1998 - 2019年尼日利亚与其他西非国家的人群健康结果：全球疾病负担研究的系统分析
Population health outcomes in Nigeria compared with other west African countries, 1998-2019: a systematic analysis for the Global Burden of Disease Study.
作者信息
Angell Blake, Sanuade Olutobi, Adetifa Ifedayo M O, Okeke Iruka N, Adamu Aishatu Lawal, Aliyu Muktar H, Ameh Emmanuel A, Kyari Fatima, Gadanya Muktar A, Mabayoje Diana A, Yinka-Ogunleye Adesola, Oni Tolu, Jalo Rabiu Ibrahim, Tsiga-Ahmed Fatimah I, Dalglish Sarah L, Abimbola Seye, Colbourn Tim, Onwujekwe Obinna, Owoaje Eme Theodora, Aliyu Gambo, Aliyu Sani H, Archibong Belinda, Ezeh Alex, Ihekweazu Chikwe, Iliyasu Zubairu, Obaro Stephen, Obadare Ebenezer Babatunde, Okonofua Friday, Pate Muhammed, Salako Babatunde L, Zanna Fatima H, Glenn Scott, Walker Ally, Ezalarab Maha, Naghavi Mohsen, Abubakar Ibrahim
机构信息
UCL Institute for Global Health, University College London, London, UK; The George Institute for Global Health, University of New South Wales, Sydney, Sydney, NSW, Australia.
UCL Institute for Global Health, University College London, London, UK; Center for Global Cardiovascular Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
出版信息
Lancet. 2022 Mar 19;399(10330):1117-1129. doi: 10.1016/S0140-6736(21)02722-7. Epub 2022 Mar 15.
BACKGROUND
Population-level health and mortality data are crucial for evidence-informed policy but scarce in Nigeria. To fill this gap, we undertook a comprehensive assessment of the burden of disease in Nigeria and compared outcomes to other west African countries.
METHODS
In this systematic analysis, using data and results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we analysed patterns of mortality, years of life lost (YLLs), years lived with disability (YLDs), life expectancy, healthy life expectancy (HALE), and health system coverage for Nigeria and 15 other west African countries by gender in 1998 and 2019. Estimates of all-age and age-standardised disability-adjusted life-years for 369 diseases and injuries and 87 risk factors are presented for Nigeria. Health expenditure per person and gross domestic product were extracted from the World Bank repository.
FINDINGS
Between 1998 and 2019, life expectancy and HALE increased in Nigeria by 18% to 64·3 years (95% uncertainty interval [UI] 62·2-66·6), mortality reduced for all age groups for both male and female individuals, and health expenditure per person increased from the 11th to third highest in west Africa by 2018 (US$18·6 in 2001 to $83·75 in 2018). Nonetheless, relative outcomes remained poor; Nigeria ranked sixth in west Africa for age-standardised mortality, seventh for HALE, tenth for YLLs, 12th for health system coverage, and 14th for YLDs in 2019. Malaria (5176·3 YLLs per 100 000 people, 95% UI 2464·0-9591·1) and neonatal disorders (4818·8 YLLs per 100 000, 3865·9-6064·2) were the leading causes of YLLs in Nigeria in 2019. Nigeria had the fourth-highest under-five mortality rate for male individuals (2491·8 deaths per 100 000, 95% UI 1986·1-3140·1) and female individuals (2117·7 deaths per 100 000, 1756·7-2569·1), but among the lowest mortality for men older than 55 years. There was evidence of a growing non-communicable disease burden facing older Nigerians.
INTERPRETATION
Health outcomes remain poor in Nigeria despite higher expenditure since 2001. Better outcomes in countries with equivalent or lower health expenditure suggest health system strengthening and targeted intervention to address unsafe water sources, poor sanitation, malnutrition, and exposure to air pollution could substantially improve population health.
FUNDING
The Bill & Melinda Gates Foundation.
背景
人群层面的健康和死亡率数据对于循证决策至关重要，但在尼日利亚却很稀缺。为填补这一空白，我们对尼日利亚的疾病负担进行了全面评估，并将结果与其他西非国家进行了比较。
方法
在这项系统分析中，我们利用2019年全球疾病、伤害及风险因素负担研究的数据和结果，分析了1998年和2019年尼日利亚以及其他15个西非国家按性别划分的死亡率、寿命损失年数（YLLs）、伤残调整生命年数（YLDs）、预期寿命、健康预期寿命（HALE）以及卫生系统覆盖率。呈现了尼日利亚369种疾病和伤害以及87种风险因素的全年龄和年龄标准化伤残调整生命年数估计值。人均卫生支出和国内生产总值数据来自世界银行数据库。
结果
1998年至2019年期间，尼日利亚的预期寿命和健康预期寿命增加了18%，达到64.3岁（95%不确定区间[UI]为62.2 - 66.6），男女各年龄组的死亡率均有所下降，到2018年人均卫生支出从西非第11位升至第3位（从2001年的18.6美元升至2018年的83.75美元）。尽管如此，相对结果仍然较差；2019年，尼日利亚在西非的年龄标准化死亡率排名第六，健康预期寿命排名第七，寿命损失年数排名第十，卫生系统覆盖率排名第十二，伤残调整生命年数排名第十四。疟疾（每10万人5176.3个寿命损失年数，95% UI为2464.0 - 9591.1）和新生儿疾病（每10万人4818.8个寿命损失年数，3865.9 - 6064.2）是2019年尼日利亚寿命损失年数的主要原因。尼日利亚5岁以下男性死亡率（每10万人2491.8例死亡，95% UI为1986.1 - 3140.1）和女性死亡率（每10万人2117.7例死亡，1756.7 - 2569.1）在西非排名第四，但55岁以上男性死亡率在西非处于最低水平之一。有证据表明，尼日利亚老年人面临的非传染性疾病负担在不断增加。
解读
尽管自2001年以来卫生支出有所增加，但尼日利亚的健康结果仍然较差。在卫生支出相当或更低的国家取得了更好的结果，这表明加强卫生系统以及针对不安全水源、卫生条件差、营养不良和接触空气污染等问题进行有针对性的干预，可以大幅改善人群健康。
资金来源
比尔及梅琳达·盖茨基金会。
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