National Institute for Medical Research, Dar es Salaam, Tanzania.
SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania.
PLoS One. 2020 Jun 9;15(6):e0234300. doi: 10.1371/journal.pone.0234300. eCollection 2020.
BACKGROUND: Mortality statistics are traditionally used to quantify the burden of disease and to determine the relative importance of the various causes of death. Some of the most frequently used indices to quantify the burden of disease are the years of potential life lost (YPLL) and years of potential productive life lost (YPPLL). These two measures reflect the mortality trends in younger age groups and they provide a more accurate picture of premature mortality. This study was carried out to determine YPLL, YPPLL and cost of productivity lost (CPL) due to premature mortality caused by selected causes of deaths in Tanzania. METHODS AND FINDINGS: Malaria, respiratory diseases, HIV/AIDS, tuberculosis, cancers and injuries were selected for this analysis. The number of deaths by sex and age groups were obtained from hospital death registers and ICD-10 reporting forms in 39 public hospitals in Tanzania, covering a period of 2006-2015. The life expectancy method and human capital approach were used to estimate the YPLL, YPPLL and CPL due to premature mortality. During 2006-2015, malaria, HIV/AIDS, tuberculosis, respiratory diseases, HIV+tuberculosis, cancer and injury were responsible for a total of 96,834 hospital deaths, of which 46.4% (n = 57,508) were among individuals in the productive age groups (15-64 years). The reported deaths contributed to 2,850,928 YPLL (female = 1,326,724; male = 1,524,205) with an average of 29 years per death. The average YPLL among females (32) was higher than among males (28). Malaria (YPLL = 38 per death) accounted for over one-third (35%) of the total YPLL. There was a significant increase in YPLL due to the selected underlying causes of death over the 10-year period. Deaths from the selected causes resulted into 1,207,499 YPPLL (average = 21 per death). Overall, HIV/AIDS contributed to the highest YPPLL (323,704), followed by malaria (243,490) and injuries (196,505). While there was a general decrease in YPPLL due to malaria, there was an increase of YPPLL due to HIV/AIDS, respiratory diseases, cancer and injuries during the 10-year period. The total CPL due to the six diseases was US$ 148,430,009 for 10 years. The overall CPL was higher among males than females by 29.1%. Over half (58%) of the losses were due to deaths among males. HIV/AIDS accounted for the largest (29.2%) CPL followed by malaria (17.8%) and respiratory diseases (14.6%). The CPL increased from US$11.4 million in 2006 to US$17.9 million in 2016. CONCLUSIONS: The YPLL, YPPLL and CPL due to premature death associated with the six diseases in Tanzania are substantially high. While malaria accounted for highest YPLL, HIV/AIDS accounted for highest YPPLL and CPL. The overall CPL was higher among males than among females. Setting resource allocation priorities to malaria, HIV/AIDS and respiratory diseases that are responsible for the majority of premature deaths could potentially reduce the costs of productivity loss in Tanzania.
背景:死亡率统计数据传统上用于量化疾病负担,并确定各种死因的相对重要性。用于量化疾病负担的一些最常用指标是潜在寿命损失年数(YPLL)和潜在工作生产损失年数(YPPLL)。这两个指标反映了年轻人群的死亡率趋势,更准确地反映了过早死亡的情况。本研究旨在确定坦桑尼亚选定死因导致的过早死亡的 YPLL、YPPLL 和生产力损失成本(CPL)。
方法和发现:疟疾、呼吸道疾病、艾滋病毒/艾滋病、结核病、癌症和伤害被选为此项分析的原因。通过医院死亡登记处和坦桑尼亚 39 家公立医院的 ICD-10 报告表获得了按性别和年龄组划分的死亡人数,涵盖了 2006 年至 2015 年期间的数据。采用预期寿命法和人力资本法来估算由于过早死亡而导致的 YPLL、YPPLL 和 CPL。2006 年至 2015 年期间,疟疾、艾滋病毒/艾滋病、结核病、呼吸道疾病、艾滋病毒/结核病、癌症和伤害导致了坦桑尼亚 39 家公立医院共 96834 例医院死亡,其中 46.4%(n=57508)发生在 15-64 岁的生产年龄组。报告的死亡导致 2850928 个 YPLL(女性=1326724;男性=1524205),平均每例死亡损失 29 年。女性的平均 YPLL(32)高于男性(28)。疟疾(YPLL=每例死亡 38 年)占总 YPLL 的三分之一以上(35%)。在过去 10 年中,由于选定的根本死因导致的 YPLL 显著增加。所选死因导致的死亡导致 1207499 个 YPPLL(平均=每例死亡 21 年)。总体而言,艾滋病毒/艾滋病导致的 YPPLL 最高(323704),其次是疟疾(243490)和伤害(196505)。虽然疟疾导致的 YPPLL 普遍下降,但在过去 10 年中,艾滋病毒/艾滋病、呼吸道疾病、癌症和伤害导致的 YPPLL 有所增加。六种疾病导致的总 CPL 为 10 年 14843 万美元。总体而言,男性的 CPL 比女性高 29.1%。损失的一半以上(58%)是由于男性死亡造成的。艾滋病毒/艾滋病导致的 CPL 最大(29.2%),其次是疟疾(17.8%)和呼吸道疾病(14.6%)。CPL 从 2006 年的 1140 万美元增加到 2016 年的 1790 万美元。
结论:坦桑尼亚六种疾病导致的过早死亡的 YPLL、YPPLL 和 CPL 非常高。虽然疟疾导致的 YPLL 最高,但艾滋病毒/艾滋病导致的 YPPLL 和 CPL 最高。总的来说,男性的 CPL 比女性高。优先配置资源,重点解决疟疾、艾滋病毒/艾滋病和呼吸道疾病问题,这些疾病是导致过早死亡的主要原因,这可能会降低坦桑尼亚的生产力损失成本。
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