Silicosis burden due to silicon exposure based on the Global Burden of Disease Study 2021: trend analysis of incidence, mortality, DALYs and projections for the next 30 years
基于 2021 年全球疾病负担研究的硅暴露引起的矽肺病负担：发病率、死亡率、DALY 趋势分析以及未来 30 年的预测

Xinxin Zhang^{1#^}, Luna Zhao^1#, Maolang He^1#, Xin Huang¹，Dong Liu²
张欣欣 ^{1#^}， 赵 露娜^1#， 何茂郎 ^1#， 黄欣¹，刘东²

¹ School of Medicine, Shihezi University, Shihezi, China (X Zhang MS, L Zhao MS, M He MS, X Hunag BS). ² Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Shihezi University, Shihezi, China (D Liu Corresponding Author)
¹ 石河子大学医学院，石河子，中国（X Zhang MS， L Zhao MS， M He MS， X Hunag BS）。 ² 石河子大学 第一附属医院肺与危重症医学科，石河子（刘丹 通讯作者）

Contributions: (I) Conception and design: X Zhang, L Zhao, M He; (II) Administrative support: D Liu; (III) Provision of study materials or patients: X Zhang, L Zhao, M He, X Hunag; (IV) Collection and assembly of data: X Zhang, L Zhao, M He; (V) Data analysis and interpretation: X Zhang, L Zhao, M He; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
贡献：（I） 构思和设计：X Zhang， L Zhao， M He;（II） 行政支持：D Liu;（III） 提供研究资料或患者：X Zhang、L Zhao、M He、X Hunag;（四）资料收集与汇编：张晓晓， 赵丽， 何明;（V） 数据分析与解释： X Zhang， L Zhao， M He;（VI） 稿件写作：所有作者;（VII） 稿件最终批准：所有作者。

^# These authors contributed equally to this work.
^#这些作者对这项工作做出了同等贡献。

^ORCID: 0009-0007-6062-7218
^ORCID：0009-0007-6062-7218

Correspondence to: Dong Liu, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Shihezi University, Shihezi, China 2322800100@qq.com.
通信地址：石河子大学第一附属医院肺病与重症监护医学科 Dong Liu，中国石河子 2322800100@qq.com。

Abstract
抽象

Background Silicosis, an occupational disease caused by chronic silica exposure, has a high global burden and limited treatment options. This study analyzed the epidemiological trends and future projections of silicosis based on global burden of disease (GBD) data, aiming to provide data support for public health interventions.
背景 矽肺病是一种由慢性二氧化硅暴露引起的职业病，全球负担沉重，治疗选择有限。本研究基于全球疾病负担 （GBD） 数据分析了矽肺病的流行病学趋势和未来预测，旨在为公共卫生干预提供数据支持。

Methods We extracted and analyzed data on incidence, mortality and disability-adjusted life years (DALYs), and age-standardized rates (ASRs) of silicosis from the GBD 2021 and described them in five dimensions: global, regional, national, age, and sex. We used Join-point regression software (V.5.2.0) to calculate average annual percent change (AAPC) measurements for describing mean time trends in ASR from 1990-2021, and BPAC model to predict silicosis trends over the next thirty years.
方法 我们从 GBD 2021 中提取并分析了矽肺病的发病率、死亡率和残疾调整生命年 （DALY） 以及年龄标准化率 （ASR） 的数据，并从全球、区域、国家、年龄和性别五个维度对其进行描述。我们使用连接点回归软件 （V.5.2.0） 计算平均年度百分比变化 （AAPC） 测量值，以描述 1990-2021 年 ASR 的平均时间趋势，并使用 BPAC 模型预测未来 30 年的矽肺病趋势。

Result From 1990 to 2021, global silicosis incidence, deaths, and (DALYs) have all trended upward. However, the corresponding ASRs all showed decreasing trends, with AAPCs of -1.1 (-1.1 to -1.0), -2.5 (-2.7 to -2.3), and -2.5 (-2.7 to -2.3), respectively. However, the burden of silicosis varies significantly across countries and regions, with countries such as China, South Africa, and Chile having silicosis ASIRs and ASDRs well above the global average. In addition, silicosis ASIR and ASDR are generally higher among men. There were also differences between regions at different socioeconomic levels, with the burden of silicosis being lowest among males and females in low social demographic index (SDI) regions and highest among males in medium and high SDI regions. BPAC model showed silicosis burden decreasing gradually from 2021 to 2050.
结果从 1990 年到 2021 年，全球矽肺病发病率、死亡人数和 （DALYs） 均呈上升趋势。然而，相应的 ASR 均呈下降趋势，AAPC 分别为 -1.1（-1.1 至 -1.0）、-2.5（-2.7 至 -2.3）和 -2.5（-2.7 至 -2.3）。然而，矽肺病的负担因国家和地区而异，中国、南非和智利等国家的矽肺病 ASIR 和 ASDR 远高于全球平均水平。此外，男性的矽肺病 ASIR 和 ASDR 通常较高。不同社会经济水平的地区之间也存在差异，在低社会人口指数 （SDI） 地区，男性和女性的矽肺病负担最低，而在中高 SDI 地区，男性的矽肺病负担最高。BPAC 模型显示， 从 2021 年到 2050 年，矽肺病负担逐渐下降。

Conclusions: Although the disease burden of silicosis showed a decreasing trend globally from 1990-2021, it still needs attention. We should take effective preventive and curative measures to address the challenges posed by silicosis and to protect the lives and health of workers.
结论： 尽管 1990-2021 年全球矽肺病的疾病负担呈下降趋势，但仍需关注。我们应该采取有效的预防和治疗措施来应对矽肺病带来的挑战，并保护工人的生命和健康。

Keywords Silicosis, Global burden of disease, Age-standardized rate, Joinpoint regression, Prediction
关键词矽肺病、总体疾病负担、年龄标化率、连接点回归、P判罚

