Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA.
PLoS Negl Trop Dis. 2008 Mar 5;2(3):e158. doi: 10.1371/journal.pntd.0000158.
Schistosomiasis is among the most prevalent parasitic infections worldwide. However, current Global Burden of Disease (GBD) disability-adjusted life year estimates indicate that its population-level impact is negligible. Recent studies suggest that GBD methodologies may significantly underestimate the burden of parasitic diseases, including schistosomiasis. Furthermore, strain-specific disability weights have not been established for schistosomiasis, and the magnitude of human disease burden due to Schistosoma japonicum remains controversial. We used a decision model to quantify an alternative disability weight estimate of the burden of human disease due to S. japonicum. We reviewed S. japonicum morbidity data, and constructed decision trees for all infected persons and two age-specific strata, <15 years (y) and > or =15 y. We conducted stochastic and probabilistic sensitivity analyses for each model. Infection with S. japonicum was associated with an average disability weight of 0.132, with age-specific disability weights of 0.098 (<15 y) and 0.186 (> or =15 y). Re-estimated disability weights were seven to 46 times greater than current GBD measures; no simulations produced disability weight estimates lower than 0.009. Nutritional morbidities had the greatest contribution to the S. japonicum disability weight in the <15 y model, whereas major organ pathologies were the most critical variables in the older age group. GBD disability weights for schistosomiasis urgently need to be revised, and species-specific disability weights should be established. Even a marginal increase in current estimates would result in a substantial rise in the estimated global burden of schistosomiasis, and have considerable implications for public health prioritization and resource allocation for schistosomiasis research, monitoring, and control.
血吸虫病是全球最普遍的寄生虫感染病之一。然而,目前全球疾病负担(GBD)残疾调整生命年的估计表明,其对人群的影响可以忽略不计。最近的研究表明,GBD 方法可能严重低估了寄生虫病的负担,包括血吸虫病。此外,血吸虫病的病种特异性残疾权重尚未确定,而日本血吸虫病给人类带来的疾病负担程度仍存在争议。我们使用决策模型来量化日本血吸虫病导致的人类疾病负担的替代残疾权重估计。我们回顾了日本血吸虫病的发病率数据,并为所有感染者以及两个年龄组(<15 岁和≥15 岁)构建了决策树。我们对每个模型进行了随机和概率敏感性分析。感染日本血吸虫病与平均残疾权重 0.132 相关,年龄特异性残疾权重为 0.098(<15 岁)和 0.186(≥15 岁)。重新估计的残疾权重比当前 GBD 测量值高 7 至 46 倍;没有模拟产生残疾权重估计值低于 0.009。营养性发病在<15 岁模型中对日本血吸虫病的残疾权重贡献最大,而主要器官病变是年龄较大组中最关键的变量。GBD 对血吸虫病的残疾权重迫切需要修订,并且应该建立病种特异性残疾权重。即使当前估计值略有增加,也会导致全球血吸虫病负担的估计值大幅上升,这对血吸虫病的公共卫生优先事项和资源分配将产生重大影响,包括血吸虫病研究、监测和控制。