School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
Diabetes Care. 2020 May;43(5):964-974. doi: 10.2337/dc19-1614. Epub 2020 Mar 5.
No study has reported global disability burden estimates for individual diabetes-related lower-extremity complications (DRLECs). The Global Burden of Disease (GBD) study presents a robust opportunity to address this gap.
GBD 2016 data, including prevalence and years lived with disability (YLDs), for the DRLECs of diabetic neuropathy, foot ulcer, and amputation with and without prosthesis were used. The GBD estimated prevalence using data from systematic reviews and DisMod-MR 2.1, a Bayesian meta-regression tool. YLDs were estimated as the product of prevalence estimates and disability weights for each DRLEC. We reported global and sex-, age-, region-, and country-specific estimates for each DRLEC for 1990 and 2016.
In 2016, an estimated 131 million people (1.8% of the global population) had DRLECs. An estimated 16.8 million YLDs (2.1% global YLDs) were caused by DRLECs, including 12.9 million (95% uncertainty interval 8.30-18.8) from neuropathy only, 2.5 million (1.7-3.6) from foot ulcers, 1.1 million (0.7-1.4) from amputation without prosthesis, and 0.4 million (0.3-0.5) from amputation with prosthesis. Age-standardized YLD rates of all DRLECs increased by between 14.6% and 31.0% from 1990 estimates. Male-to-female YLD ratios ranged from 0.96 for neuropathy only to 1.93 for foot ulcers. The 50- to 69-year-old age-group accounted for 47.8% of all YLDs from DRLECs.
These first-ever global estimates suggest that DRLECs are a large and growing contributor to the disability burden worldwide and disproportionately affect males and middle- to older-aged populations. These findings should facilitate policy makers worldwide to target strategies at populations disproportionately affected by DRLECs.
目前尚无研究报告过糖尿病相关下肢并发症（DRLECs）的全球残疾负担估计值。全球疾病负担（GBD）研究为解决这一空白提供了一个强有力的机会。
本研究使用了 GBD 2016 数据，包括糖尿病神经病变、足部溃疡和截肢（有或无假肢）的 DRLEC 的患病率和残疾生命年（YLD）。GBD 使用来自系统评价和 DisMod-MR 2.1 的数据来估计患病率，DisMod-MR 2.1 是一种贝叶斯元回归工具。YLD 是通过每个 DRLEC 的患病率估计值和残疾权重的乘积来估计的。我们报告了 1990 年和 2016 年全球以及按性别、年龄、地区和国家划分的每个 DRLEC 的估计值。
2016 年，全球约有 1.31 亿人（占全球人口的 1.8%）患有 DRLEC。DRLEC 导致的残疾生命年（YLD）估计为 1680 万（占全球 YLD 的 2.1%），其中仅神经病变导致的残疾生命年（YLD）为 1290 万（95%置信区间为 830 万至 1880 万），足部溃疡导致的残疾生命年（YLD）为 250 万（170 万至 360 万），无假肢截肢导致的残疾生命年（YLD）为 110 万（70 万至 140 万），有假肢截肢导致的残疾生命年（YLD）为 40 万（30 万至 50 万）。与 1990 年的估计值相比，所有 DRLEC 的年龄标准化 YLD 率均增长了 14.6%至 31.0%。男性与女性的 YLD 比值范围为 0.96（仅神经病变）至 1.93（足部溃疡）。50 岁至 69 岁年龄组占所有 DRLEC 残疾生命年（YLD）的 47.8%。
这些全球首次估计表明，DRLEC 是全球残疾负担的一个重要且不断增长的因素，并且不成比例地影响男性和中老年人群。这些发现应该有助于全球决策者针对受 DRLEC 影响较大的人群制定策略。
