Chang Cindy Y, Abujaber Samer, Reynolds Teri A, Camargo Carlos A, Obermeyer Ziad
Harvard Affiliated Emergency Medicine Residency Program, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Emerg Med J. 2016 Nov;33(11):794-800. doi: 10.1136/emermed-2016-205709. Epub 2016 Jun 22.
To estimate the global and national burden of emergency conditions, and compare them to emergency care usage rates.
We coded all 291 Global Burden of Disease 2010 conditions into three categories to estimate emergency burden: conditions that, if not addressed within hours to days of onset, commonly lead to serious disability or death; conditions with common acute decompensations that lead to serious disability or death; and non-emergencies. Emergency care usage rates were obtained from a systematic literature review on emergency care facilities in low-income and middle-income countries (LMICs), supplemented by national health system reports.
All 15 leading causes of death and disability-adjusted life years (DALYs) globally were conditions with potential emergent manifestations. We identified 41 facility-based reports in 23 countries, 12 of which were in LMICs; data for 17 additional countries were obtained from national or regional reports on emergency usage. Burden of emergency conditions was the highest in low-income countries, with median DALYs of 47 728 per 100 000 population (IQR 45 253-50 085) in low-income, 25 186 (IQR 21 982-40 480) in middle-income and 15 691 (IQR 14 649-16 382) in high-income countries. Patterns were similar using deaths to measure burden and excluding acute decompensations from the definition of emergency conditions. Conversely, emergency usage rates were the lowest in low-income countries, with median 8 visits per 1000 population (IQR 6-10), 78 (IQR 25-197) in middle-income and 264 (IQR 177-341) in high-income countries.
Despite higher burden of emergency conditions, emergency usage rates are substantially lower in LMICs, likely due to limited access to emergency care.
评估全球及各国紧急情况的负担，并将其与急诊医疗使用率进行比较。
我们将《2010年全球疾病负担》中的所有291种疾病分为三类来评估紧急情况负担：如果在发病数小时至数天内未得到治疗，通常会导致严重残疾或死亡的疾病；伴有常见急性失代偿并导致严重残疾或死亡的疾病；以及非紧急情况。急诊医疗使用率通过对低收入和中等收入国家（LMICs）急诊医疗设施的系统文献综述获得，并辅以国家卫生系统报告。
全球所有15种主要死因和伤残调整生命年（DALYs）均为具有潜在紧急表现的疾病。我们在23个国家确定了41份基于机构的报告，其中12份来自LMICs；另外17个国家的数据来自关于急诊使用情况的国家或地区报告。紧急情况负担在低收入国家最高，低收入国家每10万人口的DALYs中位数为47728（四分位间距45253 - 50085），中等收入国家为25186（四分位间距21982 - 40480），高收入国家为15691（四分位间距14649 - 16382）。使用死亡来衡量负担并从紧急情况定义中排除急性失代偿时，模式相似。相反，急诊使用率在低收入国家最低，每1000人口的中位数为8次就诊（四分位间距6 - 10），中等收入国家为78次（四分位间距25 - 197），高收入国家为264次（四分位间距177 - 341）。结论：尽管LMICs的紧急情况负担更高，但急诊使用率却低得多，这可能是由于获得急诊医疗的机会有限。
