Lancet Neurol. 2018 Nov;17(11):939-953. doi: 10.1016/S1474-4422(18)30295-3. Epub 2018 Oct 1.
Neurological disorders are now the leading source of disability globally, and ageing is increasing the burden of neurodegenerative disorders, including Parkinson's disease. We aimed to determine the global burden of Parkinson's disease between 1990 and 2016 to identify trends and to enable appropriate public health, medical, and scientific responses.
Through a systematic analysis of epidemiological studies, we estimated global, regional, and country-specific prevalence and years of life lived with disability for Parkinson's disease from 1990 to 2016. We estimated the proportion of mild, moderate, and severe Parkinson's disease on the basis of studies that used the Hoehn and Yahr scale and assigned disability weights to each level. We jointly modelled prevalence and excess mortality risk in a natural history model to derive estimates of deaths due to Parkinson's disease. Death counts were multiplied by values from the Global Burden of Disease study's standard life expectancy to compute years of life lost. Disability-adjusted life-years (DALYs) were computed as the sum of years lived with disability and years of life lost. We also analysed results based on the Socio-demographic Index, a compound measure of income per capita, education, and fertility.
In 2016, 6·1 million (95% uncertainty interval [UI] 5·0-7·3) individuals had Parkinson's disease globally, compared with 2·5 million (2·0-3·0) in 1990. This increase was not solely due to increasing numbers of older people, because age-standardised prevalence rates increased by 21·7% (95% UI 18·1-25·3) over the same period (compared with an increase of 74·3%, 95% UI 69·2-79·6, for crude prevalence rates). Parkinson's disease caused 3·2 million (95% UI 2·6-4·0) DALYs and 211 296 deaths (95% UI 167 771-265 160) in 2016. The male-to-female ratios of age-standardised prevalence rates were similar in 2016 (1·40, 95% UI 1·36-1·43) and 1990 (1·37, 1·34-1·40). From 1990 to 2016, age-standardised prevalence, DALY rates, and death rates increased for all global burden of disease regions except for southern Latin America, eastern Europe, and Oceania. In addition, age-standardised DALY rates generally increased across the Socio-demographic Index.
Over the past generation, the global burden of Parkinson's disease has more than doubled as a result of increasing numbers of older people, with potential contributions from longer disease duration and environmental factors. Demographic and potentially other factors are poised to increase the future burden of Parkinson's disease substantially.
Bill & Melinda Gates Foundation.
神经障碍现在是全球残疾的主要来源，老龄化增加了神经退行性疾病（包括帕金森病）的负担。我们旨在确定 1990 年至 2016 年期间全球帕金森病的负担，以确定趋势，并为公共卫生、医疗和科学做出适当的应对。
通过对流行病学研究的系统分析，我们估计了 1990 年至 2016 年全球、区域和国家帕金森病的患病率和残疾生命年。我们根据使用 Hoehn 和 Yahr 量表的研究，估计了轻度、中度和重度帕金森病的比例，并为每个级别分配了残疾权重。我们在自然史模型中联合建模患病率和超额死亡风险，以得出帕金森病死亡的估计数。死亡人数乘以全球疾病负担研究的标准预期寿命中的值，以计算失去的生命年。通过残疾调整生命年（DALY）计算，即残疾生命年和失去的生命年之和。我们还根据社会人口指数（一种收入、教育和生育率的综合衡量标准）进行了结果分析。
2016 年，全球有 610 万人（95%置信区间[UI]为 5.0-7.3）患有帕金森病，而 1990 年为 250 万人（2.0-3.0）。这种增加不仅仅是由于老年人数量的增加，因为同期年龄标准化患病率增加了 21.7%（95%UI 为 18.1-25.3）（相比之下，粗患病率增加了 74.3%，95%UI 为 69.2-79.6）。2016 年，帕金森病导致 320 万人（95%UI 为 2.6-4.0）残疾调整生命年和 211296 人死亡（95%UI 为 1677111-265160）。2016 年和 1990 年的年龄标准化患病率的男女比例相似（分别为 1.40，95%UI 为 1.36-1.43 和 1.37，1.34-1.40）。从 1990 年到 2016 年，除了南拉丁美洲、东欧和大洋洲外，所有全球疾病负担地区的年龄标准化患病率、DALY 率和死亡率都有所增加。此外，社会人口指数普遍增加了年龄标准化的 DALY 率。
在过去的一代人中，由于老年人数量的增加，帕金森病的全球负担增加了一倍以上，可能还与疾病持续时间延长和环境因素有关。人口和潜在的其他因素可能会大幅增加未来帕金森病的负担。
比尔和梅琳达·盖茨基金会。
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