MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland.
Lancet. 2014 Aug 2;384(9941):427-37. doi: 10.1016/S0140-6736(14)60616-4. Epub 2014 May 2.
Countries have agreed to reduce premature mortality (defined as the probability of dying between the ages of 30 years and 70 years) from four main non-communicable diseases (NCDs)--cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes--by 25% from 2010 levels by 2025 (referred to as 25×25 target). Targets for selected NCD risk factors have also been agreed on. We estimated the contribution of achieving six risk factor targets towards meeting the 25×25 mortality target.
We estimated the impact of achieving the targets for six risk factors (tobacco and alcohol use, salt intake, obesity, and raised blood pressure and glucose) on NCD mortality between 2010 and 2025. Our methods accounted for multi-causality of NCDs and for the fact that when risk factor exposure increases or decreases, the harmful or beneficial effects on NCDs accumulate gradually. We used data for risk factor and mortality trends from systematic analyses of available country data. Relative risks for the effects of individual and multiple risks, and for change in risk after decreases or increases in exposure, were from re-analyses and meta-analyses of epidemiological studies.
If risk factor targets are achieved, the probability of dying from the four main NCDs between the ages of 30 years and 70 years will decrease by 22% in men and by 19% in women between 2010 and 2025, compared with a decrease of 11% in men and 10% in women under the so-called business-as-usual trends (ie, projections based on current trends with no additional action). Achieving the risk factor targets will delay or prevent more than 37 million deaths (16 million in people aged 30-69 years and 21 million in people aged 70 years or older) from the main NCDs over these 15 years compared with a situation of rising or stagnating risk factor trends. Most of the benefits of achieving the risk factor targets, including 31 million of the delayed or prevented deaths, will be in low-income and middle-income countries, and will help to reduce the global inequality in premature NCD mortality. A more ambitious target on tobacco use (a 50% reduction) will almost reach the target in men (>24% reduction in the probability of death), and enhance the benefits to a 20% reduction in women.
If the agreed risk factor targets are met, premature mortality from the four main NCDs will decrease to levels that are close to the 25×25 target, with most of these benefits seen in low-income and middle-income countries. On the basis of mortality benefits and feasibility, a more ambitious target than currently agreed should be adopted for tobacco use.
UK MRC.
各国已同意将四项主要非传染性疾病（NCDs）（心血管疾病、慢性呼吸道疾病、癌症和糖尿病）的过早死亡率（定义为 30 岁至 70 岁之间的死亡概率）从 2010 年的水平降低 25%，到 2025 年实现（简称 25×25 目标）。还商定了针对某些 NCD 风险因素的目标。我们估计实现六个风险因素目标对实现 25×25 死亡率目标的贡献。
我们估计了在 2010 年至 2025 年间实现六个风险因素（烟草和酒精使用、盐摄入量、肥胖、高血压和高血糖）目标对 NCD 死亡率的影响。我们的方法考虑了 NCD 的多病因性，以及当风险因素暴露增加或减少时，对 NCD 的有害或有益影响逐渐积累的事实。我们使用了来自系统分析现有国家数据的风险因素和死亡率趋势的数据。个别和多个风险的相对风险，以及在风险暴露增加或减少后风险变化的相对风险，均来自流行病学研究的再分析和荟萃分析。
如果实现了风险因素目标，与所谓的照常营业趋势（即基于当前趋势且没有额外行动的预测）相比，男性死于这四种主要 NCD 的概率将在 30 至 70 岁之间降低 22%，女性将降低 19%，而男性将降低 11%，女性将降低 10%。在这 15 年期间，实现风险因素目标将延迟或预防超过 3700 万人（30-69 岁人群中 1600 万人，70 岁或以上人群中 2100 万人）死于主要 NCD。与风险因素上升或停滞趋势相比，实现风险因素目标的大部分好处，包括 3100 万延迟或预防的死亡，将在低收入和中等收入国家实现，并有助于减少过早 NCD 死亡率方面的全球不平等。更具雄心的烟草使用目标（减少 50%）将使男性接近目标（死亡概率降低超过 24%），并增强女性减少 20%的益处。
如果达到商定的风险因素目标，四项主要 NCD 的过早死亡率将降低到接近 25×25 目标的水平，其中大部分受益于低收入和中等收入国家。基于死亡率获益和可行性，应该为烟草使用制定一个比目前商定的更为雄心勃勃的目标。
英国医学研究理事会。