Highlight box
高亮显示框

Key findings
主要发现

• This study found a decreasing global burden of silicosis. However, the trends differed across countries and territories. In addition, silicosis age-standardized rate incidence (ASIR) and age-standardized rate disability-adjusted life-years (ASDR) were usually higher in males.
• 这项研究发现全球矽肺病负担下降。然而，不同国家和地区的趋势有所不同。此外，男性的矽肺病年龄标准化率发病率 （ASIR） 和年龄标准化率残疾调整生命年 （ASDR） 通常较高。

What is known and what is new?
什么是已知的，什么是新的？

• Previous studies have reported various health metrics of silicosis in different countries and regions around the world.
• 以前的研究报告了 全球不同国家和地区的矽肺病的各种健康指标。

• This cross-sectional study provides the most up-to-date estimates of silicosis incidence, deaths, and DALYs and their temporal trends from 204 countries and territories, with significant differences by gender, region, country, age, and sociodemographic index (SDI). In addition, the global ASIR, ASMR, ASDR of silicosis is predicted for the next 30 years.
• 这项横断面研究提供了 204 个国家和地区的矽肺病发病率、死亡人数和 DALY 及其时间趋势的最新估计值，在性别、地区、国家、年龄和社会人口指数 （SDI） 方面存在显著差异。此外，预测未来 30 年全球矽肺病的 ASIR、ASMR、ASDR。

What is the implication, and what should change now?
这意味着什么，现在应该改变什么？

• Currently, silicosis continues to pose a public health issue, and it is essential to enhance health interventions in certain regions to reduce the damage inflicted by this condition.
• 目前，矽肺病仍然构成公共卫生问题，必须加强某些地区的健康干预以减少这种情况造成的损害。

Introduction
介绍

Silicosis is a common pneumoconiosis and an occupational disease, mainly caused by long-term exposure of the population to high concentrations of free silica (SiO₂), which is an interstitial lung disease that is progressive and irreversible (1).Depending on the duration of exposure to SiO₂, silicosis can be categorized as acute, accelerated, or chronic, with the chronic type being more common and the accelerated type being relatively rare. Patients commonly experience symptoms such as chest discomfort, difficulty breathing, mild fever, and nocturnal sweating. As the disease progresses, silicosis can lead to a variety of complications, with respiratory failure being the leading cause of death (2, 3).A study by Faubry et al. found that other lung diseases occurring after exposure to SiO₂, such as lung cancer, tuberculosis, emphysema, and interstitial pulmonary fibrosis, increased the morbidity and mortality of silicosis (4).Despite the high morbidity and mortality of silicosis, the available treatment options are still very limited (5).
矽肺病是一种常见的尘肺病和职业病，主要由人群长期暴露于高浓度的游离二氧化硅 （SiO2） 引起，这是一种进行性且不可逆的间质性肺病 （1）。根据暴露于 SiO2 的持续时间，矽肺病可分为急性、加速或慢性，慢性类型更常见，加速型相对罕见。患者通常会出现胸部不适、呼吸困难、轻度发热和夜间出汗等症状。随着疾病的进展，矽肺病可导致各种并发症，其中呼吸衰竭是导致死亡的主要原因 （2， 3）。Faubry 等人的一项研究发现，暴露于 SiO2 后发生的其他肺部疾病，如肺癌、肺结核、肺气肿和间质性肺纤维化，会增加矽肺病的发病率和死亡率 （4）。尽管矽肺病的发病率和死亡率很高，但可用的治疗选择仍然非常有限 （5）。

Globally, more than 2,000 people are diagnosed with silicosis each year, totaling more than 12,900 deaths, while the disability-adjusted life year for silicosis reached 650,000 years in 2019 (6). To date, silicosis remains a global public health problem. There is an estimate that about 230 million people are exposed to SiO₂ annually, of which 40.5 million work in the mining industry (7). Some recent studies showed that about 2 million people in the United States and Europe were exposed to SiO₂ each (8); South African workers were exposed to SiO₂ at concentrations ranging from 9% to 39% (9); and studies in southern Spain showed that from 2009 to 2018 a total of 106 people were diagnosed with silicosis (10). Furthermore, according to the GBD 2019, approximately 12,900 deaths worldwide were attributed to Silicosis, which also stated that the burden of silicosis was more pronounced in middle and high-middle countries(11).
在全球范围内，每年有超过 2,000 人被诊断出患有矽肺病，总计超过 12,900 人死亡，而矽肺病的残疾调整生命年在 2019 年达到 650,000 年 （6）。迄今为止，矽肺病仍然是一个全球性的公共卫生问题。据估计，每年约有 2.3 亿人接触 SiO2，其中 4050 万人在采矿业工作 （7）。最近的一些研究表明，美国和欧洲各约有 200 万人接触过 SiO2 （8）;南非工人暴露于浓度为 9% 至 39% 的 SiO2 （9）;西班牙南部的研究表明，从 2009 年到 2018 年，共有 106 人被诊断出患有矽肺病 （10）。此外，根据 2019 年 GBD，全球约有 12,900 人死于矽肺病，该研究还指出，矽肺病的负担在中高中部国家更为明显 （11）。

There is still a lack of up-to-date literature on the global dynamics of silicosis analysis and surveillance. Therefore, we analyzed the overall trend of silicosis between 1990 and 2021 by GBD, updating its incidence and mortality data. At the same time, the latest DALYs of the disease were predicted and its trend for the next thirty years was projected using the AAPC. We aimed to assess silicosis' global status and its regional distribution characteristics, and to provide scientific basis and rational recommendations for the development of effective prevention and control measures.
仍然缺乏关于矽肺病分析和监测的全球动态的最新文献。因此，我们通过 GBD 分析了 1990 年至 2021 年间矽肺病的总体趋势，更新了其发病率和死亡率数据。同时，预测了该疾病的最新 DALY，并使用 AAPC 预测了其未来 30 年的趋势。我们旨在评估矽肺病的全球状况及其区域分布特征，为制定有效的防控措施提供科学依据和合理建议。

