1990年至2021年全球和中国艾滋病发病率趋势的连接点回归和年龄-时期-队列分析-动脉网

Joinpoint regression and age period cohort analysis of global and Chinese HIV incidence trends from 1990 to 2021

Nature 等信源发布 2025-03-09 22:17

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可切换为仅中文

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Abstract

摘要

In China and globally, to analyze the temporal trends of HIV incidence and age, period and cohort effects from 1990 to 2021. A Joinpoint regression model was applied to analyze the time-varying trends of standardized HIV incidence rates worldwide and in China from 1990 to 2021, using data from the Global Burden of Disease Study 2021.

在中国和全球范围内，分析1990年至2021年期间HIV发病率的时间趋势以及年龄、时期和队列效应。应用Joinpoint回归模型，利用2021年全球疾病负担研究的数据，分析1990年至2021年全球和中国标准化HIV发病率的时间变化趋势。

The study also explored the effects of age, period, and cohort on HIV incidence trends. From 1990 to 2021, the global standardized incidence of AIDS increased initially and then declined, with females experiencing a higher disease burden than males. In China, the burden was greater in males than females.

该研究还探讨了年龄、时期和队列对艾滋病发病率趋势的影响。从1990年到2021年，全球艾滋病标准化发病率呈现先上升后下降的趋势，女性的疾病负担高于男性；而在中国，男性的疾病负担高于女性。

The age–period–cohort model revealed that the global risk of AIDS incidence peaked between ages 60 and 69, while in China, it was highest between ages 75 and 79. From 1990 to 2021, the global and Chinese standardized incidence rates of AIDS generally followed an increasing trend before declining, with notable gender differences and the highest incidence rates observed in older populations.

年龄-时期-队列模型显示，全球艾滋病发病率的风险在60至69岁之间达到峰值，而在中国，这一风险在75至79岁之间最高。从1990年到2021年，全球和中国的艾滋病标准化发病率总体呈上升趋势，随后下降，性别差异显著，且发病率最高出现在老年人群中。

It is important to address the issues related to AIDS among the elderly and develop targeted health policies to reduce societal burdens and improve public health..

重要的是要解决老年人群中的艾滋病相关问题，制定有针对性的健康政策，以减轻社会负担并改善公共健康。

Introduction

简介

Acquired immune deficiency syndrome (AIDS), caused by human immunodeficiency virus (HIV), is a deadly infectious disease with high morbidity and mortality rates, posing a significant threat to human health

由人类免疫缺陷病毒（HIV）引起的获得性免疫缺陷综合症（AIDS）是一种致命的传染病，具有高发病率和死亡率，对人类健康构成重大威胁。

. HIV infection is characterized by a typically long incubation period, with an asymptomatic period of 2–10 years from initial infection to the onset of AIDS

艾滋病毒感染的特征是通常具有较长的潜伏期，从初始感染到艾滋病发病的无症状期为2至10年。

. During this period, the virus persists through blood, sexual contact, and vertical transmission from mother to child, and infected individuals may become a hidden source of transmission due to the lack of typical clinical symptoms

在这段时期，病毒通过血液、性接触和母婴垂直传播持续存在，由于缺乏典型的临床症状，感染者可能成为隐性传染源。

. Despite being recognized for over 40 years, HIV remains a leading global sexually transmitted disease (STD)

尽管已被发现40多年，艾滋病毒仍然是全球主要的性传播疾病（STD）之一。

，

. Since 1981, nearly 80 million AIDS cases have been reported worldwide, resulting in over 35 million deaths

自1981年以来，全球已报告近8000万艾滋病病例，导致超过3500万人死亡。

. The Centers for Disease Control and Prevention (CDC) defines individuals aged 50 and above as older adults among those infected with HIV

美国疾病控制与预防中心 (CDC) 将感染艾滋病毒的50岁及以上的人定义为老年人。

. With the progress of antiretroviral therapy (ART), survival rates for AIDS patients have improved, and the growing number of newly infected older adults has led to a significant increase in AIDS patients aged 50 and above

