美国肺炎与脑血管疾病死亡率的趋势与差异（1999-2020年）

文献信息

中文摘要

背景： 肺炎是脑血管疾病（CVD）常见且常致命的并发症。自20世纪90年代末以来，卒中诊疗已有显著改善，但涉及这两种疾病的死亡的国家趋势及其在人口学和地理群体中的分布尚未被描述。
方法： 我们使用美国疾病控制与预防中心流行病学研究广泛在线数据（CDC WONDER）多死因档案，识别1999年至2020年间死亡的55岁及以上美国死者，其死因中同时记录有肺炎（ICD-10编码J18.0、J18.1、J18.2、J18.8和J18.9）和CVD（I60-I69）。每10万人口的年龄调整死亡率（AAMR）以2000年美国人口进行标准化。Joinpoint回归估计总体及按性别、年龄组、种族和民族、城市化程度和人口普查地区分层的年度百分比变化（APC）和平均年度百分比变化（AAPC）。对总体序列的敏感性分析使用了更广泛的肺炎定义（J12-J18）。
结果： 我们识别出316,760例涉及这两种疾病的死亡。总体AAMR从1999年的每10万45.4降至2019年的9.1（下降80.0%），并在2020年升至15.8（较2019年率高出73.6%）；1999年至2020年的AAPC为-5.09%（95%置信区间[CI] -5.92至-4.26）。每个分层在整个时期均显示净下降，并在2020年出现上升。男性、75岁及以上成人以及非都市县在整个期间率均较高，且除2017年外，非西班牙裔黑人成人在每一年均最高。随着总体率下降，各组之间的绝对差异缩小。2020年的相对增幅在非西班牙裔美洲印第安人或阿拉斯加原住民（160%）、西班牙裔（144%）和非西班牙裔黑人（115%）成人以及55-74岁成人（97%）中最大。更广泛的肺炎定义增加了15,521例死亡（4.9%），并产生相同的joinpoint和相似的AAPC（-4.89%）。
结论： 涉及肺炎和CVD的死亡在1999年至2019年间下降约80%，并在2020年急剧上升，与COVID-19大流行同时发生。按性别、年龄、种族和民族以及城市化程度的差异持续存在，且2020年的增加在若干少数群体中比例更大。这些汇总的死亡证明数据描述了模式，但无法确定其原因。需要具有个体水平临床数据的研究来检验吞咽困难筛查、疫苗接种和感染预防是否能解释长期下降和这些差异。

英文摘要

BACKGROUND: Pneumonia is a frequent and often fatal complication of cerebrovascular disease (CVD). Stroke care has improved considerably since the late 1990s, but national trends in deaths involving both conditions and their distribution across demographic and geographic groups have not been described.
METHODS: We used the Centers for Disease Control and Prevention Wide Ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death files to identify United States decedents aged 55 years and older who died between 1999 and 2020 with pneumonia (ICD-10 codes J18.0, J18.1, J18.2, J18.8, and J18.9) and CVD (I60-I69), both recorded among the causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 populations were standardized to the 2000 United States population. Joinpoint regression estimated the annual percent change (APC) and average annual percent change (AAPC) overall and by sex, age group, race and ethnicity, urbanization, and census region. A sensitivity analysis of the overall series used a broader pneumonia definition (J12-J18).
RESULTS: We identified 316,760 deaths involving both conditions. The overall AAMR fell from 45.4 per 100,000 in 1999 to 9.1 in 2019 (80.0% decrease) and rose to 15.8 in 2020 (73.6% above the 2019 rate); the AAPC for 1999 to 2020 was -5.09% (95% confidence interval [CI] -5.92 to -4.26). Every stratum showed a net decline over the full period and an increase in 2020. Rates were higher throughout in men, in adults aged 75 years, and older and in nonmetropolitan counties and were highest in non-Hispanic Black adults in every year except 2017. Absolute differences between groups narrowed as overall rates fell. The relative increase in 2020 was largest in non-Hispanic American Indian or Alaska Native (160%), Hispanic (144%), and non-Hispanic Black (115%) adults and in adults aged 55-74 years (97%). The broader pneumonia definition added 15,521 deaths (4.9%) and produced the same joinpoints and a similar AAPC (-4.89%).
CONCLUSION: Deaths involving pneumonia and CVD fell by about 80% between 1999 and 2019 and rose sharply in 2020, coinciding with the COVID-19 pandemic. Disparities by sex, age, race and ethnicity and urbanization persisted, and the 2020 increase was proportionally larger in several minority groups. These aggregate certificate data describe patterns but cannot identify their causes. Studies with individual-level clinical data are needed to test whether dysphagia screening, vaccination, and infection prevention explain the long-term decline and the disparities.