Methods
方法

Data source
数据源

Data from the GBD 2021 study was analyzed secondary
来自 GBD 2021 研究的数据进行了次要分析. The study used existing data to assess the health costs of 371 diseases and injuries in 204 countries or territories by age and sex
.该研究使用现有数据按年龄和性别评估了 204 个国家或地区的 371 种疾病和伤害的健康成本(12). The overall
整体pressure
压力 on health and socioeconomic factors that results in poor health, disability, and early mortality is known as disease burden
导致健康状况不佳、残疾和早期死亡的健康和社会经济因素被称为疾病负担and the study of its consequences promotes the development of public health policy and the rational allocation of medical resources. The Bayesian meta-regression model (
对其后果的研究促进了公共卫生政策的制定和医疗资源的合理分配。贝叶斯元回归模型 （DisMod
DisMod 系列-MR 2.1), as the core estimation tool of the GBD, uses a mixed-effects method to analyze and integrate data across different age groups, time periods, and geographical regions. The model has the ability to correct for data bias and fuse data from different sources to produce comprehensive and consistent estimates of disease burden levels and trends
-MR 2.1） 作为 GBD 的核心估计工具，使用混合效应方法来分析和整合不同年龄组、时间段和地理区域的数据。该模型能够校正数据偏差并融合来自不同来源的数据，以对疾病负担水平和趋势进行全面且一致的估计(13). Estimates of silicosis are based primarily on systematic reviews, hospital records, and claims data reports. Demographic methods are then applied to impute and supplement missing data
矽肺病的估计主要基于系统评价、医院记录和索赔数据报告。然后应用人口统计方法来插补和补充缺失数据(14). The SDI is a comprehensive scale for assessing
SDI 是一个全面的评估量表 regional social and economic development
区域社会和经济发展. It takes into account factors such as the total fertility rate, the average number of years of education for residents aged 15 and above, and per capita income distribution. The index value changes from 0 to 1. Based on the value of SDI, 204 countries and regions are classified into five different development levels:
.它考虑了总生育率、15 岁及以上居民的平均受教育年限以及人均收入分配等因素。索引值从 0 到 1 变化。根据 SDI 的值，将 204 个国家和地区分为五个不同的发展水平： low, low-middle, middle, high-middle, and high SDI regions
低、中低、中高和高 SDI 区域(15). Based on data from the
根据Global Health Data Exchange
全球健康数据交换, we collected estimates of silicosis incidence, mortality, and DALYs and their 95% uncertainty intervals (UI), based on the GBD 2021, using the International Classification of Diseases (ICD)-11 code CA60.0 to quantify the disease burden of silicosis
，我们根据 GBD 2021 收集了矽肺病发病率、死亡率和 DALY 及其 95% 不确定性区间 （UI） 的估计值，使用国际疾病分类 （ICD）-11 代码 CA60.0 来量化矽肺病的疾病负担(16).

Data management
数据管理

To minimize the interference caused by factors such as age and gender, and to facilitate meaningful comparisons across populations, we used ASR to express disease incidence, mortality, and DALYs rates. In this study, AAPC was used to describe the average temporal trends of ASIR, ASMR, and ASDR from 1990-2021. The Join-point regression software (version 5.2.0) was utilized by us to compute the AAPC measurements. Traditional regression models are mainly applicable to the evaluation of trend fitting on a global scale and are not able to show the characteristics of localized changes over the period under study. The Join-point regression model is suitable for describing trends in single disease morbidity or mortality rates by dividing the trend line into several segments and describing them in a continuous linear fashion, and it does not strictly require a trend in the data series. AAPC and its 95% CI were used to express these results. In short, if AAPC along with its 95% CI were > 0, it indicated that ASR showed an increasing trend. Conversely, if < 0, the ASR was considered to show a decreasing trend. P <0.05 was statistically significant.
为了尽量减少年龄和性别等因素造成的干扰，并促进人群之间的有意义比较，我们使用 ASR 来表示疾病发病率、死亡率和 DALYs 率。在本研究中，AAPC 用于描述 1990-2021 年 ASIR 、 ASMR 和 ASDR 的平均时间趋势。我们使用 Join-point 回归软件（版本 5.2.0）来计算 AAPC 测量值。 传统的回归模型主要适用于全球尺度的趋势拟合评估，无法显示研究期间局部变化的特征。连接点回归模型适用于描述单一疾病发病率或死亡率的趋势，方法是将趋势线划分为几个部分并以连续线性方式描述它们，并且它并不严格要求数据序列中的趋势。AAPC 及其 95% CI 用于表达这些结果。 简而言之，如果AAPC 及其 95% CI 为 > 0，则表明 ASR 呈上升趋势。相反，如果 < 为 0，则认为 ASR 呈下降趋势。P <0.05 有统计学意义。

The BAPC model is a statistical model that can simultaneously account for the effects of age, period, and cohort, providing a more comprehensive view of why diseases occur. This multifactorial integration allows researchers to delve deeper into the causal processes of disease. AND the BAPC model handles uncertainty and complexity in data better than traditional models (17). Studies have been conducted to project the incidence and prevalence of silicosis globally, but no studies have been conducted to project mortality and DALYs (18). Therefore, this study used the BPAC model to predict the future trend of silicosis over the next 30 years, aiming to provide some guidance for the prevention and treatment of silicosis. The BAPC and INLA packages were used for BAPC model forecasting and visualization. All statistical analyses were performed using R software (version 4.4.1).
BAPC 模型是一种统计模型，可以同时解释年龄、时期和队列的影响，从而更全面地了解疾病发生的原因。这种多因素整合使研究人员能够更深入地研究疾病的因果过程。AND BAPC 模型比传统模型更好地处理数据中的不确定性和复杂性 （17）。已经进行了研究来预测全球矽肺病的发病率和患病率，但尚未进行预测死亡率和 DALY 的研究 （18）。因此，本研究采用 BPAC 模型预测了未来 30 年矽肺病的未来趋势，旨在为矽肺病的防治提供一定的指导。BAPC 和 INLA 包用于 BAPC 模型预测和可视化。所有统计分析均使用 R 软件 （4.4.1 版） 进行。