随着抗逆转录病毒疗法（ART）的进展，艾滋病患者的生存率有所提高，而新感染艾滋病毒的老年人数量不断增长，导致50岁及以上的艾滋病患者数量显著增加。

. Emphasized the significant gender differences in HIV incidence, highlighting the importance of studying HIV trends from a demographic perspective at the national level

强调了艾滋病毒发病率存在显著的性别差异，突出了从人口学角度在全国范围内研究艾滋病毒趋势的重要性。

. The current study employed the Joinpoint regression model to analyze the temporal trends in standardized HIV incidence rates globally and in China from 1990 to 2021, investigating the influence of age, period, and cohort on these trends. The goal is to provide a scientific foundation for the development of public health policies aimed at AIDS prevention and control and for optimizing the allocation of health resources..

本研究采用Joinpoint回归模型分析1990年至2021年全球及中国标准化HIV发病率的时间趋势，探讨年龄、时期和队列对时间趋势的影响，旨在为制定艾滋病防控的公共卫生政策及优化卫生资源分配提供科学依据。

Methods

方法

Source of information

信息来源

The data for this study were sourced from the Global Burden of Disease Study 2021 (GBD 2021), which employs the International Classification of Diseases (ICD-10) to classify the diseases analyzed. The GBD 2021 burden of disease and injury analysis utilized 100,983 data sources to estimate metrics such as years of disability life lived (YLDs), years of life lost (YLLs), disability-adjusted life years (DALYs)for 371 diseases and injuries.

本研究的数据来源于《2021年全球疾病负担研究》（GBD 2021），该研究采用《国际疾病分类》（ICD-10）对分析的疾病进行分类。GBD 2021的疾病和伤害负担分析利用了100,983个数据来源，估算了371种疾病和伤害的伤残生命年（YLDs）、生命损失年（YLLs）和残疾调整生命年（DALYs）等指标。

Counts and age-standardized rates were calculated from 1990 to 2021 for 7 super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations) and 811 subnational locations worldwide.

1990年至2021年期间，对7个超级地区、21个地区、204个国家和地区（包括21个具有次国家级地点的国家）以及全球811个次国家级地点进行了计数和年龄标准化率的计算。

. For data screening of the GBD2021 database, the disease “HIV/AIDS”, regions “China” and “Global”, and year range “1990–2021” were selected. The gender selection included “all-sex”, “male” and “female”. 15–79 year olds were selected for this study because of the paucity of data on HIV prevalence among those under 15 and over 79 years of age.

对于GBD2021数据库的数据筛选，选择了疾病“艾滋病/HIV”、地区“中国”和“全球”，以及年份范围“1990-2021”。性别选择包括“全性别”、“男性”和“女性”。由于15岁以下和79岁以上人群的艾滋病毒流行率数据匮乏，本研究选择了15至79岁的人群。

Each age group spans 5 years, making a total of 13 age groups. The data on HIV prevalence stratified by sex, age group (15–19, 20–24, , 70–74, 75–79 years) in GBD 2021 were pooled..

每个年龄组跨度为5年，总共分为13个年龄组。GBD 2021中按性别、年龄组（15-19岁、20-24岁、……、70-74岁、75-79岁）分层的艾滋病毒流行率数据被汇总。

Statistical analysis

统计分析

The joinpoint regression model uses the Monte Carlo permutation test to determine the best-fit model

加入点回归模型使用蒙特卡罗置换检验来确定最佳拟合模型。

. In this study, standardized incidence, DALY rates, YLD rates and YLL rates were calculated in units per 100,000 person-years by direct standardization method, and their long-term change trends in the world and China from 1990 to 2021 were analyzed by the joinpoint model. Annual rates of change (APC), annual rates of change (AAPC) and 95% confidence intervals were calculated.

本研究采用直接标准化法计算每10万人年单位的标化发病率、DALY率、YLD率和YLL率，并利用Joinpoint模型分析1990年至2021年全球及中国的变化趋势，计算年度变化百分比（APC）、年度变化百分比平均值（AAPC）及其95%置信区间。

The Joinpoint regression model can be expressed as E[y│x] = e^(β_0 + β_1 χ + δ_1 (χ−τ_1)^ + + _… + δ_k (χ−τ_k)^ +), in which y is the incidence rates, x refers to the year, β is a constant term, and δ, τ, and k denote regression coefficients of each segmented function, unknown turning points, and turning points, respectively.

