Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30333, USA.
Clin Infect Dis. 2012 Jul;55(2):216-23. doi: 10.1093/cid/cis386. Epub 2012 Apr 4.
Globally, gastroenteritis is recognized as an important contributor to mortality among children, but population-based data on gastroenteritis deaths among adults and the contributions of specific pathogens are limited. We aimed to describe trends in gastroenteritis deaths across all ages in the United States and specifically estimate the contributions of Clostridium difficile and norovirus.
Gastroenteritis-associated deaths in the United States during 1999-2007 were identified from the National Center for Health Statistics multiple-cause-of-death mortality data. All deaths in which the underlying cause or any of the contributing causes listed gastroenteritis were included. Time-series regression models were used to identify cause-unspecified gastroenteritis deaths that were probably due to specific causes; seasonality of model residuals was analyzed to estimate norovirus-associated deaths.
Gastroenteritis mortality averaged 39/1000000 person-years (11 255 deaths per year) during the study period, increasing from 25/1 000 000 person-years in 1999-2000 to 57/1 000 000 person-years in 2006-2007 (P < .001). Adults aged ≥ 65 years accounted for 83% of gastroenteritis deaths (258/1 000 000 person-years). C. difficile mortality increased 5-fold from 10/1 000 000 person-years in 1999-2000 to 48/1 000 000 person-years in 2006-2007 (P < .001). Norovirus contributed to an estimated 797 deaths annually (3/1 000 000 person-years), with surges by up to 50% during epidemic seasons associated with emergent viral strains.
Gastroenteritis-associated mortality has more than doubled during the past decade, primarily affecting the elderly. C. difficile is the main contributor to gastroenteritis-associated deaths, largely accounting for the increasing trend, and norovirus is probably the second leading infectious cause. These findings can help guide appropriate clinical management strategies and vaccine development.
在全球范围内，肠胃炎被认为是导致儿童死亡的一个重要原因，但关于成年人肠胃炎死亡的基于人群的数据以及特定病原体的贡献有限。我们旨在描述美国所有年龄段肠胃炎死亡的趋势，并特别估计艰难梭菌和诺如病毒的贡献。
在美国，1999 年至 2007 年期间，国家卫生统计中心的多病因死亡率数据确定了肠胃炎相关死亡。所有将肠胃炎列为根本原因或任何促成原因之一的死亡均包括在内。使用时间序列回归模型来确定可能由特定原因引起的原因不明的肠胃炎死亡；分析模型残差的季节性以估计与诺如病毒相关的死亡。
在研究期间，肠胃炎死亡率平均为 39/100 万人口/年（每年 11255 例死亡），从 1999 年至 2000 年的 25/100 万人口/年增加到 2006 年至 2007 年的 57/100 万人口/年（P<0.001）。≥65 岁的成年人占肠胃炎死亡人数的 83%（258/100 万人口/年）。艰难梭菌的死亡率从 1999 年至 2000 年的 10/100 万人口/年增加了 5 倍，达到 2006 年至 2007 年的 48/100 万人口/年（P<0.001）。估计每年有 797 人死于诺如病毒（3/100 万人口/年），在与新出现的病毒株相关的流行季节，其发病率高达 50%。
在过去十年中，肠胃炎相关死亡率增加了一倍以上，主要影响老年人。艰难梭菌是肠胃炎相关死亡的主要原因，在很大程度上导致了上升趋势，而诺如病毒可能是第二大传染性病因。这些发现有助于指导适当的临床管理策略和疫苗开发。