Result
结果

Global and regional burden and trends
全球和区域负担和趋势

First, we analyzed the status of silicosis and its ASR trends in 204 different countries and regions globally from 1990 to 2021. Globally,
首先，我们分析了 1990 年至 2021 年全球 204 个不同国家和地区的矽肺病状况及其 ASR 趋势。全球a decrease was observed in the ASIR, ASMR, and ASDR of silicosis
观察到矽肺病的 ASIR、ASMR 和 ASDR 降低 (Figure 1A-C). In 1990, the global ASIR of silicosis was 0.58/10
（图 1A-C）。1990 年，矽肺病的全球 ASIR 为 0.58/10⁵, and it decreased to 0.41/10
，它下降到 0.41/10⁵ in 2021, which was an overall decrease of 28.67%, and the AAPC was -1.1 (-1.1 to -1.0) (Table 1). 2021, the ASIR was highest in the medium SDI countries at 0.58/10
2021 年总体下降了 28.67%，AAPC 为 -1.1（-1.1 至 -1.0）（表 1）。2021 年，中等 SDI 国家的 ASIR 最高，为 0.58/10⁵, while the ASR in the low SDI countries was 0.58/10
，而低 SDI 国家的 ASR 为 0.58/10⁵, and the ASR in the medium SDI countries was 0.58/10
，中等 SDI 国家的 ASR 为 0.58/10⁵, which was the highest in the medium SDI countries. In 2021, medium SDI countries had the highest ASIR of 0.58/10
，这在中等 SDI 国家中最高。2021 年，中等 SDI 国家的 ASIR 最高，为 0.58/10⁵, while low SDI countries had the lowest ASIR of 0.19/10
，而低 SDI 国家的 ASIR 最低，为 0.19/10⁵ (Table 1). The regional trend of ASIR shows that East Asia has the highest ASIR from 1990 to 2021 (Figure 2A). In terms of ASMR, the global ASMR was 0.26/10
（表 1）。ASIR 的区域趋势显示，从 1990 年到 2021 年，东亚的 ASIR 最高（图 2A）。就 ASMR 而言，全球 ASMR 为 0.26/10⁵ in 1990 and 0.12/10
在 1990 年和 0.12/10⁵ in 2021, a decrease of 53.61%, with an AAPC of -2.5 (-2.7 to -2.3) (Table 2). Unlike the ASIR, the lowest ASMR in 2021 is in high SDI countries (0.05/10
2021 年下降了 53.61%，AAPC 为 -2.5（-2.7 至 -2.3）（表 2）。与 ASIR 不同，2021 年 ASMR 最低的是 SDI 高国家（0.05/10⁵) and the highest is in medium-high SDI countries (0.17/10
），最高的是中高 SDI 国家 （0.17/10⁵) (Table 2). Meanwhile, in terms of regional dominance of ASMR from 1990 to 2021, East Asia was in the first place (Figure 2B
）（表 2）。同时，就 1990 年至 2021 年 ASMR 的区域主导地位而言，东亚位居首位（图 2B).In
).在 1990, the global ASDR was 6.58/10
1990 年，全球 ASDR 为 6.58/10⁵, and in 2021, the global ASDR was 3.03/105,
，2021 年，全球 ASDR 为 3.03/105，which was a decrease of 53.88% from 1990 to 2021, with an AAPC of -2.5 (-2.7 to -2.3) (Table 3). In terms of ASDR for SDI, in 2021, medium and high SDI have the highest ASDR of 4.19/10
从 1990 年到 2021 年下降了 53.88%，AAPC 为 -2.5（-2.7 至 -2.3）（表 3）。就 SDI 的 ASDR 而言，2021 年，中高 SDI 的 ASDR 最高，为 4.19/10⁵ and high SDI have the lowest ASDR of 1.16/10
高 SDI 的 ASDR 最低，为 1.16/10⁵ (Table 3). The regional trend in ASDR from 1990 to 2021 showed that East Asia had the highest level of ASDR (Figure 2C). Finally, the spatial distribution of silicosis ASDR in 2021 showed that the global ASIR was 0.41/10
（表 3）。1990 年至 2021 年 ASDR 的区域趋势表明，东亚的 ASDR 水平最高（图 2C）。最后，2021 年矽肺病 ASDR 的空间分布显示，全球 ASIR 为 0.41/10⁵, ASMR was 0.12/10
，ASMR 为 0.12/10⁵, and ASDR was 3.03/10
，ASDR 为 3.03/10⁵, among which the ASIR of China was 1.11/10
，其中中国的 ASIR 为 1.11/10⁵, ASMR was 0.31/10
，ASMR 为 0.31/10⁵, and ASDR was 8.35/10
，ASDR 为 8.35/10⁵, which was much higher than the global level (Figure 3A-C).
，远高于全球水平（图 3A-C）。

Country-specific burden in 2021
2021 年各国特定负担

Globally speaking, the ASRs linked to silicosis in 2021 varied greatly amongst nations. In Kuwait, the ASIR was less than 0.004/10⁵, but in China, it was 1.11/10⁵. Of them, 38 countries were below 0.05/10⁵, and 7 countries (Kiribati, Paraguay, Portugal, Monaco, Chile, Democratic People's Republic of Korea, and China) were above 0.50/10⁵. (Figure 3A). At the same time, Antigua and Barbuda was also the lowest about ASMR. Sao Tome and Principe had the highest rate (0.53/10⁵), followed by Chile, Mali, Eswatini, China, Lesotho, and Guinea-Bissau, all with rates exceeding 0.30/10⁵. (Figure 3B). As reported by the ASDR, Kuwait had the lowest rate of silicosis, while Sao Tome and Principe had the highest, followed by Eswatini, Mali, and Lesotho (Figure 3C).
从全球来看，2021 年与矽肺病相关的 ASR 因国家而异。在科威特，ASIR 小于 0.004/105，但在中国，它是 1.11/105。其中，38 个国家低于 0.05/105,7 个国家（基里巴斯、巴拉圭、葡萄牙、摩纳哥、智利、朝鲜民主主义人民共和国和中国）高于 0.50/105。（图 3A）。与此同时，安提瓜和巴布达也是 ASMR 最低的。圣多美和普林西比的比率最高 （0.53/105），其次是智利、马里、斯威士兰、中国、莱索托和几内亚比绍，均超过 0.30/105。（图 3B）。根据 ASDR 的报告，科威特的矽肺病发病率最低，而圣多美和普林西比的发病率最高，其次是斯威士兰、马里和莱索托（图 3C）。