Joinpoint 回归模型可以表示为 E[y│x] = e^(β_0 + β_1 χ + δ_1 (χ−τ_1)^ + + _… + δ_k (χ−τ_k)^ +)，其中 y 是发病率，x 表示年份，β 是常数项，而 δ、τ 和 k 分别表示每个分段函数的回归系数、未知的转折点和转折点。

AAPC > 0, the incidence of the disease is increasing in that time period; conversely, if AAPC < 0, the incidence is decreasing in that time period. Similarly, AAPC > 0 and AAPC < 0 indicate that the incidence rates is increasing and decreasing over time, respectively; AAPC = APC indicates a monotonically increasing or monotonically decreasing trend.

AAPC > 0，表示在该时间段内疾病发病率正在上升；反之，若AAPC < 0，则表示发病率在下降。同样，AAPC > 0 和 AAPC < 0 分别表明发病率随着时间的推移呈上升或下降趋势；AAPC = APC 则表示单调递增或单调递减趋势。

The APC model was used to analyze the effects of age, period, and birth cohort on HIV incidence. Age and period were spaced 5 years apart, and cohort was period minus age. The effect coefficients of age, period and cohort were estimated using the endogenous factor method (IE), and then relative risk (RR) was obtained, RR = EXP (effect coefficient).

APC模型用于分析年龄、时期和出生队列对HIV发病率的影响。年龄和时期间隔为5年，队列等于时期减去年龄。使用内生因子法（IE）估算年龄、时期和队列的效应系数，然后获得相对风险（RR），RR = EXP（效应系数）。

When the effect coefficient < 0, the risk of morbidity is reduced; when the effect coefficient > 0, the risk of morbidity is increased. In this study, we used EXCEL to organize the data, Joinpoint (version 4. 9. 0. 0) to analyze the time trend, and Stata1 software to construct the APC model, with the test level of α = 0.

当效应系数 < 0时，发病风险降低；当效应系数 > 0时，发病风险增加。本研究使用EXCEL整理数据，采用Joinpoint（版本4.9.0.0）分析时间趋势，利用Stata1软件构建APC模型，检验水准为α = 0。

05..

Results

结果

Trends in the incidence of AIDS

艾滋病发病率的趋势

Between 1990 and 2021, the global standardized incidence rates of AIDS generally showed an upward and then a downward trend, with the burden of AIDS disease being higher among women than among men. However, the burden of disease is higher for men than for women in China. The global standardized incidence rates of AIDS declined from 36.54 per 100,000 in 1990 to 20.77 per 100,000 in 2021; among them, the incidence rates of AIDS among men declined from 33.69 per 100,000 in 1990 to 21.16 per 100,000 in 2021; it is worth noting that the trend of change in the incidence rates of AIDS among women is larger, from 39.52 per 100,000 in 1990 to 20.44 per 100,000 in 2021.

1990年至2021年间，全球艾滋病标化发病率总体呈现先上升后下降的趋势，且女性的艾滋病疾病负担高于男性，但中国的男性艾滋病疾病负担高于女性。全球艾滋病标化发病率从1990年的36.54/10万下降到2021年的20.77/10万；其中，男性的艾滋病发病率从1990年的33.69/10万下降到2021年的21.16/10万；值得注意的是，女性艾滋病发病率的变化趋势较大，从1990年的39.52/10万下降到2021年的20.44/10万。

The global standardized HIV incidence rates has decreased by an average of 1.80% annually (AAPC = − 1.80%, .

