Rehm Jürgen, Dawson Deborah, Frick Ulrich, Gmel Gerrit, Roerecke Michael, Shield Kevin D, Grant Bridget
Institute for Clinical Psychology and Psychotherapy, TU Dresden, Germany; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada; Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
Alcohol Clin Exp Res. 2014 Apr;38(4):1068-77. doi: 10.1111/acer.12331. Epub 2014 Jan 15.
Alcohol use disorders (AUD) have long been considered to be some of the most disabling mental disorders; however, empirical data on the burden of disease associated with AUD have been sparse. The objective of this article is to quantify the burden of disease (in disability-adjusted life years [DALYs] lost), deaths, years of life lost due to premature mortality (YLL), and years of life lost due to disability (YLD) associated with AUD for the United States in 2005.
Statistical modeling was based on epidemiological indicators derived from the National Epidemiologic Survey on Alcohol and Related Conditions. Formal consistency analyses were applied. Risk relations were taken from recent meta-analyses and the disability weights from the burden of disease study of the National Institutes of Health. Monte Carlo simulations were used to derive confidence intervals. All analyses were performed by sex and age. Sensitivity analyses were undertaken on key indicators.
In the United States in 2005, 65,000 deaths, 1,152,000 YLL, 2,443,000 YLD, and 3,595,000 DALYs were associated with AUD. For individuals 18 years of age and older, AUD were associated with 3% of all deaths (5% for men and 1% for women), and 5% of all YLL (7% for men and 2% for women). The majority of the burden of disease associated with AUD stemmed from YLD, which accounted for 68% of DALYs associated with AUD (66% for men and 74% for women). The youngest age group had the largest proportion of DALYs associated with AUD stemming from YLD.
Using data from a large representative survey (checked for consistency) and by combining these data with the best available evidence, we found that AUD were associated with a larger burden of disease than previously estimated. To reduce this disease burden, implementation of prevention interventions and expansion of treatment are necessary.
长期以来,酒精使用障碍(AUD)一直被视为最具致残性的精神障碍之一;然而,关于与AUD相关的疾病负担的实证数据一直很少。本文的目的是量化2005年美国与AUD相关的疾病负担(以损失的伤残调整生命年[DALYs]计)、死亡人数、因过早死亡导致的生命年损失(YLL)以及因残疾导致的生命年损失(YLD)。
统计建模基于从全国酒精及相关状况流行病学调查得出的流行病学指标。应用了形式一致性分析。风险关系取自近期的荟萃分析,残疾权重取自美国国立卫生研究院的疾病负担研究。使用蒙特卡洛模拟得出置信区间。所有分析按性别和年龄进行。对关键指标进行了敏感性分析。
2005年在美国,65000例死亡、1152000个YLL、2443000个YLD以及3595000个DALYs与AUD相关。对于18岁及以上的个体,AUD与所有死亡人数的3%相关(男性为5%,女性为1%),与所有YLL的5%相关(男性为7%,女性为2%)。与AUD相关的疾病负担大部分源于YLD,其占与AUD相关的DALYs的68%(男性为66%,女性为74%)。最年轻的年龄组中,与AUD相关的DALYs中源于YLD的比例最大。
利用来自大型代表性调查(经一致性检查)的数据,并将这些数据与现有最佳证据相结合,我们发现AUD相关的疾病负担比先前估计的更大。为减轻这种疾病负担,有必要实施预防干预措施并扩大治疗范围。