Age and sex levels
年龄和性别水平

In all age groups, the incidence of cases and the ASIR were greater in males compared to females. The number of incident cases in both sexes increased with age until it began to decline after the 55-59 age group, while it began to rise again after the 60-64 age group and gradually declined after the 65-69 age group. The 70-74 age group had the greatest number of incident cases for both genders. ASIR in males increased with age until it began to decline after the 90-94 age group. Whereas in females ASIR has always increased with age (Figure. 4A). In 2021, the highest ASIR among females were in the middle SDI region, the highest among males were in the high-middle SDI region, and the lowest among both males and females were in the low SDI region (Figure. 1A).
在所有年龄组中，男性的病例发生率和 ASIR 均高于女性。男女发病病例数均随年龄增长而增加，直到 55-59 岁年龄组后开始下降，而 60-64 岁年龄组后又开始上升，65-69 岁年龄组后逐渐下降。70-74 岁年龄组的男女事件病例数最多。男性的 ASIR 随着年龄的增长而增加，直到 90-94 岁年龄组后开始下降。而在女性中，ASIR 总是随着年龄的增长而增加（图 4A）。2021 年，女性中 ASIR 最高的是 SDI 中部区域，男性最高的是 SDI 中高区域，男性和女性最低的是在低 SDI 区域（图 1A）。

In all age groups, males exhibited a greater count of deaths and DALYs, along with higher ASMR and ASDR, in comparison to females. The number of deaths and DALYs cases among males and females increased with age. The number of deaths among males did not begin to decline until after the 75-79 age group, and the number of DALYs cases did not begin to decline until after the 55-59 age group, then began to rise again after the 60-64 age group, and gradually declined until after the 70-74 age group. The number of female deaths did not begin to decline until after the 80-84 age group, and the number of DALYs cases did not begin to decline until the 70-74 age group. ASMR and ASDR increased with age in males, with ASMR not beginning to decline until after the 90-94 age group and ASDR not beginning to decline until after the 85-89 age group. ASMR and ASDR in females have always increased with age (Figure 4B, C). In 2021, females experienced the greatest ASMR and ASDR in low SDI areas, while males had their highest ASMR and ASDR in the high-middle SDI region. Conversely, both genders recorded the lowest ASMR and ASDR in high SDI regions (Figure 1B, C).
在所有年龄组中，与女性相比，男性表现出更多的死亡人数和 DALYs，以及更高的 ASMR 和 ASDR。男性和女性的死亡人数和 DALYs 病例数随着年龄的增长而增加。男性死亡人数直到 75-79 岁年龄组之后才开始下降，DALYs 病例数直到 55-59 岁年龄组之后才开始下降，然后在 60-64 岁年龄组之后再次开始上升，并逐渐下降直到 70-74 岁年龄组之后。女性死亡人数直到 80-84 岁年龄组之后才开始下降，DALY 病例数直到 70-74 岁年龄组才开始下降。男性的 ASMR 和 ASDR 随着年龄的增长而增加，ASMR 直到 90-94 岁年龄组后才开始下降，ASDR 直到 85-89 岁年龄组后才开始下降。女性的 ASMR 和 ASDR 总是随着年龄的增长而增加（图 4B、C）。2021 年，女性在 SDI 低区域经历了最大的 ASMR 和 ASDR，而男性在 SDI 中高地区的 ASMR 和 ASDR 最高。相反，在高 SDI 区域中，两性都记录了最低的 ASMR 和 ASDR （图 1B、C）。

Predictions for silicosis in the next 30 years
未来 30 年矽肺病预测

The BPAC model was used to observe and predict the trend of ASIR, ASMR, and ASDR of silicosis during 1990-2050. Figure 5 shows that the burden of silicosis will gradually decrease from 2021 to 2050. In 2021, the global ASIR, ASMR, and ASDR for silicosis are 0.44, 0.17, and 4.26, respectively. By 2050, the global ASIR, ASMR, and ASDR of silicosis will decrease to 0.44, 0.07, and 1.95, respectively.
采用 BPAC 模型观察和预测 1990-2050 年矽肺病 ASIR 、 ASMR 和 ASDR 的趋势。图 5 显示，从 2021 年到 2050 年，矽肺病的负担将逐渐下降。2021 年，全球矽肺病的 ASIR、ASMR 和 ASDR 为 0.44,0。17 和 4.26，例如。到 2050 年，全球矽肺病的 ASIR、ASMR 和 ASDR 将分别下降到 0.44、0.07 和 1.95。

Discussion
讨论

Silicosis is an important component of the global pneumoconiosis burden. The study reported the time trends of ASIR, ASMR, and ASDR for silicosis from 1990 to 2021 across various regions, countries, ages, and genders. Since 1990, this research discovered an upward trend in the worldwide incidence of cases and deaths, whereas the total number of DALYs has exhibited a downward trend. The global ASIR, ASMR and ASDR of silicosis are on a downward trend. Across all age groups, males had higher ASIR, ASMR, and ASDR than females. These results provided reliable and comprehensive estimates that contributed to reduce the global burden of this disease.
矽肺病是全球尘肺病负担的重要组成部分。该研究报告了 1990 年至 2021 年不同地区、国家、年龄和性别的 ASIR 、 ASMR 和 ASDR 治疗矽肺病的时间趋势。自 1990 年以来，这项研究发现全球病例和死亡发生率呈上升趋势，而 DALY 的总数呈下降趋势。全球矽肺病的 ASIR 、 ASMR 和 ASDR 呈下降趋势。在所有年龄组中，男性的 ASIR 、 ASMR 和 ASDR 高于女性。这些结果提供了可靠和全面的估计，有助于减轻这种疾病的全球负担。

