Higashi Hideki, Barendregt Jan J, Kassebaum Nicholas J, Weiser Thomas G, Bickler Stephen W, Vos Theo
Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, Suite 600, Seattle, Washington, 98121, USA,
World J Surg. 2015 Jan;39(1):1-9. doi: 10.1007/s00268-014-2685-x.
Injuries accounted for 11 % of the global burden of disease in 2010. This study aimed to quantify the burden of injury in low- and middle-income countries (LMICs) that could be averted if basic surgical services were made available and accessible to the entire population.
We examined all causes of injury from the Global Burden of Disease 2010 Study. We split the disability-adjusted life years (DALYs) for these conditions between surgically "avertable" and "nonavertable" burdens. For estimating the avertable fatal burden, we applied the lowest fatality rates among the 21 epidemiologic regions to each LMIC region, assuming that the differences in death rates between each region and the lowest rates reflect the gap in surgical care. We adjusted for fatal cases that occur prior to reaching hospitals as they are not surgically avertable. Similarly, we applied the lowest nonfatal burden per case to each LMIC region.
Overall, 21 % of the injury burden in LMICs was potentially avertable by basic surgical care (52.3 million DALYs). The avertable proportion was greater for deaths than for nonfatal burden (23 vs. 20 %), suggesting that surgical services for injuries more effectively save lives than ameliorate disability. Sub-Saharan Africa had the largest proportion of potentially avertable burden (25 %). South Asia had the highest total avertable DALYs (17.4 million). Road injury comprised the largest total avertable burden in LMICs (16.1 million DALYs).
Basic surgical care has the potential to play a major role in reducing the injury-related burden in LMICs.
2010年，伤害占全球疾病负担的11%。本研究旨在量化低收入和中等收入国家（LMICs）的伤害负担，如果能为全体人口提供并使其可获得基本外科服务，这些负担是可以避免的。
我们研究了《2010年全球疾病负担研究》中所有的伤害原因。我们将这些疾病的伤残调整生命年（DALYs）分为外科手术“可避免”和“不可避免”的负担。为了估计可避免的致命负担，我们将21个流行病学区域中的最低死亡率应用于每个LMIC区域，假设每个区域与最低死亡率之间的死亡率差异反映了外科护理的差距。我们对在到达医院之前发生的致命病例进行了调整，因为这些病例无法通过外科手术避免。同样，我们将每个病例的最低非致命负担应用于每个LMIC区域。
总体而言，LMICs中21%的伤害负担可通过基本外科护理避免（5230万DALYs）。可避免的死亡比例高于非致命负担比例（23%对20%），这表明伤害的外科服务在挽救生命方面比改善残疾更有效。撒哈拉以南非洲地区潜在可避免负担的比例最大（25%）。南亚地区可避免的DALYs总数最高（1740万）。道路伤害在LMICs中占可避免负担的总数最大（1610万DALYs）。
基本外科护理有潜力在减轻LMICs与伤害相关的负担方面发挥重要作用。
