Wei Xiang, Ning Peishan, Cheng Xunjie, Hu Guoqing
Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2019 Feb 28;44(2):193-200. doi: 10.11817/j.issn.1672-7347.2019.02.012.
To examine differences in burden of disease among people aged ≥70 years old in countries with different developmental levels from 1990 to 2016. Methods: The sociodemographic index (SDI) of global burden of disease (GBD) was used to divide 195 countries into five developmental levels: high, high middle, middle, low middle and low. The results of the Global Burden of Diseases Study 2016 (GBD 2016) were extracted to examine disability-adjusted life years (DALY) and the health loss from the top 10 diseases and risk factors among the people aged ≥70 years old in countries with different SDIs. Results: Between 1990 and 2016, the age-standardized DALY rate among people aged ≥70 years old in countries with different SDIs all showed a downward trend. Different decreases in DALY rate in over-seventy old people were observed across countries with different SDI levels: -23.9% in high SDI, -21.3% in high-middle SDI, -23.4% in middle SDI, -18.8% in low-middle SDI and -16.3% in low SDI. In 1990, the age-standardized DALY rate among people aged ≥70 years old in low and low middle SDI countries was 1.67 and 1.49 times of that in high SDI countries; and the gaps rose to 1.83 and 1.59 times in 2016. The DALY rate of the aged people remained remarkably higher in low middle and low SDI countries in 2016, and the gap widened compared with that in 1990. The reduction of age-standardized DALY rate was mainly due to the decrease of years of life lost (YLL). In 2016, low SDI and low-middle SDI countries suffered much higher burden of disease from infectious diseases and chronic non-communicable diseases. Analysis of leading causes and risk factors of DALY showed significant disparities across different SDI countries; burden of disease caused by environmental pollution and adverse health conditions was much higher in the low SDI and lower-middle SDI countries than that in the other countries. Conclusion: During 1990-2016, the burden of disease in countries of all 5 SDI levels declined. But the reductions in the developing countries were less than those in the developed countries, widening health disparities for the elderly between low and high SDI countries. International organizations and individual governments should take measures to narrow health gaps among old adults across countries with different developmental levels.
研究1990年至2016年不同发展水平国家中70岁及以上人群的疾病负担差异。
利用全球疾病负担（GBD）的社会人口学指数（SDI）将195个国家分为五个发展水平：高、高中、中、低中、低。提取《2016年全球疾病负担研究》（GBD 2016）的结果，以研究不同SDI国家中70岁及以上人群的伤残调整生命年（DALY）以及前10种疾病和风险因素造成的健康损失。
1990年至2016年，不同SDI国家中70岁及以上人群的年龄标准化DALY率均呈下降趋势。不同SDI水平国家的70岁以上老年人DALY率下降幅度不同：高SDI国家为-23.9%，高中SDI国家为-21.3%，中SDI国家为-23.4%，低中SDI国家为-18.8%，低SDI国家为-16.3%。1990年，低SDI和低中SDI国家中70岁及以上人群的年龄标准化DALY率分别是高SDI国家的1.67倍和1.49倍；到2016年，差距扩大到1.83倍和1.59倍。2016年，低中SDI和低SDI国家老年人的DALY率仍然显著较高，与1990年相比差距扩大。年龄标准化DALY率的下降主要归因于生命年损失（YLL）的减少。2016年，低SDI和低中SDI国家在传染病和慢性非传染性疾病方面承受的疾病负担要高得多。对DALY的主要原因和风险因素的分析表明，不同SDI国家之间存在显著差异；低SDI和低中SDI国家因环境污染和不良健康状况导致的疾病负担远高于其他国家。
1990 - 2016年期间，所有5个SDI水平国家的疾病负担均有所下降。但发展中国家的降幅小于发达国家，这扩大了低SDI和高SDI国家老年人之间的健康差距。国际组织和各国政府应采取措施缩小不同发展水平国家老年人之间的健康差距。