全球标准化的艾滋病毒发病率平均每年下降1.80%（AAPC = − 1.80%，。

< 0.001). The decline in female incidence has been more pronounced, with a decrease of 2.11% per year (AAPC = − 2.11%,

<0.001）。女性发病率的下降更为明显，每年减少2.11%（AAPC = − 2.11%，

< 0.001). Joinpoint analysis revealed that, while the global HIV incidence rates is declining, China experienced an average annual increase of 3.99% in its standardized HIV incidence rates from 1990 to 2021 (AAPC = 3.99%,

<0.001）。加入点分析显示，虽然全球艾滋病毒发生率正在下降，但中国从1990年到2021年其标准化的艾滋病毒发生率平均每年增加3.99%（AAPC=3.99%，

< 0.001), and the standardized HIV incidence rates in men increased by an average of 4.26% per year (AAPC = 4.26%,

<0.001），男性标准化艾滋病发病率平均每年增加4.26%（AAPC=4.26%，

< 0.001), and the standardized incidence rates of AIDS in females increased by an average of 2.98% per year (AAPC = 2.98%,

<0.001），女性艾滋病的标准化发病率平均每年增加2.98%（AAPC=2.98%，

< 0.001) from 1990 to 2021. See Table

< 0.001）从1990年到2021年。见表

and Fig.

和图。

. Global AIDS DALY rates began to rise in 1990, peaked and declined in 2002–2005, while China is generally on the rise. Data are as follows: global AIDS DALY rates increased from 346.90/100,000 in 1990 to 496.40/100,000 in 2021, and China increased from 6.75/100,000 in 1990 to 83.47/100,000 in 2021;global AIDS YLD rates increased from 18.23/100,000 in 1990 to 50.76/100,000 in 2021, and China increased from 0.66/100,000 in 1990 to 4.89/100,000 in 2021;global AIDS YLL rates from 328.67/100,000 in 1990 to 445.63/100,000 in 2021, and China from 6.09/100,000 in 1990 to 78.57/100,000 in 2021.

全球艾滋病DALY率在1990年开始上升，2002-2005年达到峰值后下降，而中国总体呈上升趋势。数据如下：全球艾滋病DALY率从1990年的346.90/10万上升到2021年的496.40/10万，中国从1990年的6.75/10万上升到2021年的83.47/10万；全球艾滋病YLD率从1990年的18.23/10万上升到2021年的50.76/10万，中国从1990年的0.66/10万上升到2021年的4.89/10万；全球艾滋病YLL率从1990年的328.67/10万上升到2021年的445.63/10万，中国从1990年的6.09/10万上升到2021年的78.57/10万。

See Figs. .

参见图。

，

and

和

。

Table 1 APC and AAPC (%) for global and Chinese standardised HIV incidence, 1990–2021.

表1 全球和中国标准化HIV发病率的APC和AAPC（%），1990-2021年。

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Fig. 1

图1

Trends in global and Chinese standardised HIV incidence, 1990–2021. *Indicates that the Annual Percent Change (APC) is significantly different from zero at the alpha = 0.05 level.

1990年至2021年全球和中国标准化HIV发病率趋势。*表示年度百分比变化（APC）在显著性水平alpha=0.05时与零显著不同。

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Fig. 2

图2

Global and Chinese trends in HIV DALYs, 1990–2021. *Indicates that the Annual Percent Change (APC) is significantly different from zero at the alpha = 0.05 level.

1990年至2021年全球和中国的HIV伤残调整生命年（DALYs）趋势。*表示年度百分比变化（APC）在显著性水平alpha=0.05时显著不同于零。

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Fig. 3

图3

Global and Chinese trends in HIV YLDs, 1990–2021. *Indicates that the Annual Percent Change (APC) is significantly different from zero at the alpha = 0.05 level.

1990年至2021年全球及中国HIV伤残调整生命年（YLDs）趋势。*表示年度百分比变化（APC）在显著性水平alpha=0.05时与零显著不同。

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Fig. 4

图4

Global and Chinese trends in HIV YLLs, 1990–2021. *Indicates that the Annual Percent Change (APC) is significantly different from zero at the alpha = 0.05 level.

1990年至2021年全球和中国的HIV伤残调整生命年（YLLs）趋势。*表示年度百分比变化（APC）在显著性水平alpha=0.05时与零显著不同。

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Age–period–cohort modeling of HIV incidence

年龄-时期-队列对艾滋病发病率的建模

Age effect

年龄效应

The global risk of HIV incidence tends to increase and then decrease with age, with the highest risk of incidence for males in the age group 60–64 years (with an effect size of 0.93), followed by the age group 65–69 years (with an effect size of 0.88). For women, the risk of AIDS peaked at age 65–69 (with an effect factor of 1.04), followed by age 70–74 (with an effect factor of 0.70).

