摘要目的:分析1990—2019年全球不孕不育疾病负担变化趋势，并对2020—2029年男女不育不孕的年龄标准化患病率（age-standardized prevalence rate，ASPR）与年龄标准化伤残调整寿命年（disability-adjusted life-year，DALY）率进行预测，从而为不孕不育疾病防治提供一定的参考依据。方法:基于2019版全球疾病负担数据库，采用患病率、ASPR、DALY率和年龄标准化DALY率综合评估全球不孕不育疾病负担。采用估计年度变化百分比来描述全球21个区域不孕不育疾病负担变化趋势。使用贝叶斯年龄-时期-队列模型预测2020—2029年全球204个国家和地区男女不育不孕的ASPR与年龄标准化DALY率，并通过自回归移动平均模型进行敏感性分析。结果:全球男性不育的患病率、DALY率、ASPR和年龄标准化DALY率分别从1990年的319.52/10万、1.82/10万、2 856.53/10万和16.19/10万上升至2019年的565.30/10万、3.22/10万、3 398.53/10万和19.36/10万。全球女性不孕的患病率、DALY率、ASPR和年龄标准化DALY率分别从1990年的656.67/10万、3.53/10万、6 036.36/10万和32.27/10万上升至2019年的1 223.78/10万、6.59/10万、7 483.12/10万和40.33/10万。30~34岁男女不育不孕疾病负担最高，2019年男女的ASPR分别为4 407.47/10万、10 270.55/10万，年龄标准化DALY率分别为25.08/10万、55.65/10万。仅在45~49岁，2019年女性不孕的患病率（11.31/10万）和DALY率（0.06/10万）低于男性（患病率为15.68/10万，DALY率为0.08/10万）。高社会人口学指数地区不孕不育的疾病负担最低。喀麦隆国家男性不育的ASPR（7 652.40/10万）和年龄标准化DALY率（43.94/10万）最高，中国女性不孕的ASPR（20 402.30/10万）和年龄标准化DALY率（106.16/10万）最高。预测结果显示2020—2029年全球204个国家和地区男女不育不孕疾病负担均呈现上升趋势。结论:1990—2019年全球204个国家和地区男女不育不孕疾病负担均呈上升趋势，预测在2020—2029年全球不孕不育疾病负担仍呈上升趋势。应尽早开展不孕不育的初步筛查，加强健康教育并制定有效的防治策略。

abstractsObjective:To analyze the trend of infertility disease burden from 1990 to 2019 and predict the age-standardized prevalence rate (ASPR) and age-standardized disability-adjusted life-year (DALY) rate of male and female infertility for 2020—2029, providing a certain reference for the prevention and treatment of infertility diseases.Methods:Based on the Global Burden of Disease 2019, prevalence, ASPR, DALY rate, and age-standardized DALY rate were used to evaluate the global burden of infertility comprehensively. The estimated annual percentage change was used to describe trends in the disease burden of infertility in 21 regions worldwide. The Bayesian age period cohort model was used to predict the ASPR and age-standardized DALY rate for male and female infertility in 204 countries and regions from 2020 to 2029. Sensitivity analysis was performed using the autoregressive integrated moving average model.Results:The prevalence, DALY rate, ASPR and age-standardized DALY rate of global male infertility increased from 319.52 per 100 000,1.82 per 100 000, 2 856.53 per 100 000, and 16.19 per 100 000 in 1990 to 565.30 per 100 000, 3.22 per 100 000, 3 398.53 per 100 000, and 19.36 per 100 000 in 2019, respectively. The prevalence, DALY rate, ASPR, and age-standardized DALY rate of global female infertility increased from 656.67 per 100 000, 3.53 per 100 000, 6 036.36 per 100 000, and 32.27 per 100 000 in 1990 to 1 223.78 per 100 000, 6.59 per 10 000, 7 483.12 per 100 000, and 40.33 per 100 000 in 2019, respectively. The burden of infertility disease was the highest in men and women aged 30-34 years, and the ASPR and age-standardized DALY rates were 4 407.47 per 100 000, 25.08 per 100 000, 10 270.55 per 100 000 and 55.65 per 100 000, respectively. Only in 45-49 years of age, the prevalence of infertility (11.31 per 100 000) and DALY rate (0.06 per 100 000) in women were lower than those in men (15.68 per 100 000 and 0.08 per 100 000). In addition, the burden of infertility was the lowest in high socio-demographic index regions. Cameroon had the highest ASPR (7 652.40 per 100 000) and age-standardized DALY rate (43.94 per 100 000) for male infertility. Chinese women had the highest ASPR (20 402.30 per 100 000) and age-standardized DALY rate (106.16 per 100 000) of infertility. The forecast results show that the burden of male and female infertility diseases will increase in 204 countries and regions from 2020 to 2029.Conclusion:The burden of infertility diseases in men and women increased in 204 countries and regions from 1990 to 2019, and it is predicted that the global burden of infertility diseases will continue to rise in 2020—2029. Preliminary screening of infertility should be carried out as soon as possible, health education should be strengthened and effective prevention and treatment strategies should be formulated.