背景:抑郁症是全球残疾和健康状况不佳的主要原因,预计到2030年将在全球排名第一。本研究的目的是通过利用全球疾病负担(GBD)数据库和Joinpoint回归模型,分析中国和各个收入水平国家的抑郁症负担的转变和趋势。此分析旨在了解不同收入地区抑郁症负担的变化,并评估其发展模式。
方法:基于GBD2019开放数据集,这项研究提取了YLD(残疾寿命年)的数据,DALY(残疾调整寿命年),与抑郁症相关的发病率。分析的重点是1990年至2019年,涵盖全球数据,区分高收入、中上收入,中低收入,低收入国家,和中国。我们利用Joinpoint回归模型拟合了不同收入水平国家之间的时空趋势变化。进行了成对比较,以检查并行性,并确定各个地区之间趋势变化的差异是否具有统计学意义。
结果:从1990年到2019年,女性抑郁症的年龄标准化YLD和DALY高于男性。抑郁症男性的YLD总变化率高于女性。中国在性别之间的总YLD变化率方面表现出最大的差距,达到0.08在1990年至2019年期间,2005-2019年中高收入国家女性抑郁症的发病率增加,低收入国家,与1990-2005年相比,中国。值得注意的是,中国女性发病率增加最多(从-0.4%增加到0.84%)。此时期中国抑郁症患者的YLD变化最为显著(AAPC=0.45,95%CI=0.41,0.48,P<0.01)。与全球相比,中国的YLD/发病率更高,HIC,UMCs,LMC,和LIC。在中国,YLD/抑郁症的发病率在1994年开始上升,在2010年左右达到峰值,然后逐渐下降.自2010年以来,中国抑郁症DALYs的增长率一直高于全球平均水平,高收入国家,中上收入国家,中低收入国家,和低收入国家。HLC的DALY的AAPC值最高(AAPC=0.24,95%CI=0.22,0.25,P<0.01)。UMCs,与其他地区相比,AAPC发生率最高(AAPC=0.48,95%CI=0.46,0.50,P<0.01)。
结论:鉴于不同收入水平国家的抑郁症负担存在显著差异,未来旨在减轻抑郁症负担的战略应根据每个国家的具体需求和发展阶段采用量身定制的差异化方法。
BACKGROUND: Depression is a leading cause of disability and poor health worldwide and is expected to rank first worldwide by 2030. The aim of this study is to analyze the transition and trend of depression
burden in
China and various income-level countries by utilizing the Global
Burden of Disease (GBD) database and the Joinpoint regression model. This analysis seeks to comprehend the variations in the
burden of depression across different income regions and evaluate their developmental patterns.
METHODS: Based on the GBD 2019 open dataset, this study extracted data on YLD (Years Lived with Disability), DALY (Disability-Adjusted Life Years), and incidence related to depression. The analysis focused on the period between 1990 and 2019, covering global data and distinguishing between high-income, upper-middle-income, lower-middle-income, low-income countries, and China. We utilized the Joinpoint regression model to fit the spatiotemporal trend changes among different income-level countries. Pairwise comparisons were conducted to examine the parallelism and to determine if the differences in trend changes among various regions were statistically significant.
RESULTS: From 1990 to 2019, the age-standardized YLD and DALY for depression female were higher than that in male. The YLD total change rate of depression men was higher than that of women. China exhibited the largest disparity in total YLD change rates between genders, reaching 0.08. During 1990 to 2019, the incidence of depression in 2005-2019 increased among females in middle to high-income countries, low-income countries, and China as compare to that of 1990-2005. Notably, China shown the most increase the incidence rate of females (from -0.4 % to 0.84 %). China experienced the most significant change in the YLD of depression during this period (AAPC = 0.45, 95 % CI = 0.41, 0.48, P < 0.01). China\'s YLD/Incidence rate was higher compared to the global, HICs, UMCs, LMCs, and LICs. In China, the YLD/incidence rate of depression began to rise in 1994, peaking around 2010, and then gradually declining. Since 2010, the growth rate of depression DALYs in China has been higher than the global average, high-income countries, upper-middle-income countries, lower-middle-income countries, and low-income countries. The DALY\'s AAPC value for the HLCs was the highest (AAPC = 0.24, 95 % CI = 0.22, 0.25, P < 0.01). The UMCs, in comparison to other regions, incidence rate had the highest AAPC value (AAPC = 0.48, 95 % CI = 0.46, 0.50, P < 0.01).
CONCLUSIONS: Given the significant variations in the
burden of depression across countries with different income levels, future strategies aimed at reducing the
burden of depression should adopt tailored and differentiated approaches according to each country\'s specific needs and developmental stages.