全球范围内，HIV发病率的风险随着年龄增长呈现先上升后下降的趋势。男性在60至64岁年龄段的发病率风险最高（效应量为0.93），其次为65至69岁年龄段（效应量为0.88）。对于女性，艾滋病风险在65至69岁达到峰值（效应因子为1.04），随后是70至74岁年龄段（效应因子为0.70）。

In China, the risk of AIDS also peaks at age 75–79 (with an effect factor of 0.73), as shown in Fig. .

在中国，如图所示，75-79岁年龄段的艾滋病风险也达到峰值（影响因子为0.73）。

。

Fig. 5

图5

Age effect on AIDS incidence, 1990–2021.

年龄对艾滋病发病率的影响，1990-2021年。

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Time effect

时间效应

The global risk of HIV incidence shows an increasing and then decreasing trend over time from 1990 to 2021, reaching a peak in 1995–1999 (with an effect coefficient of 0.25). The risk of HIV incidence in China peaked from 2005 to 2009 (with an effect coefficient of 0.90), and then declined year by year over time.

1990年至2021年期间，全球艾滋病毒（HIV）发病率风险随时间呈现先上升后下降的趋势，并在1995年至1999年达到峰值（效应系数为0.25）。中国HIV发病率风险在2005年至2009年达到峰值（效应系数为0.90），之后随着时间逐年下降。

See Fig. .

见图。

。

Fig. 6

图6

Period effect of AIDS incidence from 1990 to 2021.

1990年至2021年艾滋病发病率的周期效应。

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Cohort effects

群体效应

The global risk of HIV incidence has been generally decreasing over birth cohorts. For males, the risk decreased from 0.24 in 1915–1919 to − 0.82 in 2005–2009, a decrease of 2.89%. For females, the risk decreased from 0.54 in 1930–1934 to − 0.81 in 2010–2014, a decrease of 3.87%. The risk of AIDS incidence in China has generally shown an upward and downward fluctuating trend as the birth cohort has progressed, with the risk of incidence for males decreasing from 0.97 in 1915 to 1919 to − 0.49 in 1925 to 1929, a decrease of 4.30%, and increasing from − 0.57 in 1980 to 1984 to 1.00 in 2000 to 2004, an increase of 5.08%.

全球艾滋病发病风险随着出生队列的推移总体呈下降趋势。男性发病风险从1915-1919年的0.24降至2005-2009年的-0.82，降幅为2.89%；女性发病风险从1930-1934年的0.54降至2010-2014年的-0.81，降幅为3.87%。中国艾滋病发病风险随着出生队列的推移总体呈现波动上升和下降的趋势，其中男性发病风险从1915-1919年的0.97降至1925-1929年的-0.49，降幅为4.30%，随后从1980-1984年的-0.57升至2000-2004年的1.00，增幅为5.08%。

The risk of morbidity for females decreased from 0.75 in 1915–1919 to − 0.59 in 1925–1929, a decrease of 3.81%, and increased from − 0.58 in 1980–1984 to 2.28 in 2005–2009, an increase of 5.26%. See Fig. .

女性的发病率风险从1915-1919年的0.75下降到1925-1929年的-0.59，下降了3.81%，并从1980-1984年的-0.58上升到2005-2009年的2.28，上升了5.26%。见图。

。

Fig. 7

图7

Period effect of AIDS incidence from 1990 to 2021.

1990年至2021年艾滋病发病率的周期效应。

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Discussion

讨论

In this study, we explored the temporal trends of HIV incidence using the APC model with the IE algorithm and joinpoint regression analysis,and systematically assessed the long-term trends of global and Chinese AIDS incidence rates from 1990 to 2021. The results show that AIDS incidence and DALY rates have experienced an “upward and then downward” trend globally, and the burden of AIDS disease is higher among women than men.