Incidences of silicosis, along with deaths and DALYs, as well as ASIR, ASMR, and ASDR, were greater in males compared to females.
与女性相比，男性矽肺病的发病率以及死亡和 DALY 以及 ASIR、ASMR 和 ASDR 更高。 This was because industries such as road construction, demolition work, and concrete manufacturing had a higher risk of developing silicosis, and most people working in these industries were males
这是因为道路建设、拆除工作和混凝土制造等行业患矽肺病的风险更高，而在这些行业工作的大多数人都是男性(10). There
.那里were
是 slight increase in male deaths and significant increase in female deaths in 2021 compared to 1990. First, in some traditional industries such as gold mining
与 1990 年相比，2021 年男性死亡人数略有增加，女性死亡人数显著增加。首先，在一些传统行业，如金矿开采absenteeism
旷课, males and females had the same risk of silicosis exposure
，男性和女性暴露矽肺病的风险相同(19). Second, a variety of new industries, such as jeans sandblasting, artificial stone, and glass manufacturing, caused equal exposure to silicosis in both males and females
.其次，各种新行业，如牛仔裤喷砂、人造石和玻璃制造，导致男性和女性患矽肺病的人数相等(20-22). Finally, due to the lack of diagnosis of female silicosis occupational history by medical personnel, it was difficult to prevent silicosis early, resulting in an increase in the number of deaths
.最后，由于医务人员缺乏对女性矽肺病职业史的诊断，难以及早预防矽肺病，导致死亡人数增加(23). These may explain the rise in female deaths and remind us to pay more attention to females in the fight against silicosis. The highest number of incidences, deaths, and DALYs among males and females were in the 65-69, 75-79, and
.这些可能解释了女性死亡人数的增加，并提醒我们在对抗硅肺病的斗争中更加关注女性。男性和女性的发病率、死亡数和 DALY 数最高，分别在 65-69 岁、75-79 岁和70-74 age groups, respectively. Chronic silicosis had a latency period of up to several decades, which caused many patients to begin experiencing symptoms only after retirement or as they enter old age
分别为 70-74 岁年龄组。慢性矽肺病的潜伏期长达数十年，这导致许多患者在退休后或步入老年后才开始出现症状(24). Some studies had pointed out that silicosis mainly affected older workers and that the 65-79 age group had a higher risk of developing silicosis, which was consistent with our findings
.一些研究指出，矽肺病主要影响老年工人，而 65-79 岁年龄组患矽肺病的风险更高，这与我们的研究结果一致(25, 26). This is also a warning that we need to strengthen the health management of silicosis in older workers and conduct regular health checks to detect potential health problems at an early stage.
.这也是一个警示，我们需要加强老年工人矽肺病的健康管理，定期进行健康检查，及早发现潜在的健康问题。

Detailed studies of silicosis, a traditional occupational disease, were published more than a century ago and effective occupational health interventions were available
一个多世纪前就发表了对矽肺病（一种传统职业病）的详细研究，并且有有效的职业健康干预措施(27). Our study found that in 1990 the global incidence was 24,000 and the number of deaths was 0.9 million, whereas by 2021, the number of incidence and deaths increased to 35,000 and 10,000, respectively. However, the ASIR, ASMR, and ASDR showed an overall decreasing trend, indicating that positive and effective measures have been taken globally to prevent and control silicosis.
.我们的研究发现，1990 年全球发病率为 24,000 人，死亡人数为 90 万，而到 2021 年，发病率和死亡人数分别增加到 35,000 人和 10,000 人。然而，ASIR、ASMR 和 ASDR 总体呈下降趋势，表明全球已采取积极有效的措施来预防和控制矽肺病。Meanwhile, silicosis represents a type of pneumoconiosis that results from prolonged exposure to elevated levels of SiO2
同时，矽肺病是一种尘肺病，是由于长期暴露于高水平的 SiO2 引起的(28). SiO
.氧化硅₂ was present in many workplaces such as mining, metallurgy and porcelain industries
出现在许多工作场所，如采矿、冶金和瓷器行业(29). Recently, several studies have reported emerging SiO
.最近，几项研究报道了新兴的 SiO₂ workplaces, such as artificial stone in indoor building materials, which contain high concentrations of SiO
工作场所，例如室内建筑材料中的人造石，其中含有高浓度的 SiO₂ ranging from 85% to 93%
范围从 85% 到 93%(30, 31). The results of one study showed that young workers using artificial stone became an important emerging population for silicosis
.一项研究的结果表明，使用人造石的年轻工人成为矽肺病的重要新兴人群(32). In addition, exposure to working environments where manufactured stone was processed is the main reason for the current increase in the number of silicosis cases, especially in Spain, Australia and Israel
.此外，暴露在加工人造石的工作环境是目前矽肺病病例数量增加的主要原因，尤其是在西班牙、澳大利亚和以色列(8). Besides, cohort studies from Australia found that artificial stone has become a new cause of silicosis with a prevalence rate of
.此外，来自澳大利亚的队列研究发现，人造石已成为矽肺病的新原因，患病率28.2%, which led to the banning of artificial stone by the Australian government
28.2%，这导致澳大利亚政府禁止人造石(33, 34). Despite the long history of silicosis prevention and treatment, attention needed to be paid to the emergence of new exposure sites such as artificial stone, denim sandblasting and jewelry manufacturing
.尽管矽肺病的预防和治疗历史悠久，但需要注意新的暴露场所的出现，例如人造石、牛仔布喷砂和珠宝制造(10, 35). A retrospective cohort study found that the level of silicosis-associated lung function decline in workers using artificial stone was more than five times the level in workers using non-artificial stone
一项回顾性队列研究发现，使用人造石的工人与矽肺病相关的肺功能下降水平是使用非人造石的工人的五倍多(36). The above studies show that the main cause of silicosis has never changed and the
以上研究表明，矽肺病的主要原因从未改变，causative form
致病形式 of the disease is constantly changing, but its essence is always SiO
的疾病在不断变化，但它的本质始终是 SiO₂.

