Lancet Diabetes Endocrinol. 2022 Sep;10(9):655-667. doi: 10.1016/S2213-8587(22)00186-3. Epub 2022 Jul 15.
High prevalence of diabetes has been reported in the Americas, but no comprehensive analysis of diabetes burden and related factors for the region is available. We aimed to describe the burden of type 1 and type 2 diabetes and that of hyperglycaemia in the Americas from 1990 to 2019.
We used estimates from GBD 2019 to evaluate the burden of diabetes in adults aged 20 years or older and high fasting plasma glucose in adults aged 25 years or older in the 39 countries and territories of the six regions in the Americas from 1990 to 2019. The main source to estimate the mortality attributable to diabetes and to chronic kidney disease due to diabetes was vital registration. Mortality due to overall diabetes (ie, diabetes and diabetes due to chronic kidney disease) was estimated using the Cause of Death Ensemble model. Years of life lost (YLLs) were calculated as the number of deaths multiplied by standard life expectancy at the age that the death occurred, years lived with disability (YLDs) were estimated based on the prevalence and severity of complications of diabetes. Disability-adjusted life-years (DALYs) were estimated as a sum of YLDs and YLLs. We assessed the association of diabetes burden with the level of development of a country (according to the Socio-demographic Index), health-care access and quality (estimated with the Healthcare Access and Quality Index), and diabetes prevalence. We also calculated the population attributable fraction (PAF) of diabetes burden due to each of its risk factors. We report the 95% uncertainty intervals for all estimates.
In 2019, an estimated total of 409 000 (95% uncertainty interval 373 000-443 000) adults aged 20 years or older in the Americas died from diabetes, which represented 5·9% of all deaths. Diabetes was responsible for 2266 (1930-2649) crude DALYs per 100 000 adults in the Americas, and high fasting plasma glucose for 4401 DALYs (3685-5265) per 100 000 adults, with large variation across regions. DALYs were mostly due to type 2 diabetes and distribution was heterogeneous, being highest in central Latin America and the Caribbean and lowest in high-income North America and southern Latin America. Between 1990 and 2019, age-standardised DALYs due to type 2 diabetes increased 27·4% (22·0-32·5). This increase was particularly high in Andean Latin America and high-income North America. Burden for both type 1 and type 2 diabetes across countries increased with higher diabetes prevalence and decreased with greater Socio-demographic and Healthcare Access and Quality Indices. Main risk factors for the burden were high BMI, with a PAF of 63·2% and dietary risks, with a PAF of 27·5%. The fraction of burden due to disability has increased since 1990 and now represents nearly half of the overall burden in 2019.
The burden of diabetes in the Americas is large, increasing, heterogeneous, and expanding. To confront the rising burden, population-based interventions aimed to reduce type 2 diabetes risk and strengthening health systems to provide effective and cost-efficient care for those affected are mandatory.
Bill & Melinda Gates Foundation.
美洲的糖尿病患病率很高，但该地区尚无全面分析糖尿病负担和相关因素的报告。我们旨在描述 1990 年至 2019 年期间美洲地区 1 型和 2 型糖尿病以及高血糖的负担。
我们使用 GBD 2019 的估计数来评估 39 个国家和地区的 6 个区域中，20 岁及以上成年人的糖尿病负担以及 25 岁及以上成年人的高空腹血糖负担。估计糖尿病死亡率和糖尿病导致的慢性肾脏病死亡率的主要数据源是生命登记。使用死因综合模型估计与糖尿病相关的总体死亡率（即糖尿病和糖尿病导致的慢性肾脏病）。用死亡人数乘以死亡时的标准预期寿命来计算生命损失年（YLLs），根据糖尿病并发症的流行率和严重程度来估算伤残生命年（YLDs）。通过 YLDs 和 YLLs 的总和来计算伤残调整生命年（DALYs）。我们评估了糖尿病负担与国家发展水平（根据社会人口指数）、医疗保健可及性和质量（用医疗保健可及性和质量指数评估）以及糖尿病流行率之间的关联。我们还计算了由于每个风险因素而导致的糖尿病负担的人群归因分数（PAF）。我们报告了所有估计值的 95%置信区间。
2019 年，美洲估计有 409000 名（95%置信区间为 373000-443000）20 岁及以上成年人死于糖尿病，占所有死亡人数的 5.9%。糖尿病导致美洲每 10 万人中有 2266 个（1930-2649）粗伤残调整生命年，高空腹血糖导致每 10 万人中有 4401 个伤残调整生命年（3685-5265），不同地区之间存在较大差异。伤残调整生命年主要归因于 2 型糖尿病，分布不均，中拉丁美洲和加勒比地区最高，高收入北美和南拉丁美洲最低。1990 年至 2019 年间，归因于 2 型糖尿病的年龄标准化伤残调整生命年增加了 27.4%（22.0-32.5）。这种增长在安第斯拉丁美洲和高收入北美尤为明显。随着糖尿病患病率的升高，各国的 1 型和 2 型糖尿病负担均有所增加，而随着社会人口指数和医疗保健可及性和质量指数的提高，负担则有所降低。主要的风险因素是高 BMI，其 PAF 为 63.2%，饮食风险的 PAF 为 27.5%。自 1990 年以来，残疾负担的比例一直在增加，现在占 2019 年总负担的近一半。
美洲的糖尿病负担很大，且呈上升趋势、存在异质性、不断扩大。为应对不断增加的负担，必须采取以人群为基础的干预措施，旨在降低 2 型糖尿病的风险，并加强卫生系统，为受影响者提供有效和具有成本效益的护理。
比尔及梅琳达·盖茨基金会。
