Patwardhan Vedavati, Gil Gabriela F, Arrieta Alejandra, Cagney Jack, DeGraw Erin, Herbert Molly E, Khalil Mariam, Mullany Erin C, O'Connell Erin M, Spencer Cory N, Stein Caroline, Valikhanova Aiganym, Gakidou Emmanuela, Flor Luisa S
Center on Gender Equity and Health, University of California, San Diego, CA, USA.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Lancet Public Health. 2024 May;9(5):e282-e294. doi: 10.1016/S2468-2667(24)00053-7.
BACKGROUND: Sex and gender shape health. There is a growing body of evidence focused on comprehensively and systematically examining the magnitude, persistence, and nature of differences in health between females and males. Here, we aimed to quantify differences in the leading causes of disease burden between females and males across ages and geographies. METHODS: We used the Global Burden of Disease Study 2021 to compare disability-adjusted life-year (DALY) rates for females and males for the 20 leading causes of disease burden for individuals older than 10 years at the global level and across seven world regions, between 1990 and 2021. We present absolute and relative differences in the cause-specific DALY rates between females and males. FINDINGS: Globally, females had a higher burden of morbidity-driven conditions with the largest differences in DALYs for low back pain (with 478·5 [95% uncertainty interval 346·3-632·8] more DALYs per 100 000 individuals among females than males), depressive disorders (348·3 [241·3-471·0]), and headache disorders (332·9 [48·3-731·9]), whereas males had higher DALY rates for mortality-driven conditions with the largest differences in DALYs for COVID-19 (with 1767·8 [1581·1-1943·5] more DALYs per 100 000 among males than females), road injuries (1012·2 [934·1-1092·9]), and ischaemic heart disease (1611·8 [1405·0-1856·3]). The differences between sexes became larger over age and remained consistent over time for all conditions except HIV/AIDS. The largest difference in HIV/AIDS was observed among those aged 25-49 years in sub-Saharan Africa with 1724·8 (918·8-2613·7) more DALYs per 100 000 among females than males. INTERPRETATION: The notable health differences between females and males point to an urgent need for policies to be based on sex-specific and age-specific data. It is also important to continue promoting gender-sensitive research, and ultimately, implement interventions that not only reduce the burden of disease but also achieve greater health equity. FUNDING: Bill & Melinda Gates Foundation.
背景：性别影响健康状况。越来越多的证据聚焦于全面系统地研究女性和男性在健康方面差异的程度、持续性及本质。在此，我们旨在量化不同年龄和地域的女性与男性之间疾病负担主要原因的差异。 方法：我们利用《2021年全球疾病负担研究》，比较了1990年至2021年期间全球及七个世界区域10岁以上人群中，女性和男性因20种主要疾病负担原因导致的伤残调整生命年（DALY）率。我们展示了女性和男性在特定病因DALY率上的绝对差异和相对差异。 研究结果：在全球范围内，女性在以发病率为主导的疾病状况中负担较重，其中下背痛的DALY差异最大（每10万人中，女性比男性多478.5[95%不确定区间346.3 - 632.8]个DALY）、抑郁症（348.3[241.3 - 471.0]）和头痛症（332.9[48.3 - 731.9]）；而男性在以死亡率为主导的疾病状况中DALY率较高，其中COVID - 19的DALY差异最大（每10万人中，男性比女性多1767.8[1581.1 - 1943.5]个DALY）、道路伤害（1012.2[934.1 - 1092.9]）和缺血性心脏病（1611.8[1405.0 - 1856.3]）。除艾滋病毒/艾滋病外，所有疾病状况下，性别差异随年龄增长而增大，且随时间保持一致。在撒哈拉以南非洲地区25 - 49岁人群中观察到艾滋病毒/艾滋病的性别差异最大，每10万人中女性比男性多1724.8（918.8 - 2613.7）个DALY。 解读：女性和男性之间显著的健康差异表明迫切需要基于性别和年龄特异性数据制定政策。持续推动对性别问题有敏感认识的研究也很重要，最终要实施不仅能减轻疾病负担，还能实现更大健康公平的干预措施。 资金来源：比尔及梅琳达·盖茨基金会
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