收稿日期: 2025-01-28
录用日期: 2025-06-09
网络出版日期: 2025-06-25
基金资助
国家自然科学基金(82070740);国家自然科学基金(81700647);国家自然科学基金(81870492);国家重点研发计划(2016YFC1305402);苏州市科技计划项目(SKYD2022017);国家重点基础研究发展计划（973计划）重点项目(2012CB517700)
Global and Chinese burden of chronic kidney disease due to type 2 diabetes and associated risk factors from 1990 to 2021
Received date: 2025-01-28
Accepted date: 2025-06-09
Online published: 2025-06-25
目的：评估1990年至2021年间，全球及中国不同年龄、性别、区域和社会人口指数（socio-demographic index，SDI）人群中2型糖尿病（type 2 diabetes，T2D）导致的慢性肾脏病（chronic kidney disease，CKD）（CKD-T2D）的疾病负担。方法：基于2021年全球疾病负担研究（Global Burden of Disease Study，GBD）数据，分析204个国家和地区的CKD-T2D发病率、患病率、死亡率和伤残调整寿命年（disability-adjusted life years，DALYs），计算绝对数值及其95%不确定性区间（uncertainty interval，UI）。结果：1990年至2021年间，全球CKD-T2D的疾病负担显著增加，2021年新发病例达2 012 024例（95% UI为1 857 800~2 154 288），较1990年增长167.2%（95%UI为153.5%~182.6%），年龄标准化发病率（age-standardized incidence rate，ASIR）为23.07/10万[95%UI为（21.40~24.72）/10万]，较1990年上升21.0%（95%UI为15.0%~27.5%）。区域分析显示，北非和中东地区CKD-T2D的ASIR较高（42.802/10万）。相比于1990年，2021年中国的CKD-T2D发病人数显著增加，达354 157例（95% UI为321 265~382 784）粗发病率增长177.6%（95%UI为154.8%~205.5%），ASIR仅微升7.8%[95%UI为（-0.1%）~17.8%]；其余指标的粗率增长，而年龄标准化率（age-standardized rate，ASR）下降。2021年，全球65~74岁人群的CKD-T2D发病最高[65~69岁人群新发364 163例（95%UI为272 571~475 468例），70~74岁人群新发366 045例（95%UI为286 728~459 891例）]，其中男性负担高于女性[65~69岁，男性新发187 097例（95%UI为140 064~243 571例），女性新发177 066例（95%UI为132 338~231 769例）；70~74岁，男性新发187 216例（95%UI为146 377~234 997例），女性新发178 830例（95%UI为140 938~224 801例）]。SDI分层显示，在1990年至2021年间，高SDI地区CKD-T2D的ASIR最高，且持续上升；而低SDI地区的CKD-T2D死亡率最高，且改善有限。高血糖、肥胖、高热量饮食和高血压是CKD-T2D的主要危险因素。结论：CKD-T2D仍是重大公共卫生问题，中低收入国家及老年、男性群体的疾病负担突出。中国的粗率攀升，但年龄标准化死亡率（age-standardized mortality rates，ASMR）和DALYs下降。
史曼曼 , 马毓华 , 郑金鑫 , 柯燕容 , 王语欣 , 刘剑 , 王伟铭 . 1990年至2021年全球及中国2型糖尿病导致的慢性肾脏病疾病负担及危险因素分析[J]. 诊断学理论与实践, 2025 , 24(03) : 268 -278 . DOI: 10.16150/j.1671-2870.2025.03.005
Objective To assess the burden of chronic kidney disease (CKD) caused by type 2 diabetes (T2D) (CKD-T2D) among populations of different ages, genders, regions, and socio-demographic index (SDI) levels globally and in China from 1990 to 2021. Methods Based on data from the 2021 Global Burden of Disease Study (GBD), incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of CKD-T2D in 204 countries and regions were analyzed, with absolute numbers and their 95% uncertainty intervals (UIs) calculated. Results From 1990 to 2021, the global burden of CKD-T2D increased significantly. In 2021, there were 2 012 024 (95%UI: 1 857 800-2 154 288) new cases, marking a 167.2% (95%UI: 153.5%-182.6%) increase from 1990. The age-standardized incidence rate (ASIR) reached 23.07 per 100 000 (95%UI: 21.40-24.72), an increase of 21.0% (15.0%-27.5%) since 1990. Regional analysis showed that North Africa and the Middle East had the highest ASIR (42.802 per 100 000). Compared to 1990, China's CKD-T2D incidence rose significantly to 354,157 cases (95%UI: 321 265-382 784), with crude incidence increasing by 177.6% (95%UI: 154.8%- 205.5%) and ASIR rising slightly by 7.8% [95%UI: (-0.1%) to 17.8%]. For other indicators, crude rates increased whereas age-standardized rates declined. In 2021, CKD-T2D incidence was highest among people aged 65-74 worldwide [364 163 new cases in ages 65-69 (95%UI: 272 571-475 468) and 366 045 in ages 70-74 (95%UI: 286 728-459 891)], with males bearing a higher burden than females [65-69: males 187 097 (95%UI: 140 064-243 571), females 177 066 (95%UI: 132 338-231 769); 70-74: males 187 216 (95%UI: 146 377-234 997), females 178 830 (95%UI: 140 938-224 801)]. SDI stratification indicated that from 1990 to 2021, high-SDI regions had the highest ASIR with a continuous upward trend, while low-SDI regions had the highest mortality rates with limited improvement. Hyperglycemia, obesity, high-calorie diets, and hypertension were the main risk factors for CKD-T2D. Conclusion CKD-T2D remains a major public health issue, with a particularly high disease burden among elderly males and in low- and middle-income countries. While crude rates have risen in China, age-standardized mortality rate (ASMR) and DALYs have declined.
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