在这项研究中，我们使用APC模型结合IE算法和Joinpoint回归分析探讨了HIV发病率的时间趋势，并系统评估了1990年至2021年全球和中国艾滋病发病率的长期趋势。结果表明，全球艾滋病发病率和DALY率经历了“先上升后下降”的趋势，且女性的艾滋病疾病负担高于男性。

In China, the incidence of AIDS has been increasing, then decreasing, and then leveling off,DALY rates are on a slow upward trend,especially in the male population and the elderly. The difference in HIV incidence between China and the rest of the world may be due to the following reasons:.

在中国，艾滋病发病率呈现先上升、后下降、再趋于平缓的趋势，DALY率则呈缓慢上升趋势，尤其在男性人群和老年人群中。中国与世界其他国家在HIV发病率上的差异可能由以下几个原因导致：。

In recent years, the gradual decline in the global standardized incidence rates and DALY rates of AIDS is related to the strengthening of global measures for the prevention, testing, and treatment of HIV. The widespread use of ART has not only increased patient survival but also significantly reduced virus transmission rates.

近年来，全球艾滋病标准化发病率和伤残调整生命年率的逐渐下降与全球加强艾滋病预防、检测和治疗措施有关。抗逆转录病毒疗法的广泛使用不仅提高了患者的生存率，还显著降低了病毒传播率。

In addition, governments and international organizations have dedicated substantial resources to preventing HIV spread, particularly through interventions targeting high-risk groups, such as the use of pre-exposure prophylaxis (PrEP) and promoting safer sex practices.

此外，政府和国际组织已投入大量资源用于预防艾滋病的传播，特别是通过针对高风险群体的干预措施，例如使用暴露前预防药物（PrEP）和推广安全性行为实践。

. These combined efforts have contributed to the decline in global AIDS incidence over the past three decades, with a more significant reduction observed in women. This may be due to higher adherence to HIV prevention stratesgies and better access to treatment for women

这些共同努力促使过去三十年全球艾滋病发病率下降，其中女性的下降幅度更大。这可能是由于女性对艾滋病毒预防策略的依从性较高，并且获得治疗的机会较多。

，

. Women globally have a higher incidence of HIV than men and are more susceptible to HIV-1 infection due to factors such as viral load differences, hormonal levels, and immune response disparities between the sexes

全球女性的艾滋病毒发病率高于男性，由于病毒载量差异、荷尔蒙水平和性别间的免疫反应差异等因素，女性更容易感染艾滋病毒1型。

. Although the global standardized incidence of AIDS has declined, China’s standardized incidence of AIDS has increased by an average of 3.99% per year from 1990 to 2021. Possible explanations include the following: China’s rapid socio-economic development in recent years has led to significant changes in the lifestyles of the population, especially in the male population, with an increase in the prevalence of high-risk sexual behaviors, including sexual behaviors without condom use and the phenomenon of multiple sexual partners.

尽管全球艾滋病标化发病率有所下降，但1990年至2021年，中国艾滋病标化发病率平均每年增加3.99%。可能的解释包括以下几点：近年来中国的快速社会经济发展导致人群生活方式发生了显著变化，尤其是男性人群中高危性行为（包括无保护措施性行为和多性伴侣现象）的流行率上升。

The size of China’s migrant population and men who have sex with men (MSM) groups has been expanding, and these groups often suffer from low HIV testing rates and weak awareness of prevention and treatment, resulting in a higher risk of HIV infection.

中国的流动人口和男男性行为者（MSM）群体规模不断扩大，这些群体的艾滋病病毒检测率往往较低，对防治的认识也较薄弱，感染艾滋病病毒的风险较高。

，

. With the gradual improvement of China’s HIV testing and surveillance system, more cases of HIV infection are being recognized and reported in a timely manner, thus reflecting the rising incidence

随着中国艾滋病检测和监测系统的逐步完善，更多的艾滋病毒感染病例被及时发现和报告，从而反映出发病率的上升。

. The higher global HIV prevalence among women than men may stem from biological differences higher risk of mucosal exposure and social structural factors sexual violence or transactional sex as a result of gender power inequality

女性的全球艾滋病患病率高于男性的原因可能在于生物学差异、更高的黏膜暴露风险以及社会结构性因素，如性别权力不平等导致的性暴力或交易性行为。

. In contrast, the significantly higher prevalence of men than women in China is associated with the concentration of high-risk behaviors and high exposure of men in the mobile population, and the higher tolerance of traditional Chinese culture towards male sexuality, which may lead to a weak sense of protection.

