估算 2000 年、2006 年和 2012 年南非归因于空腹血糖升高的疾病负担变化情况。

Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.

Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

S Afr Med J. 2022 Sep 30;112(8b):594-606. doi: 10.7196/SAMJ.2022.v112i8b.16659.

BACKGROUND

Worldwide, higher-than-optimal fasting plasma glucose (FPG) is among the leading modifiable risk factors associated with all- cause mortality and disability-adjusted life years (DALYs) due to the direct sequelae of diabetes and the increased risk for cardiovascular and chronic kidney disease.

OBJECTIVES

To report deaths and DALYs of health outcomes attributable to high FPG by age and sex for South Africa (SA) for 2000, 2006 and 2012.

METHODS

Comparative risk assessment methodology was used to estimate the burden attributable to high FPG. A meta-regression analysis was performed using data from national and small-area studies to estimate the population distribution of FPG and diabetes prevalence. Attributable fractions were calculated for selected health outcomes and applied to local burden estimates from the second South African National Burden of Disease Study (SANBD2). Age-standardised rates were calculated using World Health Organization world standard population weights.

RESULTS

We estimated a 5% increase in mean FPG from 5.31 (95% confidence interval (CI) 5.18 - 5.43) mmol/L to 5.57 (95% CI 5.41 - 5.72) mmol/L and a 75% increase in diabetes prevalence from 7.3% (95% CI 6.7 - 8.3) to 12.8% (95% CI 11.9 - 14.0) between 2000 and 2012. The age-standardised attributable death rate increased from 153.7 (95% CI 126.9 - 192.7) per 100 000 population in 2000 to 203.5 (95% CI 172.2 - 240.8) per 100 000 population in 2012, i.e. a 32.4% increase. During the same period, age-standardised attributable DALY rates increased by 43.8%, from 3 000 (95% CI 2 564 - 3 602) per 100 000 population in 2000 to 4 312 (95% CI 3 798 - 4 916) per 100 000 population in 2012. In each year, females had similar attributable death rates to males but higher DALY rates. A notable exception was tuberculosis, with an age-standardised attributable death rate in males double that in females in 2000 (14.3 v. 7.0 per 100 000 population) and 2.2 times higher in 2012 (18.4 v. 8.5 per 100 000 population). Similarly, attributable DALY rates were higher in males, 1.7 times higher in 2000 (323 v. 186 per 100 000 population) and 1.6 times higher in 2012 (502 v. 321 per 100 000 population). Between 2000 and 2012, the age-standardised death rate for chronic kidney disease increased by 98.3% (from 11.7 to 23.1 per 100 000 population) and the DALY rate increased by 116.9% (from 266 to 578 per 100 000 population).

CONCLUSION

High FPG is emerging as a public health crisis, with an attributable burden doubling between 2000 and 2012. The consequences are costly in terms of quality of life, ability to earn an income, and the economic and emotional burden on individuals and their families. Urgent action is needed to curb the increase and reduce the burden associated with this risk factor. National data on FPG distribution are scant, and efforts are warranted to ensure adequate monitoring of the effectiveness of the interventions.

背景

在全球范围内，由于糖尿病的直接后果以及心血管疾病和慢性肾脏病风险增加，高于最佳空腹血糖（FPG）是所有原因死亡和残疾调整生命年（DALYs）的主要可改变风险因素之一。

目的

报告 2000 年、2006 年和 2012 年南非（SA）高 FPG 导致的健康结果的死亡人数和 DALY。

方法

采用比较风险评估方法估计高 FPG 所致负担。利用国家和小区域研究的数据进行荟萃回归分析，估计 FPG 和糖尿病患病率的人群分布。为选定的健康结果计算归因分数，并将其应用于第二次南非国家疾病负担研究（SANBD2）的当地负担估计。使用世界卫生组织世界标准人口权重计算年龄标准化率。

结果

我们估计，2000 年至 2012 年间，平均 FPG 从 5.31（95%置信区间（CI）5.18-5.43）mmol/L 增加到 5.57（95% CI 5.41-5.72）mmol/L，糖尿病患病率从 7.3%（95% CI 6.7-8.3）增加到 75%，至 12.8%（95% CI 11.9-14.0）。2000 年年龄标准化归因死亡率为每 100 000 人 153.7（95% CI 126.9-192.7），2012 年增加到每 100 000 人 203.5（95% CI 172.2-240.8），即增加了 32.4%。同期，年龄标准化归因 DALY 率增加了 43.8%，从 2000 年的每 100 000 人 3000（95% CI 2564-3602）增加到 2012 年的每 100 000 人 4312（95% CI 3798-4916）。在每年中，女性的归因死亡率与男性相似，但 DALY 率更高。结核病是一个显著的例外，2000 年男性的年龄标准化归因死亡率是女性的两倍（每 100 000 人 14.3 对 7.0），2012 年则高出两倍（每 100 000 人 18.4 对 8.5）。同样，归因 DALY 率在男性中更高，2000 年高出 1.7 倍（每 100 000 人 323 对 186），2012 年高出 1.6 倍（每 100 000 人 502 对 321）。2000 年至 2012 年间，慢性肾脏病的年龄标准化死亡率增加了 98.3%（从每 100 000 人 11.7 增加到 23.1），DALY 率增加了 116.9%（从每 100 000 人 266 增加到 578）。

结论

高 FPG 正在成为一个公共卫生危机，2000 年至 2012 年期间负担增加了一倍。其后果是生活质量、赚取收入的能力以及个人及其家庭的经济和情感负担的代价高昂。需要采取紧急行动来遏制这一风险因素的增加并减轻与之相关的负担。南非 FPG 分布的国家数据很少，有必要努力确保对干预措施的有效性进行充分监测。