1990~2021年心房颤动/扑动流行病学及其危险因素分析：基于2021年中国全球疾病负担研究与孟德尔随机化研究的系统分析

doi:10.12122/j.issn.1673-4254.2025.10.14

南方医科大学学报 ›› 2025, Vol. 45 ›› Issue (10): 2182-2190.doi: 10.12122/j.issn.1673-4254.2025.10.14

• • 上一篇

1990~2021年心房颤动/扑动流行病学及其危险因素分析：基于2021年中国全球疾病负担研究与孟德尔随机化研究的系统分析

马会华¹^,²^,³, 闫奎坡¹^,²(), 刘刚¹^,², 徐亚洲¹^,², 张磊¹^,², 李一卓¹^,²

^1.河南中医药大学第一附属医院心脏中心//国家区域（中医）心血管诊疗中心，河南郑州 450000
^2.中西医防治重大疾病河南省协同创新中心，河南郑州 450000
^3.河南中医药大学第一临床医学院，河南郑州 450000

收稿日期:2025-06-23 出版日期:2025-10-20 发布日期:2025-10-24
通讯作者: 闫奎坡 E-mail:ykp19821122@163.com
作者简介:马会华，在读硕士研究生，E-mail: 17790065627@163.com
基金资助:
河南省中医药科学研究专项课题(2016ZY3003);河南省中医药科学研究专项课题(2022JDZX106);河南省中医药科学研究专项课题(2017ZY2017)

Epidemiology of atrial fibrillation/atrial flutter and its risk factors from 1990 to 2021: a systematic analysis and Mendelian randomization study based on the China and Global Burden of Disease Study 2021

Huihua MA¹^,²^,³, Kuipo YAN¹^,²(), Gang LIU¹^,², Yazhou XU¹^,², Lei ZHANG¹^,², Yizhuo LI¹^,²

^1.Department of Cardiovascular Disease, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450000, China
^2.Collaborative Innovation Center of Prevention and Treatment of Major Diseases by Chinese and Western Medicine, Zhengzhou 450000, China
^3.First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou 450000, China

Received:2025-06-23 Online:2025-10-20 Published:2025-10-24
Contact: Kuipo YAN E-mail:ykp19821122@163.com

摘要/Abstract

摘要：

目的分析1990~2021年中国和全球心房颤动/扑动（AF/AFL）疾病负担及其危险因素的变化情况，为我国AF/AFL制定有效的预防措施。方法基于GBD 2021数据库提供的1990~2021年204个国家或地区及全球的不同性别和不同年龄组中AF/AFL负担各项指数并进行标准化处理，使用joinpoint计算平均年百分比变化（AAPC）分析AF/AFL的趋势；此外，研究分析AF/AFL的发病率、患病率、死亡率和伤残调整寿命年（DALYs）来衡量AF/AFL的负担。最后分析AF/AFL的风险因素，并进一步采用孟德尔随机化分析验证其结果。结果 1990~2021年，中国AF/AFL年龄标准化发病率（ASIR）从42.63/10万上升至44.93/10万，而全球呈下降趋势。中国AF/AFL年龄标准化死亡率（ASMR）从4.93/10万下降至4.33/10万，全球从4.24/10万上升到4.36/10万。中国AF/AFL年龄标准化DALY率（ASDR）从93.29/10万下降至93.29/10万，全球从100.81/10万增加至101.40/10万。中国及全球年龄和性别对AF/AFL负担影响存在显著差异（P<0.05）。男性ASIR与ASDR高于女性，但是女性ASMR与ASDR高于男性。中国AF/AFL发病率与患病率高于全球水平，但死亡率与DAYL率低于全球水平。在2021年，AF/AFL主要危险因素为高收缩压、高BMI、吸烟、酗酒、高钠饮食及低温等。除高收缩压外，吸烟是男性的重要因素，而女性主要则在于高体重指数的危险。结论中国AF/AFL发病与患病人数显著增加，人口基数大和老龄化问题成为重要公共卫生挑战；此外，居民应保持健康生活习惯，戒烟限酒，低钠饮食，定期筛查，早发现早治疗。

关键词: 心房颤动/心房扑动, 疾病负担, 流行病学, 危险因素, 孟德尔随机化

Abstract:

