1990-2019年204个国家和地区369种疾病和伤害的全球负担:2019年全球疾病负担研究的系统分析。

PubMed ID
发表日期 2020年10月

原始出处 柳叶刀(英国伦敦)
Lancet (London, England)
作者

文献标题 1990-2019年204个国家和地区369种疾病和伤害的全球负担:2019年全球疾病负担研究的系统分析。
Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.

文献摘要 BACKGROUND

在一个全球议程不断变化、非传染性疾病和伤害以及传染性疾病日益受到重视的时代,在国家一级就各种原因的趋势提供可靠证据至关重要。《全球疾病、伤害和风险因素负担研究》(GBD)对已发布、公开可用和贡献的发病率、患病率和死亡率数据进行了系统的科学评估,列出了相互排斥、共同详尽的疾病和伤害清单。

METHODS

GBD估计了因369种疾病和伤害导致的发病率、患病率、死亡率、寿命损失年(YLLs)、残疾生存年(YLDs)和残疾调整生命年(DALYs),适用于两性和204个国家和地区。输入数据来自人口普查、住户调查、民事登记和人口动态统计、疾病登记、卫生服务使用、空气污染监测、卫星成像、疾病通知和其他来源。使用死亡原因集合模型和时空高斯过程回归计算特定原因死亡率和原因分数。对特定原因死亡进行调整,以匹配作为GBD人口、生育率和死亡率估计的一部分计算的全因死亡总数。死亡人数乘以每个年龄段的标准预期寿命来计算YLL。使用贝叶斯元回归建模工具DisMod MR 2.1,确保大多数病因的发病率、患病率、缓解率、超额死亡率和病因特异性死亡率之间的一致性。患病率估计值乘以疾病和伤害互斥后遗症的残疾权重,计算YLDs。我们在社会人口指数(SDI)的背景下考虑了结果,SDI是一个综合指标,反映25岁以下女性的人均收入、受教育年限和生育率。使用后验分布的第25次和第975次1000次绘制值,为每个度量生成不确定度区间(UI)。

FINDINGS

根据年龄标准化伤残调整生命年比率衡量,过去30年来,全球健康状况稳步改善。考虑到人口增长和老龄化,伤残调整生命年的绝对数量保持稳定。自2010年以来,与1990-2010年期间相比,50岁以下年龄组的全球年龄标准化伤残调整生命年比率下降速度加快,其中0-9岁年龄组的年化下降率最大。2019年,6种传染病位列10岁以下儿童伤残调整生命年前十大病因之列:下呼吸道感染(排名第二)、腹泻病(排名第三)、疟疾(排名第五)、脑膜炎(排名第六)、百日咳(排名第九)和性传播感染(在这一年龄组中,先天梅毒占全部比例;排名第十)。在10-24岁的青少年中,三种伤害原因是伤残调整生命年的首要原因:道路伤害(排名第一)、自我伤害(第三)和人际暴力(第五)。在10-24岁年龄段的前十名中,有五个原因也在25-49岁年龄段的前十名中:道路伤害(排名第一)、艾滋病毒/艾滋病(第二)、腰痛(第四)、头痛障碍(第五)和抑郁症(第六)。2019年,缺血性心脏病和中风是50-74岁和75岁及以上年龄组中导致伤残调整生命年的首要原因。自1990年以来,由于非传染性疾病和伤害造成的YLDs,负担的比例明显增加。2019年,有11个国家的非传染性疾病和伤害YLD占所有疾病负担的一半以上。过去十年来,在SDI范围较低的国家,年龄标准化伤残调整生命年比率的下降速度加快,而在SDI较高的国家,这方面的改善已开始停滞甚至逆转。

INTERPRETATION

随着残疾成为疾病负担的一个越来越大的组成部分和卫生支出的一个更大的组成部分,需要更多的研究和发展投资,以确定新的、更有效的干预战略。随着全球人口迅速老龄化,对医疗服务的需求将随着年龄的增长而增加,这将要求决策者预测这些变化。由于对健康的影响具有普遍性和地域性,因此有必要定期详细报告人口健康状况,并分析其根本原因,以帮助决策者确定疾病控制的成功案例,并加以效仿,以及改进的机会。

FUNDING

比尔和梅琳达·盖茨基金会。


BACKGROUND

In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries.

METHODS

GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution.

FINDINGS

Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI.

INTERPRETATION

As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve.

FUNDING

Bill & Melinda Gates Foundation.


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