Lancet. 2018 Nov 10;392(10159):1789-1858. doi: 10.1016/S0140-6736(18)32279-7. Epub 2018 Nov 8.
BACKGROUND: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. FINDINGS: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). INTERPRETATION: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. FUNDING: Bill & Melinda Gates Foundation.
背景:全球疾病、伤害和危险因素研究 2017 年(GBD 2017)包括对 195 个国家和地区 1990 年至 2017 年 354 种原因的发病率、患病率和伤残生命年(YLDs)的全面评估。之前的 GBD 研究表明,死亡率从 1990 年到 2016 年的下降如何导致预期寿命的延长、全球人口老龄化以及非致命性疾病和伤害负担的扩大。这些研究还表明,世界上相当一部分人口经历了非致命性健康损失,不同原因、地点、年龄和性别之间存在相当大的异质性。GBD 研究的持续目标包括提高估计细节水平、改进分析策略和增加高质量数据的数量。
方法:我们估计了 354 种疾病和伤害以及 3484 种后遗症的发病率和患病率。我们使用了大量广泛的文献研究、调查数据、监测数据、住院记录、门诊记录和医疗保险索赔,此外还使用死因模型的结果来告知使用总共 68781 个数据源进行估计。印度、伊朗、日本、约旦、尼泊尔、中国、巴西、挪威和意大利的新临床数据以及美国的更新索赔数据和台湾(中国)和新加坡的新索赔数据被纳入其中。我们使用 DisMod-MR 2.1,这是一种贝叶斯元回归工具,作为主要的估计方法,以确保每种疾病的发病率、患病率、缓解率和死亡率之间的一致性。YLDs 是通过对每个相互排斥的后遗症的健康状态的患病率估计和残疾权重进行调整来估计的,以调整合并症的影响。我们更新了社会人口指数(SDI),这是一个收入水平、受教育年限和总生育率的综合发展指标。此外,我们还计算了男女 YLDs 的差异,以确定性别之间的不同趋势。GBD 2017 符合准确和透明健康估计报告指南。
结果:在全球范围内,对于女性来说,1990 年和 2017 年发病率标准化患病率最高的疾病是口腔疾病、头痛疾病和血红蛋白病以及溶血性贫血。对于男性来说,1990 年和 2017 年发病率标准化患病率最高的疾病是口腔疾病、头痛疾病和包括潜伏性结核病感染在内的结核病。就 YLDs 而言,腰痛、头痛疾病和缺铁性饮食是 1990 年 YLD 数量的主要 3 级原因,而腰痛、头痛疾病和抑郁症是 2017 年男女共同的主要原因。所有原因的年龄标准化 YLD 率从 1990 年到 2017 年下降了 3.9%(95%置信区间为 3.1-4.6);然而,所有年龄的 YLD 率增加了 7.2%(6.0-8.4),而全球 YLDs 的总和从 56200 万(42100-72300)增加到 85300 万(64200-11000)。男性和女性的增长情况相似,男性的所有年龄 YLD 率增长了 7.9%(6.6-9.2),女性增长了 6.5%(5.4-7.7)。我们发现,多个原因的男女之间的年龄标准化患病率估计存在显著差异。2017 年,男女之间差异最大的原因包括物质使用障碍(男性每 10 万人中有 3018 例[95%置信区间为 3082-3252],女性为 s1400[1279-1524])、交通伤害(男性每 10 万人中有 3322 例[3082-3583],女性为 2336 例[2154-2535])和自我伤害和人际暴力(男性每 10 万人中有 3265 例[2943-3630],女性为 5643 例[5057-6302])。
解释:近三十年来,全球所有原因的年龄标准化 YLD 率仅略有改善。然而,全球非致命性疾病负担的规模已经扩大,患有各种疾病的人数不断增加。自 1990 年以来,一组疾病在全球范围内仍然普遍存在,而其他疾病则表现出更动态的趋势,全球不同地区的不同年龄、性别和地理区域都经历着不同的健康损失负担和趋势。本研究强调了全球某些疾病的过早死亡率改善如何导致人口老龄化,人口老龄化伴有复杂且可能昂贵的疾病,但也突显了全球在某些疾病和伤害领域的成就。
资助:比尔及梅琳达·盖茨基金会。
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