Departments of Neurology and Psychiatry, Harvard Medical School; Department of Environmental Health, Harvard T.H. Chan School of Public Health; Boston Children's Hospital, Boston, MA, USA.
Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
Environ Res. 2019 Mar;170:416-421. doi: 10.1016/j.envres.2018.12.042. Epub 2018 Dec 19.
We describe analyses to estimate the global burden of disease associated with methylmercury (MeHg). An intelligence quotient < 70, indicating intellectual disability (ID), was selected as the critical disease, maternal hair Hg concentration during pregnancy selected as the critical exposure biomarker, and a dose-effect relationship of an 0.18 point IQ reduction per µg/g increase in maternal hair Hg was assumed, based on a meta-analysis. A systematic review was conducted to obtain country-specific data on the distribution of maternal hair Hg concentrations. The country-specific incidence of MeHg-associated ID was calculated, and a random effects model was used to impute the incidence for countries for which no exposure data could be found. The global burden of MeHg-associated ID was quantified in terms of Disability-Adjusted Life Years (DALYs) using the World Health Organization (WHO) Global Health Estimates methodology, and presented by 14 subregions. In 2015, the global total for MeHg-associated cases of ID was 226,655; 210,074 of these cases (93%) were mild cases of ID. The highest rate of ID (6 cases per 100,000 population) was found in the Americas D subregion. The global DALY estimate was 1,963,869. The Western Pacific B subregion contributed the most to this total (696,417), although the Americas D subregion had the greatest rate (54 DALYs per 100,000 population). The burden of disease associated with MeHg is therefore highly subregion-dependent even in areas that are geographically related. The priority given to reducing this burden can therefore be expected to vary considerably by subregion depending on other health needs.
我们描述了用于估计与甲基汞（MeHg）相关的全球疾病负担的分析。智力商数<70，表明存在智力残疾（ID），被选为关键疾病，妊娠期间母亲头发中的汞浓度被选为关键暴露生物标志物，并基于荟萃分析假设了母亲头发中每增加 0.18 个智商点与 Hg 增加 1 µg/g 的剂量-效应关系。进行了系统评价以获得有关母发中 Hg 浓度分布的国家特异性数据。计算了 MeHg 相关 ID 的国家特异性发病率，并使用随机效应模型对无法找到暴露数据的国家进行了发病率推断。使用世界卫生组织（WHO）全球健康估计方法，以残疾调整生命年（DALYs）来量化与 MeHg 相关的 ID 的全球负担，并按 14 个亚区域进行了呈现。2015 年，全球与 MeHg 相关的 ID 病例总数为 226,655 例；其中 210,074 例（93%）为轻度 ID 病例。ID 发生率最高的是美洲 D 亚区（每 10 万人中有 6 例）。全球 DALY 估计值为 1,963,869。西太平洋 B 亚区对此总数的贡献最大（696,417），尽管美洲 D 亚区的比率最高（每 100,000 人中有 54 个 DALYs）。即使在地理上相关的地区，与 MeHg 相关的疾病负担也高度依赖于亚区。因此，根据其他健康需求，不同亚区对减轻这种负担的重视程度预计会有很大差异。
