可避免的疾病负担：药物滥用流行病学中的概念和方法问题
Avoidable burden of disease: conceptual and methodological issues in substance abuse epidemiology.
作者信息
Rehm Jürgen, Taylor Benjamin, Patra Jayadeep, Gmel Gerhard
机构信息
Centre for Addiction and Mental Health, Toronto, Ontario Canada.
出版信息
Int J Methods Psychiatr Res. 2006;15(4):181-91. doi: 10.1002/mpr.199.
Abstract
Determining the proportion of avoidable disease burden attributable to substance use is important for both policy development and intervention implementation. Current epidemiological theory has in principle provided a method to estimate avoidable burden of disease and the available statistical tools can provide first rough estimates. The method described in this paper, and its statistical procedures, are exemplified to estimate avoidable burden of tobacco-related disease in Canada. However, further effort is needed to find solutions in the methodological details, namely exposure measurement, risk factor multidimensionality, estimation of changes in exposure distribution over time, and estimation of risk relationships from multiple exposures changing over time with multiple endpoints (causal webs). The impetus to begin refining methods to obtain better starting points for estimating avoidable burden of disease is obvious and should be carried through in order to see real changes through evidence-based policy and intervention.
摘要
确定可归因于物质使用的可避免疾病负担比例对于政策制定和干预措施实施都很重要。当前的流行病学理论原则上已提供了一种估计可避免疾病负担的方法，且现有的统计工具能够提供初步的粗略估计。本文所描述的方法及其统计程序，以加拿大烟草相关疾病可避免负担的估计为例进行了说明。然而，在方法细节方面，即暴露测量、风险因素多维性、随时间推移暴露分布变化的估计以及随时间变化的多种暴露与多个终点（因果网络）的风险关系估计方面，仍需进一步努力寻找解决方案。开始完善方法以获得更好的估计可避免疾病负担起点的动力是显而易见的，并且应该持续推进，以便通过基于证据的政策和干预措施看到实际变化。
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