估计 195 个国家的全球、区域和国家腹泻发病率、死亡率和病因：2016 年全球疾病负担研究的系统分析。

Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016.

出版信息

Lancet Infect Dis. 2018 Nov;18(11):1211-1228. doi: 10.1016/S1473-3099(18)30362-1. Epub 2018 Sep 19.

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6202444/

Abstract

BACKGROUND

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 provides an up-to-date analysis of the burden of diarrhoea in 195 countries. This study assesses cases, deaths, and aetiologies in 1990-2016 and assesses how the burden of diarrhoea has changed in people of all ages.

METHODS

We modelled diarrhoea mortality with a Bayesian hierarchical modelling platform that evaluates a wide range of covariates and model types on the basis of vital registration and verbal autopsy data. We modelled diarrhoea incidence with a compartmental meta-regression tool that enforces an association between incidence and prevalence, and relies on scientific literature, population representative surveys, and health-care data. Diarrhoea deaths and episodes were attributed to 13 pathogens by use of a counterfactual population attributable fraction approach. Diarrhoea risk factors are also based on counterfactual estimates of risk exposure and the association between the risk and diarrhoea. Each modelled estimate accounted for uncertainty.

FINDINGS

In 2016, diarrhoea was the eighth leading cause of death among all ages (1 655 944 deaths, 95% uncertainty interval [UI] 1 244 073-2 366 552) and the fifth leading cause of death among children younger than 5 years (446 000 deaths, 390 894-504 613). Rotavirus was the leading aetiology for diarrhoea mortality among children younger than 5 years (128 515 deaths, 105 138-155 133) and among all ages (228 047 deaths, 183 526-292 737). Childhood wasting (low weight-for-height score), unsafe water, and unsafe sanitation were the leading risk factors for diarrhoea, responsible for 80·4% (95% UI 68·2-85·0), 72·1% (34·0-91·4), and 56·4% (49·3-62·7) of diarrhoea deaths in children younger than 5 years, respectively. Prevention of wasting in 1762 children (95% UI 1521-2170) could avert one death from diarrhoea.

INTERPRETATION

Substantial progress has been made globally in reducing the burden of diarrhoeal diseases, driven by decreases in several primary risk factors. However, this reduction has not been equal across locations, and burden among adults older than 70 years requires attention.

FUNDING

Bill & Melinda Gates Foundation.

摘要

背景

全球疾病、伤害和危险因素研究（GBD）2016 年提供了对 195 个国家腹泻负担的最新分析。本研究评估了 1990 年至 2016 年期间的病例、死亡和病因，并评估了所有年龄段人群中腹泻负担的变化情况。

方法

我们使用贝叶斯分层建模平台来模拟腹泻死亡率，该平台根据生命登记和死因推断数据评估了广泛的协变量和模型类型。我们使用隔室荟萃回归工具来模拟腹泻发病率，该工具强制规定发病率与流行率之间的关联，并依赖于科学文献、具有代表性的人群调查和医疗保健数据。使用反事实人群归因分数方法将腹泻死亡和发作归因于 13 种病原体。腹泻危险因素也基于风险暴露的反事实估计和风险与腹泻之间的关联。每个建模估计都考虑了不确定性。

结果

2016 年，腹泻是所有年龄段人群中第八大死因（1655944 例死亡，95%不确定区间[UI]为 1244073-2366552），也是 5 岁以下儿童的第五大死因（446000 例死亡，390894-504613）。轮状病毒是 5 岁以下儿童腹泻死亡率（128515 例死亡，105138-155133）和所有年龄段人群腹泻死亡率（228047 例死亡，183526-292737）的主要病因。儿童消瘦（低身高体重得分）、不安全用水和不安全环境卫生设施是腹泻的主要危险因素，分别导致 5 岁以下儿童腹泻死亡的 80.4%（68.2-85.0）、72.1%（34.0-91.4）和 56.4%（49.3-62.7）。预防 1762 名儿童消瘦（95%UI 为 1521-2170）可以避免 1 例腹泻死亡。