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Received:July 03, 2025 Published Online:May 22, 2026
Received:July 03, 2025 Published Online:May 22, 2026
中文摘要: 目的 基于2021年全球疾病负担研究（GBD 2021）数据，旨在量化1990—2021年40~64岁早发性痴呆症的时空分布特征，预测至 2050 年的疾病发展态势，并识别健康不平等与可干预危险因素。方法 整合 GBD2021数据库中204个国家/地区的流行病学数据，采用年龄标准化率、连接点回归模型及贝叶斯年龄-时期-队列模型（BAPC），分析发病率、患病率、死亡率及伤残调整生命年（DALYs）的长期趋势。通过分解法评估人口增长、老龄化与流行病学变化的贡献，并利用不平等斜率指数和集中指数量化社会人口学指数（SDI）相关的健康不平等。结果 1990—2021年，全球早发性痴呆症的年龄标准化发病率（ASIR）、年龄标准化患病率（ASPR）及年龄标准化DALYs率（ASR-DALYs）的估计年度百分比变化（EAPC）（EAPC of ASIR=0.17、EAPC of ASPR=0.08及EAPC of ASR-DALYs=0.07）持续上升，55~59岁人群负担增速最显著（EAPC of ASIR=1.52）。女性发病率高于男性（69.27/10万 vs 57.69/10万），但男性增速更快（年均增速为女性的1.6倍）。中高SDI地区（如东亚、东南亚）的发病率（70.57/10万）与患病率（387.58/10万）最高且增速最快（EAPC of ASIR=0.30和EAPC of ASPR=0.21），而低SDI地区死亡率与ASR-DALYs的相对不公平加剧。危险因素存在性别差异：女性以高空腹血糖（FPG）和高身体质量指数（BMI）为主，男性以吸烟及高FPG 为主。预测显示，至2050年全球发病率与患病率将分别升至76.92/10万和403.95/10万。结论 本研究揭示了早发性痴呆症的全球性增长趋势与健康不平等格局，强调需加强中高SDI地区高危人群的代谢健康管理，扩展可干预危险因素监测（如教育、生活方式），并提升低SDI地区的疾病诊断能力，以减轻未来疾病负担，促进健康公平。
Abstract:Objective Based on the 2021 Global Burden of Disease Study（GBD 2021）data，this study aims to quantify the spatiotemporal distribution characteristics of early-onset dementia among individuals aged 40-64 from 1990 to 2021，predict the disease development trend up to 2050，and identify health inequalities and modifiable risk factors.Methods Integrating epidemiological data from 204 countries/regions in the GBD 2021 database，the long-term trends of incidence，prevalence，mortality，and disability-adjusted life years（DALYs）were analyzed using age-standardized rates，joinpoint regression models，and Bayesian age-period-cohort（BAPC）models. The contribution of population growth，aging and epidemiological changes was evaluated by decomposition analysis，and the socio-demographic index（SDI）related health inequality was quantified by slope index of inequality and concentration index. Results From 1990 to 2021，the estimated annual percentage changes（EAPC）of the age-standardized incidence rate（ASIR），age-standardized prevalence rate（ASPR），and age-standardized DALYs rate（ASR-DALYs）for early-onset dementia worldwide continued to rise（EAPC of ASIR = 0.17，EAPC of ASPR = 0.08，and EAPC of ASR-DALYs=0.07），with the most significant increase in burden observed among people aged 55-59（EAPC of ASIR = 1.52）. Women had higher incidence rates compared to men（69.27/100 000 vs 57.69/100 000），but men showed a faster growth rate（with an average annual growth rate 1.6 times that of women）. Middle-high SDI regions（e.g.，East Asia and Southeast Asia）reported the highest incidence（70.57/100 000）and prevalence（387.58/100 000）with rapid increases（EAPC of ASIR=0.30 and EAPC of ASPR=0.21），while low SDI regions faced widening relative inequalities in mortality and ASR-DALYs. Risk factors demonstrated gender specificity：high fasting plasma glucose（FPG）and high body mass index（BMI）dominated in women，whereas smoking and high FPG jointly influenced men. Projections indicated that global incidence and prevalence would rise to 76.92/100 000 and 403.95/100 000 by 2050，respectively. Conclusion This study reveals the global increasing trend of early-onset dementia and the patterns of health inequality，emphasizing the need to strengthen metabolic health management for high-risk populations in middle-high SDI regions，expand surveillance of modifiable risk factors（such as education and lifestyle），and improve disease diagnostic capacity in low SDI regions，in order to reduce the future disease burden and promote health equity.
keywords: Global Burden of Disease Study Health inequality analysis Future trend Risk factors Early-onset dementia
文章编号： 中图分类号：R181.3+2 文献标志码：A
基金项目:福建省科技计划科技创新平台项目（2022Y2017）；中国卒中学会脑血管病全程管理启航基金（2020017）
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