Currently, there was a great global effort to prevent and control silicosis, but it was still a public health problem and a priority for prevention and control in developing countries. A report from India noted a high local prevalence rate, mainly through regular medical check-ups for workers and the development of a national health program to prevent and control silicosis
目前，全球都在努力预防和控制矽肺病，但它仍然是一个公共卫生问题，也是发展中国家预防和控制的重点。印度的一份报告指出，当地的患病率很高，主要是通过对工人进行定期体检和制定国家卫生计划来预防和控制矽肺病(37). Meanwhile, educational and training interventions have been used in some countries and regions to improve dust control and the use of respiratory protective equipment
.同时，一些国家和地区已经采取了教育和培训干预措施，以改善粉尘控制和呼吸防护设备的使用(3). Socio-economic development also affected the occurrence of silicosis, with a lack of control of SiO
.社会经济发展也影响了矽肺病的发生，缺乏对 SiO 的控制₂ in some areas and workplaces not equipped with appropriate protective equipment
在某些地区和工作场所没有配备适当的防护设备(38). A study from Zambia found that mine workers had basic knowledge of SiO
.赞比亚的一项研究发现，矿工对 SiO 有基本的了解₂ protection, but the workers' employers did not provide appropriate protective equipment
保护，但工人的雇主没有提供适当的防护设备(39). The emergence of new exposure sites such as
.新的暴露站点的出现，例如cowboy
牛郎 sandblasting and jewelry production made workers unaware of the hazards, resulting in prolonged exposure
喷砂和珠宝生产使工人没有意识到危险，导致暴露时间延长(40). Meanwhile, our study on the spatial distribution characteristics of ASRs in 204 countries and regions around the world found that developing countries such as China, Chile, Paraguay, and South Africa had higher ASIR, ASMR, and ASDR than the global level. The study showed that the
.同时，我们对全球 204 个国家和地区 ASR 空间分布特征的研究发现，中国、智利、巴拉圭和南非等发展中国家的 ASIR、ASMR 和 ASDR 高于全球水平。研究表明，proportion of silicosis diagnosed in a mobile mine in Zimbabwe was 21%
在津巴布韦的一个移动矿井中诊断出的矽肺病比例为 21%(41). Furthermore, the onset of silicosis may contribute to the emergence of additional respiratory conditions, including tuberculosis and lung cancer
此外，矽肺病的发作可能会导致其他呼吸系统疾病的出现，包括肺结核和肺癌(42, 43). Ehrlich et al. found that silicosis increases the risk of tuberculosis
Ehrlich 等人发现，矽肺病会增加患结核病的风险(44). It was also found that silicosis leads to the development of lung cancer and exacerbates the formation of pulmonary fibrosis
.研究还发现，矽肺病会导致肺癌的发展并加剧肺纤维化的形成(45). Although progress has been made in the global fight against silicosis,
.尽管全球抗击矽肺病的斗争取得了进展，It
它 remains a major public health problem in developing countries,
仍然是发展中国家的一个主要公共卫生问题， and there is a need to reduce its incidence through better education, training, regulation and provision of appropriate protective equipment, as well as to focus on the risk of its association with other respiratory diseases.
有必要通过更好的教育、培训、监管和提供适当的防护设备来降低其发病率，并关注其与其他呼吸系统疾病相关的风险。

Limitation
限度

When exploring findings on silicosis, we must recognize several key limitations. First, the data on silicosis mainly came from GBD 2021, which was a global database that collected data from many different sources. This mean that there may be inconsistencies among the data, as they may be affected by the collection and reporting methods in different regions, which could lead to biases in the study results. Second, because some symptoms of silicosis may be similar to other pulmonary diseases, this could lead to an underestimation of the true number of cases. Finally, the data on silicosis relied on calculations from surveillance data, which may be subject to lag. Although the GBD provided valuable global health data, we must be cautious when interpreting the results of silicosis studies and consider the potential impact these limitations may have on data interpretation and policy-making.
在探索矽肺病的发现时，我们必须认识到几个关键的局限性。首先，关于矽肺病的数据主要来自 GBD 2021，这是一个从许多不同来源收集数据的全球数据库。这意味着数据之间可能存在不一致，因为它们可能受到不同地区收集和报告方法的影响，这可能导致研究结果出现偏差。其次，由于矽肺病的某些症状可能与其他肺部疾病相似，这可能导致低估真实病例数。最后，矽肺病的数据依赖于监测数据的计算，这可能会滞后。尽管 GBD 提供了有价值的全球健康数据，但我们在解释矽肺病研究的结果时必须谨慎，并考虑这些限制可能对数据解释和政策制定产生的潜在影响。

Conclusions
结论

Silicosis continues to be a significant public health issue and presents a potentially serious health burden on a global scale. Although ASR exhibited a downward trend globally from 1990-2021, the number of incident cases, mortality and DALYs increased significantly in females. Therefore, we should take effective preventive and curative measures to address the challenges posed by silicosis, increase the attention paid to silicosis in females, reduce its global burden and protect the lives and health of workers.
矽肺病仍然是一个重要的公共卫生问题，并在全球范围内造成潜在的严重健康负担。尽管 1990 年至 2021 年全球 ASR 呈下降趋势，但女性的发病病例数、死亡率和 DALY 显著增加。因此，我们应该采取有效的预防和治疗措施来应对矽肺病带来的挑战，提高对女性矽肺病的关注，减轻其全球负担，保护工人的生命和健康。

Acknowledgments
确认

The authors thank the GBD Project collaborators for sharing data in public, allowing relevant analysis and interpretations.
作者感谢 GBD 项目合作者公开共享数据，以便进行相关分析和解释。

Funding: Research reported in this publication was funded by Corps Guiding Science and Technology Program Projects(2023ZD019).
资金： 本出版物中报告的研究由兵团指导科学技术计划项目 （2023ZD019） 资助。

Footnote
脚注

Reporting Checklist: The authors have completed the STROBE reporting checklist.
报告清单：作者已完成 STROBE 报告清单。

