Pan American Health Organization, Washington, DC, USA.
School of International Development, University of East Anglia, Norwich, UK.
Lancet Glob Health. 2020 Apr;8(4):e511-e523. doi: 10.1016/S2214-109X(20)30035-8.
The reduction by a third of premature non-communicable disease (NCD) mortality by 2030 is the ambitious target of Sustainable Development Goal (SDG) 3.4. However, the indicator is narrowly defined, including only four major NCDs (cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases) and only for people aged 30-70 years. This study focuses on premature avertable mortality from NCDs-premature deaths caused by NCDs that could be prevented through effective public policies and health interventions or amenable to high-quality health care-to assess trends at global, regional, and national levels using estimates from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2017.
We reviewed existing lists of NCD causes of death that are either preventable through public health policies and interventions or amenable to health care to create a list of avertable NCD causes of death, which was mapped to the GBD cause list. We estimated age-standardised years of life lost (YLL) per 100 000 population due to premature avertable mortality from NCDs, avertable NCD cause clusters, and non-avertable NCD causes by sex, location, and year and reported their 95% uncertainty intervals (UIs). We examined trends in age-standardised YLL due to avertable and non-avertable NCDs, assessed the progress of premature avertable mortality from NCDs in achieving SDG 3.4, and explored specific avertable NCD cause clusters that could make a substantial contribution to overall trends in premature mortality.
Globally, premature avertable mortality from NCDs for both sexes combined declined -1·3% (95% UI -1·4 to -1·2) per year, from 12 855 years (11 809 to 14 051) in 1990 to 9008 years (8329 to 9756) in 2017. However, the absolute number of avertable NCD deaths increased 49·3% (95% UI 47·3 to 52·2) from 23·1 million (22·0-24·1) deaths in 1990 to 34·5 million (33·4 to 35·6) in 2017. Premature avertable mortality from NCDs reduced in every WHO region and in most countries and territories between 1990 and 2017. Despite these reductions, only the Western Pacific and European regions and 25 countries (most of which are high-income countries) are on track to achieve SDG target 3.4. Since 2017, there has been a global slowdown in the reduction of premature avertable mortality from NCDs. In 2017, high premature avertable mortality from NCDs was clustered in low-income and middle-income countries, mainly in the South-East Asia region, Eastern Mediterranean region, and African region. Most countries with large annual reductions in such mortality between 1990 and 2017 had achieved low levels of premature avertable mortality from NCDs by 2017. Some countries, the most populous examples being Afghanistan, the Central African Republic, Uzbekistan, Haiti, Mongolia, Turkmenistan, Pakistan, Ukraine, Laos, and Egypt, reported both an upward trend and high levels of premature avertable mortality from NCDs. Cardiovascular diseases, cancers, and chronic respiratory diseases have been the main drivers of the global and regional reduction in premature avertable mortality from NCDs, whereas premature mortality from substance use disorders, chronic kidney disease and acute glomerulonephritis, and diabetes have been increasing.
Worldwide, there has been a substantial reduction in premature avertable mortality from NCDs, but progress has been uneven across populations. Countries vary substantially in current levels and trends and, hence, the extent to which they are on track to achieve SDG 3.4. By accounting for premature avertable mortality while avoiding arbitrary age cutoffs, premature avertable mortality from NCDs is a robust, comprehensive, and actionable indicator for quantifying and monitoring global and national progress towards NCD prevention and control.
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到 2030 年，将与非传染性疾病（NCD）相关的过早死亡人数减少三分之一，这是可持续发展目标 3.4 的一项宏伟目标。然而，该指标的定义过于狭隘，仅包括四大主要 NCD（心血管疾病、癌症、糖尿病和慢性呼吸道疾病），且仅针对 30-70 岁人群。本研究侧重于可预防的 NCD 过早死亡——通过有效的公共政策和卫生干预措施可预防的 NCD 过早死亡，或可通过高质量的医疗保健来治疗的 NCD 过早死亡——利用 2017 年全球疾病、伤害和危险因素研究（GBD）的数据，在全球、区域和国家各级评估趋势。
我们查阅了现有的 NCD 死因清单，这些死因要么可以通过公共卫生政策和干预措施预防，要么可以通过医疗保健治疗，从而创建了一个可预防的 NCD 死因清单，并将其映射到 GBD 死因清单上。我们估计了由于可预防的 NCD 过早死亡、可预防的 NCD 病因集群以及不可预防的 NCD 病因而导致的每 100000 人年龄标准化的生命损失年数（YLL），并按性别、地点和年份报告了其 95%置信区间（UI）。我们研究了由于可预防和不可预防的 NCD 导致的年龄标准化 YLL 的趋势，评估了实现可持续发展目标 3.4 过程中 NCD 可预防过早死亡的进展，并探讨了可能对过早死亡率整体趋势产生重大影响的特定可预防的 NCD 病因集群。
全球范围内，两性结合的 NCD 过早死亡人数每年减少 1.3%（95%UI 为 1.4%至 1.2%），从 1990 年的 12855 年（11809 年至 14051 年）降至 2017 年的 9008 年（8329 年至 9756 年）。然而，可预防的 NCD 死亡人数绝对数增加了 49.3%（95%UI 为 47.3%至 52.2%），从 1990 年的 2310 万人（220 万人至 241 万人）增加到 2017 年的 3450 万人（334 万人至 356 万人）。1990 年至 2017 年，全球每个世界卫生组织区域和大多数国家和地区的 NCD 可预防过早死亡率都有所下降。尽管取得了这些进展，但只有西太平洋和欧洲区域以及 25 个国家（其中大多数为高收入国家）有望实现可持续发展目标 3.4。自 2017 年以来，全球减少可预防的 NCD 过早死亡的速度有所放缓。2017 年，中低收入国家主要集中在东南亚、东地中海和非洲区域，高 NCD 可预防过早死亡率。大多数国家在 1990 年至 2017 年期间此类死亡率的年降幅较大，到 2017 年已经达到了较低的 NCD 可预防过早死亡率水平。一些国家，最典型的例子是阿富汗、中非共和国、乌兹别克斯坦、海地、蒙古、土库曼斯坦、巴基斯坦、乌克兰、老挝和埃及，报告称其 NCD 可预防过早死亡率呈上升趋势且水平较高。心血管疾病、癌症和慢性呼吸道疾病一直是全球和区域减少可预防的 NCD 过早死亡的主要驱动因素，而物质使用障碍、慢性肾脏病和急性肾小球肾炎以及糖尿病的过早死亡率则在上升。
全世界范围内，NCD 可预防过早死亡率已经大幅下降，但人群之间的进展不平衡。各国在目前的水平和趋势方面存在很大差异，因此，它们在实现可持续发展目标 3.4 方面的进展情况也有所不同。通过考虑可预防的 NCD 过早死亡，同时避免任意的年龄截止值，可预防的 NCD 过早死亡率是一个稳健、全面和可操作的指标，用于量化和监测全球和国家在预防和控制 NCD 方面的进展。
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