Louw Q, Grimmer K, Berner K, Conradie T, Bedada D T, Jesus T S
Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
BMC Public Health. 2021 May 13;21(1):913. doi: 10.1186/s12889-021-10962-y.
Rehabilitation can improve function in many people with chronic health conditions. It is important to consider priority conditions requiring rehabilitation, so it can be realistically positioned and costed in national health financing systems like South Africa (SA)'s proposed National Health Insurance (NHI). This paper describes temporal trends of top-ranked conditions on years lived with disability (YLDs) rates in SA, for which physical rehabilitation can ameliorate associated disability.
This study is a systematic synthesis of publicly available Global Burden of Disease (GBD) 2017 estimates. The top 11 conditions contributing most to YLDs and for which evidence-based rehabilitation interventions exist were identified. Age-standardized rates per 100,000 and YLDs counts were extracted from 1990 to 2017. Significance of changes in temporal trends was determined using Mann-Kendall trend tests. Best-fit rates of yearly changes were calculated per condition, using GBD estimates (2012-2017), and extrapolated (by imposing the best-fit regression line onto results for each subsequent predicted year) as forecasts (2018-2022).
Trends for YLDs counts per condition year (1990-2017) and forecasted values (2018-2022) showed an overall steady increase for all conditions, except HIV and respiratory conditions. YLDs counts almost doubled from 1990 to 2017, with a 17% predicted increase from 2017 to 2022. The proportionate contribution to YLDs counts reduced over time for all conditions, except HIV. Although age-standardized YLDs rates appear relatively stable over the analyzed periods for all conditions (except HIV, respiratory conditions and type 2 diabetes), trend changes in YLDs rates over 28 years were significant for all conditions, except neonatal (p = 0.855), hearing loss (p = 0.100) and musculoskeletal conditions (p = 0.300). Significant trend decreases were apparent for 4/9 conditions, implying that another 5/9 conditions showed trend increases over 28 years. Predicted all-age prevalence in 2022 suggests relatively large increases for cardiovascular disease and heart failure, and burns, while relative decreases are predicted for fractures and dislocations, stroke, and musculoskeletal conditions.
Rehabilitation needs in SA are potentially massive and unmet, highlighting the need for innovative and context-specific rehabilitation that considers current local needs and projected changes. These findings should be considered when designing the NHI and other schemes in SA to ensure human and financial resources are deployed efficiently.
康复可改善许多慢性病患者的功能。考虑需要康复的优先疾病很重要，这样才能在南非（SA）提议的国家健康保险（NHI）等国家卫生筹资系统中进行合理定位并计算成本。本文描述了南非按残疾生存年数（YLDs）率排名靠前的疾病的时间趋势，针对这些疾病，物理康复可改善相关残疾状况。
本研究是对公开可得的《2017年全球疾病负担（GBD）》估计数据的系统综合分析。确定了对YLDs贡献最大且有循证康复干预措施的11种疾病。提取了1990年至2017年每10万人的年龄标准化率和YLDs计数。使用曼 - 肯德尔趋势检验确定时间趋势变化的显著性。利用GBD估计数据（2012 - 2017年）计算每种疾病每年变化的最佳拟合率，并进行外推（通过将最佳拟合回归线应用于每个后续预测年份的结果）作为预测（2018 - 2022年）。
每种疾病每年的YLDs计数趋势（1990 - 2017年）和预测值（2018 - 2022年）显示，除了艾滋病毒和呼吸道疾病外，所有疾病总体呈稳步上升趋势。YLDs计数从1990年到2017年几乎翻倍，预计2017年到2022年将增加17%。除艾滋病毒外，所有疾病对YLDs计数的比例贡献随时间减少。尽管在分析期内所有疾病（除艾滋病毒、呼吸道疾病和2型糖尿病外）的年龄标准化YLDs率似乎相对稳定，但28年中所有疾病（除新生儿疾病（p = 0.855）、听力损失（p = 0.100）和肌肉骨骼疾病（p = 0.300）外）的YLDs率趋势变化都具有显著性。4/9种疾病出现显著的趋势下降，这意味着另外5/9种疾病在28年中呈趋势上升。2022年预测的全年龄段患病率表明，心血管疾病、心力衰竭和烧伤患病率将有较大幅度上升，而骨折和脱位、中风以及肌肉骨骼疾病患病率预计将相对下降。
南非的康复需求可能巨大且未得到满足，这凸显了需要开展创新且因地制宜的康复服务，要考虑当前当地需求和预计变化。在设计南非的国家健康保险和其他计划时应考虑这些发现，以确保人力和财力资源得到有效配置。