Objective To analyze the changes in disease burden and risk factors of atrial fibrillation/atrial flutter (AF/AFL) in China and globally from 1990 to 2021 to provide epidemiological evidence for developing effective preventive measures for AF/AFL in China. Methods Based on data from the Global Burden of Disease Study 2021, we analyzed sex- and age-specific AF/AFL burden metrics across 204 countries or territories. Age-standardized incidence rate (ASIR), prevalence, mortality rate (ASMR), and disability-adjusted life-years (DALYs) rate (ASDR) were calculated. Joinpoint regression was employed to compute average annual percentage changes (AAPC) in trends. The risk factors were systematically evaluated and further validated using Mendelian randomization analysis. Results From 1990 to 2021, China experienced an increase in ASIR of AF/AFL (from 42.63 to 44.93 per 100 000), contrasting with the global decline. While China's ASMR decreased (from 4.93 to 4.33 per 100 000), global ASMR rose slightly (from 4.24 to 4.36 per 100 000). China's ASDR remained stable at 93.29 per 100 000, whereas global ASDR increased marginally (100.81 to 101.40 per 100 000). Significant sex disparities were observed: males showed higher ASIR and ASDR, while females exhibited greater ASMR and ASDR. China had higher incidence and prevalence but lower mortality and DALY rates compared to global averages. In 2021, the key risk factors for AF/AFL included elevated systolic blood pressure, high BMI, smoking, alcohol use, high-sodium diet, and low temperature. Gender-specific patterns emerged: smoking was predominant in males, whereas high BMI disproportionately affected females. Conclusion AF/AFL incidence and prevalence keep increasing in China, and its large population base and demographic aging pose significant public health challenges. Maintaining healthy lifestyle habits, including smoking cessation, alcohol moderation, and a low-sodium diet can help to lower AF/AFL incidence, and regular screenings is crucial for its early detection and treatment.

Key words: atrial fibrillation/atrial flutter, disease burden, epidemiology, risk factors, Mendelian randomization

马会华, 闫奎坡, 刘刚, 徐亚洲, 张磊, 李一卓. 1990~2021年心房颤动/扑动流行病学及其危险因素分析：基于2021年中国全球疾病负担研究与孟德尔随机化研究的系统分析[J]. 南方医科大学学报, 2025, 45(10): 2182-2190.

Huihua MA, Kuipo YAN, Gang LIU, Yazhou XU, Lei ZHANG, Yizhuo LI. Epidemiology of atrial fibrillation/atrial flutter and its risk factors from 1990 to 2021: a systematic analysis and Mendelian randomization study based on the China and Global Burden of Disease Study 2021[J]. Journal of Southern Medical University, 2025, 45(10): 2182-2190.

图/表 8

参考文献 35

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Variable	Case	Data source	ID	Population
Exposure				European
Hypertension	463 010	MRC-IEU	ukb-b-12493	European
BMI	681 275	GIANT	ieu-b-40	European
Smoking	607 291	GSCAN	ieu-b-4877	European
High alcohol	112 117	UK Biobank	ieu-a-1283	European
Outcome
AF/AFL	463 010	MRC-IEU	ukb-b-964	European

Variable	Case	Data source	ID	Population
Exposure				European
Hypertension	463 010	MRC-IEU	ukb-b-12493	European
BMI	681 275	GIANT	ieu-b-40	European
Smoking	607 291	GSCAN	ieu-b-4877	European
High alcohol	112 117	UK Biobank	ieu-a-1283	European
Outcome
AF/AFL	463 010	MRC-IEU	ukb-b-964	European

Location	Year	Incidence (10 000)	ASIR (/100 000)	Prevalence (10 000)	ASPR (/100 000)	Deaths (10 000)	ASMR (100 000)	DALYs (10 000)	ASDR (/100 000)
Total
China	1990	306 585	42.63	3 195 309	457.72	16 449	4.93	508 610	93.29
	2021	916 180	44.92	10 775 721	524	64 728	4.33	1 653 117	89.76
	AAPC (%, 95% CI)		0.16 (0.05-0.26)		0.43 (0.32-0.54)		-0.45 (-0.78--0.1)		-0.12 (-0.32-0.07)
Global	1990	2 006 571	52.51	22 214 495	616.58	114 540	4.24	3 358 708	100.82
	2021	4 484 926	52.12	52 552 045	620.51	338 947	4.36	8 358 894	101.40
	AAPC (%, 95% CI)		-0.02 (-0.05-0.00)		0.02 (-0.02-0.06)		0.11 (0.03-0.18)		0.01 (-0.03-0.06)
Male
China	1990	152 972	42	1 627 899	487.47	5207	3.56	221 887	81.96
	2021	451 977	45.23	5 626 767	574.50	21 789	3.81	753 106	89.62
	AAPC (%, 95% CI)		0.25 (0.10-0.4)		0.52 (0.41-0.64)		0.18 (-0.11-0.47)		0.28 (0.09-0.46)
Female
China	1990	153 613	41.74	1 567 410	429.293	11 242	5.54	286 723	97.72
	2021	464 203	43.28	5 148 954	473.40	42 939	4.58	900 010	87.69
	AAPC (%, 95% CI)		0.24 (0.10-0.2)		0.27 (0.10-0.44)		-0.64 (-1.04--0.2)		-0.37 (-0.62--0.12)
Male
Global	1990	1 015 287	57.99	11 492 470	727.79	42 677	4.20	1 569 927	109.93
	2021	2 295 811	57.11	27 899 046	728.87	134 700	4.44	4 032 121	112.05
	AAPC (%, 95% CI)		-0.05 (-0.01--0.02)		-0.00 (-0.05-0.04)		0.19 (0.09-0.30)		0.06 (0.00-0.11)
Female
Global	1990	991 284	47.43	10 722 025	529.53	71 862	4.25	1 788 781	93.29
	2021	2 189 116	47.27	24 652 999	529.11	204 247	4.295	4 326 773	92.24
	AAPC (%, 95% CI)		-0.03 (-0.09-0.03)		-0.02 (-0.07-0.03)		0.05 (-0.05-0.15)		-0.04 (-0.12- 0.04)

