全球范围内 1990 年至 2019 年的自身免疫性疾病负担和国家间不平等。
Global burden and cross-country inequalities in autoimmune diseases from 1990 to 2019.
机构信息
Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China; Department of clinical medicine, The Second School of Clinical Medicine, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China.
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China.
出版信息
Autoimmun Rev. 2023 Jun;22(6):103326. doi: 10.1016/j.autrev.2023.103326. Epub 2023 Mar 22.
AIM
To describe burden, and to explore cross-country inequalities across sociodemographic development levels for four autoimmune diseases (ADs) including rheumatoid arthritis (RA), inflammatory bowel disease (IBD), multiple sclerosis (MS) and psoriasis (PS).
METHODS
The estimates and their 95% uncertainty interval (UI) for disability-adjusted life-years (DALYs) of RA, IBD, MS and PS were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Age-standardized DALYs rate (ASDR) across 204 countries, as well as age and sex distribution of global DALYs rate of these four ADs were illustrated. Slope index of inequality and concentration index, which are two standard metrics of absolute and relative gradient inequality recommended by World Health Organization (WHO), were utilized to quantify the distributive inequalities in the burden of ADs.
RESULTS
In 2019, the ASDR of RA, IBD, MS and PS varied remarkably across 204 countries, with different age and sex distribution of global DALYs rate. The slope index of inequality changed from 26.7 (95% CI: 20.7 to 32.8) in 1990 to 40.3 (95% CI: 31.9 to 48.7) in 2019 for RA, from 17.1 (95% CI: 12.4 to 21.7) in 1990 to 25.2 (95% CI: 20.1 to 30.2) in 2019 for IBD, from 19.3 (95% CI: 15.2 to 23.4) in 1990 to 28.9 (95% CI: 24.2 to 33.5) in 2019 for MS, from 42.3 (95% CI: 33.1 to 51.6) in 1990 to 40.2 (95% CI: 32.5 to 48.0) in 2019 for PS. Moreover, the concentration index showed 20.4 (95% CI: 18.9 to 22.0) in 1990 and 18.2 (95% CI: 16.7 to 19.6) in 2019 for RA, 25.0 (95% CI: 23.0 to 27.1) in 1990 and 33.5 (95% CI: 31.6 to 35.5) in 2019 for IBD, 46.7 (95% CI: 44.0 to 49.3) in 1990 and 41.8 (95% CI: 39.6 to 44.1) in 2019 for MS, 31.7 (95% CI: 29.0 to 34.4) in 1990 and 32.6 (95% CI: 29.9 to 35.2) in 2019 for PS.
CONCLUSIONS
There is a strong heterogeneity in ASDR across all countries, as well as in age and sex distribution of global DALYs rate for four ADs including RA, IBD, MS and PS. Countries with higher sociodemographic development levels shouldered disproportionately higher burden of ADs, and the magnitude of this sociodemographic development level-related inequalities exacerbated over time.
目的
描述负担，并探索包括类风湿关节炎（RA）、炎症性肠病（IBD）、多发性硬化症（MS）和银屑病（PS）在内的四种自身免疫性疾病（ADs）在社会人口发展水平上的跨国不平等。
方法
从全球疾病、伤害和危险因素研究（GBD）2019 中提取 RA、IBD、MS 和 PS 的残疾调整生命年（DALYs）估计值及其 95%不确定区间（UI）。说明了 204 个国家的年龄标准化 DALYs 率（ASDR）以及这些四种 AD 的全球 DALYs 率的年龄和性别分布。使用世界卫生组织（WHO）推荐的两种标准衡量绝对和相对梯度不平等的不平等斜率指数和集中指数，来量化 AD 负担的分布不平等。
结果
2019 年，204 个国家的 RA、IBD、MS 和 PS 的 ASDR 差异显著，全球 DALYs 率的年龄和性别分布也不同。RA 的不平等斜率指数从 1990 年的 26.7（95%置信区间：20.7 至 32.8）变化到 2019 年的 40.3（95%置信区间：31.9 至 48.7），IBD 从 1990 年的 17.1（95%置信区间：12.4 至 21.7）变化到 2019 年的 25.2（95%置信区间：20.1 至 30.2），MS 从 1990 年的 19.3（95%置信区间：15.2 至 23.4）变化到 2019 年的 28.9（95%置信区间：24.2 至 33.5），PS 从 1990 年的 42.3（95%置信区间：33.1 至 51.6）变化到 2019 年的 40.2（95%置信区间：32.5 至 48.0）。此外，1990 年的集中指数为 20.4（95%置信区间：18.9 至 22.0），2019 年为 18.2（95%置信区间：16.7 至 19.6）；1990 年为 25.0（95%置信区间：23.0 至 27.1），2019 年为 33.5（95%置信区间：31.6 至 35.5）；1990 年为 46.7（95%置信区间：44.0 至 49.3），2019 年为 41.8（95%置信区间：39.6 至 44.1）；1990 年为 31.7（95%置信区间：29.0 至 34.4），2019 年为 32.6（95%置信区间：29.9 至 35.2）。
结论
所有国家的 ASDR 以及 RA、IBD、MS 和 PS 四种 AD 的全球 DALYs 率的年龄和性别分布都存在很大的异质性。社会人口发展水平较高的国家承受着不成比例的 AD 负担，而且这种社会人口发展水平相关的不平等程度随着时间的推移而加剧。
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