Francis-Oliviero Florence, Constantinou Panayotis, Haneef Romana, Schwarzinger Michaël, Gallay Anne, Rachas Antoine, Alla François
Service d'information médicale, Bordeaux University Hospital, 33000 Bordeaux, France.
Inserm UMR 1219-Bordeaux Population Health, 33000 Bordeaux, France.
Lancet Reg Health Eur. 2024 Feb 29;39:100848. doi: 10.1016/j.lanepe.2024.100848. eCollection 2024 Apr.
France faces nowadays some major challenges regarding its health care system including medically underserved areas, social health inequalities, and hospital pressures. Various indicators and sources of data allow us to describe the health status of a population and, consequently, to assess the impact of these challenges. We assessed the burden of diseases before COVID-19 in France in 2019 and its evolution from 1990 to 2019, and compared it with Western European countries.
We used specific Global Burden of Diseases (GBD) metrics: socio-demographic index (SDI), life expectancy (LE), healthy life expectancy (HALE), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) with their 95% uncertainty interval (95% UI). We compared French age-standardized metrics to those for other Western European Countries for both sexes and also between 1990 and 2019. We also described the specific causes of these different metrics.
We observed for life expectancy at birth in France a trend to an improvement over time from 77.2 (95% UI: 77.2-77.3) years in 1990 to 82.9 (82.7-83.1) in 2019, which represented the seventh highest life expectancy among 23 Western European countries. HALE at birth in France increased from 67.0 (64.0-69.7) to 71.5 (68.1-74.5), which represented the fourth highest HALE among 23 Western European countries. In France, the total number of DALY per 100.000 population tended to decrease from 25,192 (22,374-28,351) in 1990 to 18,782 (16,408-21,920) in 2019. As compared to other European countries, the burden due to cardiovascular diseases was lower. Neoplasms and cardio-vascular diseases were the two leading causes of YLLs. Mental and musculoskeletal disorders were the two leading causes of YLDs.
Overall, these results highlight a clear trend of improvement in the health status in France with certain differences between western European countries. The health policy makers need to devise interventional strategies to reduce the burden of diseases and injuries, with specific attention to causes such as cancers, cardiovascular diseases, mental health and musculoskeletal disorders.
Bill & Melinda Gates Foundation.
如今，法国的医疗保健系统面临一些重大挑战，包括医疗服务不足地区、社会健康不平等以及医院压力等问题。各种指标和数据来源使我们能够描述人群的健康状况，进而评估这些挑战的影响。我们评估了2019年新冠疫情之前法国的疾病负担及其在1990年至2019年期间的演变情况，并与西欧国家进行了比较。
我们使用了特定的全球疾病负担（GBD）指标：社会人口指数（SDI）、预期寿命（LE）、健康预期寿命（HALE）、生命损失年数（YLLs）、带病生存年数（YLDs）以及伤残调整生命年（DALYs）及其95%不确定性区间（95% UI）。我们将法国按年龄标准化的指标与其他西欧国家的男女指标进行了比较，还比较了1990年至2019年期间的情况。我们还描述了这些不同指标的具体成因。
我们观察到，法国出生时的预期寿命呈上升趋势，从1990年的77.2岁（95% UI：77.2 - 77.3）提高到2019年的82.9岁（82.7 - 83.1），在23个西欧国家中排名第七。法国出生时的健康预期寿命从67.0岁（64.0 - 69.7）增加到71.5岁（68.1 - 74.5），在23个西欧国家中排名第四。在法国，每10万人口的伤残调整生命年总数趋于下降，从1990年的25,192（22,374 - 28,351）降至2019年的18,782（16,408 - 21,920）。与其他欧洲国家相比，心血管疾病造成的负担较低。肿瘤和心血管疾病是生命损失年数的两大主要原因。精神和肌肉骨骼疾病是带病生存年数的两大主要原因。
总体而言，这些结果凸显了法国健康状况明显的改善趋势，西欧国家之间存在一定差异。卫生政策制定者需要制定干预策略以减轻疾病和伤害负担，尤其要关注癌症、心血管疾病、心理健康和肌肉骨骼疾病等病因。
比尔及梅琳达·盖茨基金会。
