进行预测。结果：1990~2021年，中国60岁及以上人群尿石症核心指标均呈持续下降态势：发病率从约5500/10万降至2000/10万，患病率从210/10万降至80/10万，DALYs率经高位波动后降至22/10万，死亡率于2000年后显著下降，2010年后降速趋缓；高龄组DALYs率绝对值仍较高。分解分析显示，人口增长是推动粗率上升的主要因素，老龄化效应整体贡献较小，部分指标呈负向作用，而流行病学效应是疾病负担改善的核心驱动力，且男性年龄别风险降幅更突出，女性增长主要源于人口基数扩大。ARIMA模型预测2022~2035年，四项指标总体预计维持相对平稳，预测区间呈窄幅波动，未见明显上升或反弹趋势。结论：中国老年人群尿石症负担通过防控与诊疗改善实现下降，未来将维持低位平稳状态，人口结构变化对总体下降趋势的影响相对有限；需持续关注高龄人群健康管理，巩固防控成果。

Abstract: Objective: To analyze the historical changes in the burden of urolithiasis among the population aged ≥ 60 years in China from 1990 to 2021 and to predict future trends, so as to evaluate the effectiveness of prevention and control measures and long-term risks. Methods: Based on the Global Burden of Disease (GBD) database, time series models were used to analyze trends in incidence rate, prevalence rate, disability-adjusted life years (DALYs) rate, and mortality rate. Decomposition analysis was performed to explore the driving factors underlying changes in disease burden, and the Autoregressive Integrated Moving Average (ARIMA) model was applied to project future trends. Results: From 1990 to 2021, all core indicators of urolithiasis among the population aged ≥ 60 years in China showed a sustained downward trend. The incidence rate declined from approximately 5500 per 100,000 to 2,000 per 100,000, and the prevalence rate decreased from 210 per 100,000 to 80 per 100,000. The DALYs rate declined to 22 per 100,000 after fluctuating at relatively high levels, while the mortality rate decreased markedly after 2000, with the rate of decline slowing after 2010. The absolute DALYs rate remained relatively high in the oldest age groups. Decomposition analysis showed that population growth was the main factor driving increases in crude rates, whereas the aging effect contributed relatively little overall and even showed negative effects for some indicators. In contrast, epidemiological changes were the main driver of the improvement in disease burden. The decline in age-specific risk was more pronounced in males, whereas the increase in females was mainly attributable to population expansion. ARIMA projections suggested that from 2022 to 2035, all four indicators were expected to remain relatively stable overall, with narrow fluctuations within the prediction intervals and no obvious upward or rebound trend. Conclusion: The burden of urolithiasis among the elderly population in China has declined as a result of improvements in prevention, control, and medical care, and is expected to remain at a relatively low and stable level in the future. Changes in population structure are likely to have only a limited impact on the overall downward trend. Continued attention should be paid to health management in the oldest age groups to consolidate existing prevention and control achievements.