相比之下，中国男性显著高于女性的高流行率与流动人口中高危行为的集中和男性的高暴露率有关，以及中国传统文化对男性性行为的较高容忍度，这可能导致保护意识薄弱。

。

Age effect analysis: Both global and Chinese AIDS incidence rates show an age effect, the risk is higher in older age groups. Specifically, the risk of AIDS incidence peaks at 60–69 years of age globally and at 75–79 years of age in China. This trend highlights the extended survival of HIV patients due to the wider availability of ART, resulting in a significant increase in the number of older individuals living with HIV.

年龄效应分析：全球和中国的艾滋病发病率均显示出年龄效应，年龄较大组的风险较高。具体而言，全球艾滋病发病率的风险在60-69岁达到峰值，而在中国则在75-79岁达到峰值。这一趋势突显了由于抗逆转录病毒治疗（ART）的广泛可用性，HIV患者的生存期延长，导致携带HIV的老年人数量显著增加。

，

. Additionally, the proportion of new infections among older adults is rising, likely due to their sexual activity combined with lower awareness of prevention and limited knowledge about HIV risks

此外，老年人中新感染者的比例正在上升，这可能是由于他们的性活动加上对预防的认识较低以及对艾滋病毒风险的知识有限所致。

. Consequently, health policies should focus more on HIV prevention and treatment for the elderly, promote HIV testing and education, and enhance preventive measures, especially for older age groups.

因此，健康政策应更加关注老年人的艾滋病预防和治疗，促进艾滋病检测和教育，并加强预防措施，特别是针对年龄较大的人群。

Regarding period and cohort effects, global AIDS risk peaked between 1995 and 1999 and has since declined. This shift is likely linked to the HIV outbreak peak in the early 1990s, when public awareness was limited and preventive measures were not widespread

关于时期和队列效应，全球艾滋病风险在1995年至1999年间达到高峰，此后有所下降。这一转变可能与20世纪90年代初期的艾滋病毒爆发高峰有关，当时公众意识有限，预防措施也不普及。

. As ART and preventive measures gained momentum, incidence risks were effectively controlled in the early 2000s. In China, the period effect peaked between 2005 and 2009 and then gradually decreased, reflecting enhanced HIV prevention stratesgies post-2005, such as expanded testing, ART promotion, and targeted interventions for high-risk groups.

随着抗逆转录病毒治疗（ART）和预防措施的推广，发病率在2000年代初期得到了有效控制。在中国，时期效应在2005年至2009年之间达到峰值，然后逐渐下降，这反映了2005年之后加强的艾滋病预防策略，例如扩大检测、推广抗逆转录病毒治疗以及针对高危人群的目标干预措施。

，

. Cohort analysis showed that the risk of AIDS onset generally declined with each birth cohort, especially among younger groups, where the risk was notably lower. This suggests that the risk of HIV infection in the younger cohort is gradually decreasing as HIV prevention and education efforts are intensified.

队列分析显示，艾滋病发病风险普遍随着每个出生队列下降，尤其是在较年轻群体中，发病风险显著较低。这表明，随着艾滋病预防和教育力度的加强，年轻队列的艾滋病毒感染风险正在逐渐降低。

However, the relatively small decrease in China suggests that HIV prevention and treatment measures for young people still need to be further strengthened, especially among MSM groups and mobile populations.

然而，中国降幅相对较小，这表明针对年轻人的艾滋病预防和治疗措施仍然需要进一步加强，尤其是在男男性行为人群和流动人口中。

。

In summary, although the standardized incidence of AIDS is decreasing year by year, there are still many countries where the infection situation should be paid more attention. It is possible to expand the coverage of ART, improve the health knowledge and quality of treatment of the relevant population, raise public awareness of prevention and treatment, and encourage HIV-related testing and health education among high-risk groups such as MSM, clandestine prostitutes, young people and the elderly to reduce the risk of covert transmission..