Data Sharing Statement: Figures 1, 2, 3, 4, 5, 6 and Tables 1, 2 and 3 show the estimates and results of this analysis. To download the data used in these analyses, please visit the Global Health Data Exchange GBD 2021 website at https://ghdx.healthdata.org/gbd-2021. For the codes used to generate these analyses, please visit https://github.com/ihmeuw/gem.
数据共享声明：图 1、2、3、4、5、6 和表 1、2 和 3 显示了该分析的估计值和结果。要下载这些分析中使用的数据，请访问 Global Health Data Exchange GBD 2021 网站，网址为 https://ghdx.healthdata.org/gbd-2021。有关用于生成这些分析的代码，请访问 https://github.com/ihmeuw/gem。

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form. All authors declare that they have no competing interests.
利益冲突：所有作者均已完成 ICMJE 统一披露表。所有作者都声明他们没有竞争利益。

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). Since this study is based on public data and does not involve any individual information, ethical approval is not required.
道德声明：作者对工作的各个方面负责，以确保与工作任何部分的准确性或完整性相关的问题得到适当的调查和解决。该研究是根据《赫尔辛基宣言》（2013 年修订）进行的。由于本研究基于公共数据，不涉及任何个人信息，因此不需要伦理批准。

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引用

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Table 1 The number of incidence and ASIR due to silicosis in 1990 and 2021, and changes from 1990 to 2021
表 1 1990 年和 2021 年矽肺病的发病率和 ASIR 数，以及 1990 年至 2021 年的变化

Note: ASIR: Age-standardized incidence rate; AAPCs: Average Annual Percentage Change; SDI: Socio-Demographic Index. The data in parentheses are 95% uncertainty intervals. *P < 0.05
注：ASIR：年龄标准化发病率;AAPCs：平均年度百分比变化;SDI： 社会人口指数。括号中的数据是 95% 的不确定性区间。*P < 0.05

Table 2 The number of mortality and ASMR due to silicosis in 1990 and 2021, and changes from 1990 to 2021
表 2 1990 年和 2021 年矽肺病导致的死亡率和 ASMR 数量，以及 1990 年至 2021 年的变化

Note: ASMR: Age-standardized mortality rate; AAPCs: Average Annual Percentage Change; SDI: Socio-Demographic Index. The data in parentheses are 95% uncertainty intervals. *P < 0.05
注：ASMR：年龄标准化死亡率;AAPCs：平均年度百分比变化;SDI： 社会人口指数。括号中的数据是 95% 的不确定性区间。*P < 0.05

Table 3 The number of DALYs and ASDR due to silicosis in 1990 and 2021, and changes from 1990 to 2021
表 3 1990 年和 2021 年矽肺病导致的 DALY 和 ASDR 数量，以及 1990 年至 2021 年的变化

Note: ASDR: Age-standardized DALYs rate; AAPCs: Average Annual Percentage Change; SDI: Socio-Demographic Index. The data in parentheses are 95% uncertainty intervals. *P < 0.05
注：ASDR：年龄标准化 DALYs 率;AAPCs：平均年度百分比变化;SDI： 社会人口指数。括号中的数据是 95% 的不确定性区间。*P < 0.05

Figure.1 Change trends of ASIR, ASMR, and ASDR of silicosis among different SDI regions. A, ASIR. B, ASMR. C, ASDR. Abbreviations: ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALYs rate. SDI, socio-demographic index.
图1 不同 SDI 区域矽肺病的 ASIR、ASMR 和 ASDR 的变化趋势。A， ASIR.B， ASMR. C， ASDR缩写： ASIR，年龄标化发病率;ASMR，年龄标准化死亡率;ASDR，年龄标准化 DALYs 率SDI，社会人口指数。

Figure.2 The age-standardized rates of silicosis globally and for 21 regions by SDI, 1990–2021. A, ASIR. B, ASMR. C, ASDR. For each region, the dots from left to right depict the estimated values for each year from 1990 to 2021. The blue line shows the expected incidence, mortality, and DALYs rate based on SDI alone. Abbreviations: ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALYs rate. SDI, socio-demographic index.
Figure2 1990-20 年全球和 21 个地区矽肺病的年龄标准化发病率 21.A， ASIR 的 B，AS MR C，阿斯德尔。对于每个地区，从左到右的点表示从 1990 年到 2021 年每年的估计值。基线显示仅基于 SDI 的预期发病率、死亡率和DALY 率。缩写：ASIR，年龄标准化发病率;ASMR，年龄标准化死亡率;ASDR，年龄标准化 DALYs 率。 SDI，社会人口指数。

Figure.3 The age-standardized rates for silicosis in 204 countries and territories in 2021. A, ASIR. B, ASMR. C, ASDR. Abbreviations: ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALYs rate
图 3 2021 年 204 个国家和地区的矽肺病年龄标准化发病率。A， ASIR.B，ASMR。C， ASDRAbbreviations： ASIR， 年龄标化发病率;ASMR，年龄标准化死亡率;ASDR、年龄标准化 DALY 率.

Figure.4 Age-specific numbers and rates of silicosis by sex, 2021. A, Crude incidence rate. B, Crude mortality rate. C, Crude DALYs rate.
Figure4 按性别划分的矽肺病年龄特定数字和发病率，2021 年。A， 粗发病率。B， 粗死亡率。C，粗略的 DALYs 税率。

Figure.5 Trends in observed and predicted ASRs of silicosis from 1990 to 2050. A, ASIR. B, ASMR. C, ASDR. Abbreviations: ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALYs rate
图 5 1990 年至 2050 年观测和预测的矽肺病 ASR 趋势。A， ASIR.B，ASMR。C， ASDR.缩写：ASIR，年龄标准化发病率;ASMR，年龄标准化死亡率;ASDR、年龄标准化 DALY 率.

Figure.6 Trend of ASRs by Joinpoint Regression (5 joinpoints), 1990–2019.. A, ASIR. B, ASMR. C, ASDR. Abbreviations: ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; ASDR, age-standardized DALYs rate
图 6 1990-2019 年按连接点回归划分的 ASR 趋势（5 个连接点）..A， ASIR.B，ASMR。C， ASDR.缩写：ASIR，年龄标准化发病率;ASMR，年龄标准化死亡率;ASDR、年龄标准化 DALY 率.