Lancet. 2017 Sep 16;390(10100):1211-1259. doi: 10.1016/S0140-6736(17)32154-2.
As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016.
We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).
Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228).
The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.
Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
随着死亡率的下降、预期寿命的延长和人口老龄化，疾病和伤害的非致命后果在全球疾病负担中所占的比例越来越大。《2016 年全球疾病、伤害和危险因素研究》（GBD 2016）全面评估了 195 个国家和地区在 1990 年至 2016 年期间 328 种疾病和伤害以及 2982 种后遗症的流行率、发病率和伤残生命年（YLDs）。
我们使用 DisMod-MR 2.1 贝叶斯回归工具作为主要估计方法，对 328 种疾病和伤害以及 2982 种后遗症进行了流行率和发病率的估计，这些后遗症是其非致命性后果。对于某些疾病，我们如果需要从其他数据中推导出发病率或流行率，则使用替代建模策略。我们将 YLDs 定义为所有相互排斥的后遗症的流行率与残疾权重的乘积，经过共病校正并汇总到病因水平。我们更新了社会人口指数（SDI），这是一个衡量人均收入、受教育年限和总生育率的综合指标。GBD 2016 符合准确和透明健康估计报告指南（GATHER）。
在全球范围内，腰痛、偏头痛、年龄相关性及其他听力损失、缺铁性贫血和重度抑郁症是 2016 年 YLDs 的五个主要原因，占 YLDs 的 5760 万（95%不确定区间 4080-7590 万[7.2%，6.0-8.3%]）、4510 万（2900-6280 万[5.6%，4.0-7.2%]）、3630 万（2530-5090 万[4.5%，3.8-5.3%]）、3470 万（2300-4960 万[4.3%，3.5-5.2%]）和 3410 万（2350-4600 万[4.2%，3.2-5.3%]）。所有原因的 YLDs 年龄标准化率在 1990 年至 2016 年期间下降了 2.7%（95%不确定区间 2.3-3.1）。尽管年龄标准化率基本保持稳定，但非传染性疾病的 YLDs 绝对数量在所有 SDI 五分位数中都在迅速增加，这部分是由于人口增长，但也与人口老龄化有关。全球 YLDs 总数的绝对增长最大的是 40 岁至 69 岁之间的年龄组。所有疾病的年龄标准化 YLDs 率在女性中比男性高 10.4%（95%不确定区间 9.0-11.8）。缺铁性贫血、偏头痛、阿尔茨海默病和其他痴呆、重度抑郁症、焦虑症以及除痛风外的所有肌肉骨骼疾病是导致女性 YLDs 率较高的主要原因。男性的物质使用障碍、糖尿病、心血管疾病、癌症和除性暴力外的所有伤害的年龄标准化率较高。在全球范围内，我们记录到的残疾地理差异明显小于过早死亡的地理差异。2016 年，最低发病率地区（中国，9201 个 YLDs/每 10 万人，95%不确定区间 6862-11943）和最高发病率地区（也门，14774 个 YLDs/每 10 万人，11018-19228）的所有原因的年龄标准化 YLDs 率相差不到两倍。
自 1990 年以来，大多数疾病的死亡率下降并未与年龄标准化 YLDs 率的类似下降相匹配。对于许多主要疾病，YLDs 率要么停滞不前，要么对某些疾病（如糖尿病）有所上升。随着人口老龄化以及残疾性疾病的普遍发病率随着年龄的增长急剧上升，卫生系统将面临对服务需求的增加，而这些服务的成本通常高于导致儿童期死亡率下降或成年人主要死因死亡率下降的干预措施。关于疾病趋势以及各国之间如何变化的最新信息对于规划充足的卫生系统应对措施至关重要。
比尔及梅琳达·盖茨基金会，以及美国国立卫生研究院的国家老龄化研究所和国家心理健康研究所。
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