Location	Year	Incidence (10 000)	ASIR (/100 000)	Prevalence (10 000)	ASPR (/100 000)	Deaths (10 000)	ASMR (100 000)	DALYs (10 000)	ASDR (/100 000)
Total
China	1990	306 585	42.63	3 195 309	457.72	16 449	4.93	508 610	93.29
	2021	916 180	44.92	10 775 721	524	64 728	4.33	1 653 117	89.76
	AAPC (%, 95% CI)		0.16 (0.05-0.26)		0.43 (0.32-0.54)		-0.45 (-0.78--0.1)		-0.12 (-0.32-0.07)
Global	1990	2 006 571	52.51	22 214 495	616.58	114 540	4.24	3 358 708	100.82
	2021	4 484 926	52.12	52 552 045	620.51	338 947	4.36	8 358 894	101.40
	AAPC (%, 95% CI)		-0.02 (-0.05-0.00)		0.02 (-0.02-0.06)		0.11 (0.03-0.18)		0.01 (-0.03-0.06)
Male
China	1990	152 972	42	1 627 899	487.47	5207	3.56	221 887	81.96
	2021	451 977	45.23	5 626 767	574.50	21 789	3.81	753 106	89.62
	AAPC (%, 95% CI)		0.25 (0.10-0.4)		0.52 (0.41-0.64)		0.18 (-0.11-0.47)		0.28 (0.09-0.46)
Female
China	1990	153 613	41.74	1 567 410	429.293	11 242	5.54	286 723	97.72
	2021	464 203	43.28	5 148 954	473.40	42 939	4.58	900 010	87.69
	AAPC (%, 95% CI)		0.24 (0.10-0.2)		0.27 (0.10-0.44)		-0.64 (-1.04--0.2)		-0.37 (-0.62--0.12)
Male
Global	1990	1 015 287	57.99	11 492 470	727.79	42 677	4.20	1 569 927	109.93
	2021	2 295 811	57.11	27 899 046	728.87	134 700	4.44	4 032 121	112.05
	AAPC (%, 95% CI)		-0.05 (-0.01--0.02)		-0.00 (-0.05-0.04)		0.19 (0.09-0.30)		0.06 (0.00-0.11)
Female
Global	1990	991 284	47.43	10 722 025	529.53	71 862	4.25	1 788 781	93.29
	2021	2 189 116	47.27	24 652 999	529.11	204 247	4.295	4 326 773	92.24
	AAPC (%, 95% CI)		-0.03 (-0.09-0.03)		-0.02 (-0.07-0.03)		0.05 (-0.05-0.15)		-0.04 (-0.12- 0.04)

Location	Year	High systolic blood pressure	Smoking	High alcohol	High BMI	High sodium diet	Low temperature
China	1990	24.4%	8.7%	3.3%	0.4%	7.5%	3.4%
	2021	29.8%	6.9%	3.7%	4.5%	6.6%	3.4%
Global	1990	31.2%	6.5%	4.6%	5.2%	3.4%	2.4%
	2021	30%	4.7%	4.3%	8.7%	3.4%	2.7%

1990~2021年心房颤动/扑动流行病学及其危险因素分析：基于2021年中国全球疾病负担研究与孟德尔随机化研究的系统分析

Epidemiology of atrial fibrillation/atrial flutter and its risk factors from 1990 to 2021: a systematic analysis and Mendelian randomization study based on the China and Global Burden of Disease Study 2021

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