我国艾滋病患者的死亡趋势及其相关危险因素分析

蔡畅; 汤后林; 李东民; 吕繁

Abstract

蔡畅,汤后林,李东民,吕繁.我国艾滋病患者的死亡趋势及其相关危险因素分析[J].Chinese journal of Epidemiology,2021,42(1):121-125

我国艾滋病患者的死亡趋势及其相关危险因素分析

Analysis on death trend in AIDS patients and related risk factors in China

Received:September 18, 2020

DOI：10.3760/cma.j.cn112338-20200918-01169

KeyWord: 艾滋病死亡趋势危险因素

English Key Word: AIDS Death Trend Risk factor

FundProject:国家科技重大专项（2018ZX10721-102-003-001）

Author Name	Affiliation	E-mail
Cai Chang	Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Tang Houlin	Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Li Dongmin	Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Lyu Fan	Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China	fanlv@chinaaids.cn

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Abstract:

目的描述我国报告艾滋病患者中死亡病例基本特征及其变化趋势，并研究导致死亡的危险因素，为艾滋病防治策略的制定提供线索和依据。方法从我国艾滋病防治基本信息系统下载数据库，筛选病程为"艾滋病"患者，描述其死亡数及死亡比例随时间变化趋势，并采用Cox比例风险模型分析死亡的相关危险因素。结果截至2019年12月31日，我国共报告艾滋病患者582 472例，死亡168 391例。死亡患者中男性占76.8%（129 343/168 391），传播途径以异性性传播为主，占60.9%（102 516/168 391），抗病毒治疗占54.0%（90 888/168 391），首次CD₄⁺T淋巴细胞计数（CD₄）P₂₅和P₇₅为34个/μl和240个/μl，发现感染后1年内死亡的比例为43.5%（73 191/168 391）。2007-2019年每年死亡病例从5 485例上升到18 737例，死亡比例从10.9%下降到4.3%。确证感染到死亡的平均时长逐年延长，从1.4年延长到4.0年。Cox比例回归模型分析结果显示，死亡风险的危险因素包括男性（HR=1.44）、年龄（50~和≥ 65岁的HR值分别为1.50和2.00）、少数民族（HR=1.10）、首次CD₄值较低组（0~、200~、350~个/μl组的HR值分别为2.73、1.33和1.13）、异性性传播（HR=1.64）和注射吸毒传播（HR=1.79）；死亡风险的保护因素包括文化程度（初中、高中及以上文化程度HR值分别为0.86、0.59）、抗病毒治疗（HR=0.09）。结论我国艾滋病患者死亡数2007-2019年逐年上升，死亡比例逐年下降，应继续开展早发现、早治疗，提升抗病毒治疗效果，降低死亡比例。

English Abstract:

Objective To understand the basic characteristics of death cases, analyze the death trends in AIDS patients and the risk factors in China and provide evidence for the development of AIDS prevention and control strategy. Methods The data were collected from the national basic information system of HIV/AIDS. The information of the cases in AIDS phase were used. The death number and mortality trends in AIDS cases were described, and Cox Proportion Hazards Regression Model was constructed to assess hazard ratios (HR) for independent variables. Results By the end of 2019, a total of 582 472 AIDS cases, including 168 391 deaths, had been reported in China. Among the death cases, males accounted for 76.8% (129 343/168 391), heterosexual contact was the main transmission route, accounting for 60.9% (102 516/168 391). The proportion of the death cases who had ever received ART was 54.0% (90 888/168 391). The inter-quartile (P₂₅, P₇₅) of first CD₄⁺T cells counts (CD₄) was 34 cells/μl, 240 cells/μl. Up to 43.5% (73 191/168 391) of the deaths occurred within one year after diagnosis. From 2007 to 2019, the annual death number increased from 5 485 to 18 737, the mortality rates decreased form 10.9%% to 4.3%. The average time interval from diagnosis to death ranged from 1.4 year to 4.0 years, showing increase trend by year. The results of Cox regression analysis showed that older age (50-years old:HR=1.50; ≥ 65 years old:HR=2.00), being male (HR=1.44)、being in minority ethnic group (HR=1.10), having lower first CD₄ levels (0-cells/μl, HR=2.73;200-cells/μl, HR=1.33; 350-cells/μl,HR=1.13), heterosexual transmission route (HR=1.64) and injecting drug use (HR=1.79) were the risk factors related to deaths in AIDS patients. The higher educational levels (junior middle school:HR=0.86, senior high school and above:HR=0.59) and receiving antiviral treatrment (HR=0.09) were protective factors. Conclusions The number of death cases increased, meanwhile the mortality rates decrease year by year in AIDS patients in China during 2007-2019. It is necessary to strengthen the early detection and treatment of AIDS to reduce the mortality.

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