Objective: To examine the trend of burden on ischemic heart disease (IHD) and epidemiological transition on related risk factors among the Chinese population from 1990 to 2017. Methods: Based on open access data from the Global Burden of Disease (GBD) 2017 Study, we used years of life lost (YLD), years lived with disability (YLL), and disability-adjusted of life years (DALY) to describe the changes of IHD burden stratified by different sex and age groups from 1990 to 2017. We applied population-attributable faction (PAF) to analyze the burden attributable to risk factors and epidemiological transition. Results: In 2017, rates on YLD, YLL, and DALY for IHD were 74.2/100 000, 2 459.6/100 000, and 2 523.1/100 000, respectively. DALY rate and YLL rate for IHD in males were invariably higher than those in females except for YLD rate in females. 24 modifiable risk factors were causally associated with IHD. The top five risk factors that influencing DALYs, PAF, and DALY rate in 2017 appeared as: high blood pressure (16.429 million person years, 54.6%, 1 163.1/100 000), high LDL cholesterol (13 941 million person years, 46.3%, 987.0/100 000), diet high in sodium (10.900 million person years, 36.2%, 771.1/100 000), smoking (8.647 million person years, 28.7%, 612.2/100 000), and low-nut diet (7.452 million person years, 24.8%, 527.6/100 000). DALY rate for IHD showed an increase of 90.9%, from 1 116.4/100 000 in 1990 to 2 131.0/100 000 in 2017. Compared with 1990, the YLD rate experienced an evident increase in those aged 15-49 and over 70, in 2017. Annual average growth rate of YLD rate was higher in the ≥70 age group, between 2007 and 2017 (0.4%) than that between 1990 and 2007 (0.2%). The annual average increasing rates of both YLL and DALY were much lower from 2007 to 2017 (0.6%, 0.6%) than those from 1990 to 2007 (1.3%, 1.2%). From 1990 to 2017, DALYs attributed to meaty food (929.7%), beverages with high sugar content (822.7%), and high body-mass index (327.3%) experienced the highest increase. The largest increase in PAF occurred for beverages with high sugar content (400.0%). DALY rates increased for the 8 risk factors whereas decreased on the 7 risk factors, in consecutive rankings between 2007 and 2017. Conclusions: Despite the fact that burden on IHD-caused premature death had been reducing, related disabilities remain challenging with IHD the leading cause of burden, particularly in the ≥70 year-olds. Higher IHD burden from premature death was seen in males but disability appeared higher in females. It is significantly important to strengthen programs on prevention and control for hypertension including reducing modifiable risk factors such as smoking, unreasonable diet habits.
目的： 探讨1990-2017年中国人群缺血性心脏病（IHD）疾病负担及其危险因素的变化趋势。 方法： 基于2017年全球疾病负担（GBD）中国研究开放数据，利用伤残损失寿命年（YLD）、早死损失寿命年（YLL）、伤残调整寿命年（DALY）等指标对1990-2017年中国不同性别和年龄人群IHD疾病负担变化趋势进行描述，并结合人群归因分值（PAF）分析IHD危险因素的变化情况。 结果： 2017年，IHD的YLD率、YLL率、DALY率分别为74.2/10万、2 057.2/10万、2 131.0/10万。YLD率为女性高于男性，YLL率和DALY率则为男性高于女性。与IHD有关的24种可改变危险因素中，导致DALYs、PAF、DALY率排名前5位的危险因素均为高血压（1 642.9万人年、54.6%、1 163.1/10万）、高LDL-C（1 394.1万人年、46.3%、987.0/10万）、钠摄入过多（1 090.0万人年、36.2%、771.1/10万）、吸烟（864.7万人年、28.7%、612.2/10万）、坚果摄入不足（745.2万人年、24.8%、527.6/10万）。IHD DALY率由1990年1 116.4/10万增至2017年2 131.0/10万，增长率为90.9%。与1990年相比，2017年15~49岁和≥70岁人群IHD的YLD率增加，且≥70岁人群YLD率的2007-2017年年均增长率（0.4%）高于1990-2007年年均增长率（0.2%）。但YLL率和DALY率的2007-2017年年均增长率（0.6%、0.6%）低于1990-2007年年均增长率（1.3%、1.2%）。与1990年相比，2017年归因于加工肉摄入过多（929.7%）、高糖饮料摄入过多（822.7%）、高BMI（327.3%）的DALYs增幅较大；PAF值增幅最大的为高糖饮料摄入过多（400.0%）。2007-2017年，有8种IHD危险因素的DALY率顺位上升，7种危险因素的DALY率顺位下降。 结论： IHD所致伤残负担增大，尽管其所致的过早死亡得到了有效控制，但仍为疾病负担的主要来源，≥70岁人群中表现尤为明显。IHD对男性患者的影响主要为早死所致疾病负担，对女性主要为失能所致负担。加强对高血压的预防和控制、减少吸烟和改善不合理膳食习惯等行为危险因素是防控IHD的优先措施。.
Keywords: Burden of disease; Disability-adjusted of life years; Ischemic heart disease; Risk factors.