总之，虽然艾滋病的标化发病率在逐年下降，但仍有众多国家的感染情况需要更多关注。可以通过扩大ART的覆盖范围、提高相关人群的健康知识和治疗质量、提高公众的防治意识、鼓励高危人群（如男男性行为者、暗娼、青少年及老年人）进行HIV相关检测与健康教育等措施来减少隐性传播的风险。

Limitations

限制条件

First, this study used GBD2021 data for analysis, but it is possible that some low-income countries have low testing coverage and high underreporting, and there may be some deviation from the actual situation. Second, this study analyzed only global and Chinese AIDS situation and did not take into account the variability between regions, and finally,The database lacks data on the prevalence of HIV among people under 15 and over 79 years of age..

首先，本研究使用GBD2021数据进行分析，但一些低收入国家可能存在检测覆盖率低和高漏报的情况，因此可能与实际情况存在一定偏差。其次，本研究仅分析了全球及中国艾滋病情况，未考虑区域间的差异性，最后，数据库缺乏15岁以下和79岁以上人群的HIV感染率数据。

Further research direction

进一步研究方向

Future studies consider regional differences in China, strengthen data coverage and validation, supplement data from weak regions, and visualize regional differences. In addition, expanding the age-range analysis to include pediatrics and octogenarians would provide a more comprehensive view of the AIDS epidemiology..

未来的研究应考虑中国区域差异，加强数据覆盖和验证，补充薄弱地区的数据，并对区域差异进行可视化展示。此外，将年龄范围分析扩展至包括儿科和八旬老人，将有助于提供更全面的艾滋病流行病学视角。

Data availability

数据可用性

The datasets for our study were obtained from the GBD dataset, available at [

我们研究的数据集来自GBD数据集，可访问以下链接获取 [

https://www.healthdata.org/

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Acknowledgements

致谢

We would like to express our gratitude to the public data research institute and its partners for providing the necessary data for our study.

我们要对公共数据研究所及其合作伙伴为我们研究提供必要数据表示感谢。

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Author notes

作者笔记

Menghan Wu and Cheng Hong contributed equally to this work.

吴梦涵和洪诚对这项工作做出了同等贡献。

Authors and Affiliations

作者与所属机构

School of Public Health, Wannan Medical College, Wuhu, 241002, Anhui, China

中国安徽省芜湖市皖南医学院公共卫生学院，邮编241002

Menghan Wu & Cheng Hong

吴梦涵 & 洪诚

Wuhu Center for Disease Control and Prevention, Wuhu, 241000, Anhui, China

中国安徽省芜湖市疾病预防控制中心，邮编241000

Zhengdong Dou

郑东窦

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Menghan Wu

吴梦涵

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Cheng Hong

程红

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Contributions

贡献

Menghan Wu and Cheng Hong wrote the main manuscript text. Zhengdong Dou conceptualization, writing—review and editing. All authors contributed to the article and approved the submitted version.

吴梦涵和洪诚撰写了主要的手稿文本。窦正东负责概念化、撰写——审查和编辑。所有作者都对文章做出了贡献并批准了提交的版本。

Corresponding author

通讯作者

Correspondence to

致信给

Zhengdong Dou

郑东窦

。

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竞争利益

The authors declare no competing interests.

作者声明不存在竞争性利益。

Ethics approval and consent to participate

伦理批准与参与同意

This is a database study that reuses data from GBD pooled data set. This study has received ethical approval and consent from all relevant parties.

这是一项数据库研究，重复使用了GBD汇总数据集中的数据。本研究已收到来自所有相关方的伦理批准和同意。

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Wu, M., Hong, C. & Dou, Z. Joinpoint regression and age period cohort analysis of global and Chinese HIV incidence trends from 1990 to 2021.

吴敏、洪晨和窦志勇对1990年至2021年全球和中国艾滋病发病率趋势进行了连接点回归和年龄-时期-队列分析。