1990 - 2021年非洲中风、缺血性心脏病和痴呆症的负担：全球疾病负担研究2021的生态分析
The burden of stroke, ischaemic heart disease, and dementia in Africa, 1990-2021: an ecological analysis of the Global Burden of Disease 2021.
作者信息
Avan Abolfazl, Hachinski Vladimir, Njamnshi Wepnyu Y, Andersson Neil, Njamnshi Alfred K
机构信息
Robarts Research Institute, University of Western Ontario, London, ON, Canada; Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada.
Brain Research Africa Initiative (BRAIN), Geneva, Switzerland; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon; Neuroscience Laboratory, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
出版信息
Lancet Glob Health. 2025 Jul;13(7):e1191-e1202. doi: 10.1016/S2214-109X(25)00109-3.
BACKGROUND
Stroke, ischaemic heart disease, and dementia share risk factors and influence one another, substantially affecting brain health. Limited health-care resources in Africa might exacerbate the burden of these diseases, with serious brain health consequences. We analysed trends from 1990 to 2021 to inform optimised prevention strategies.
METHODS
Using The Global Burden of Diseases, Injuries, and Risk Factors Study 2021 data, we assessed the burden of these conditions, measured by disability-adjusted life-years (DALYs) lost attributed to 12 risk factors, and their changes from 1990 to 2021. Bayesian modelling generated means and 95% uncertainty intervals (UIs) based on the 2·5th and 97·5th percentiles of 500 posterior distribution draws.
FINDINGS
In Africa in 2021, 17·3 (95% UI 15·5-19·2) million DALYs were lost due to strokes, 17·6 (15·5-19·6) million were lost due to ischaemic heart diseases, and 1·8 (0·8-4·0) million were lost due to dementia. New and prevalent cases doubled from 1990 to 2021, with two-thirds of DALYs occurring before age 70 years. Among five continents, Africa had the highest age-standardised DALY rates per 100 000 population for stroke (2628·1 [2367·4-2893·0]) and ischaemic heart disease (2743·5 [2451·8-3033·6]), and the lowest for dementia (423·4 [190·6-934·6]). Regionally, central and southern Africa showed higher stroke DALY rates, northern Africa had the highest rates for ischaemic heart disease, and central and northern Africa had the highest rates for dementia. Among 12 modifiable risk factors, high systolic blood pressure, unhealthy diet, and air pollution contributed most to DALYs. Stroke DALYs rose prominently due to high BMI, high fasting plasma glucose, high LDL cholesterol, low physical activity, and high systolic blood pressure.
INTERPRETATION
Africa faces substantial challenges from stroke, heart disease, and dementia, including the highest DALY rates globally, with worsening trends over the past three decades, including younger ages of onset. These patterns, coupled with limited health resources, necessitate urgent and targeted strategies to protect, preserve, and promote brain health in Africa.
FUNDING
Weston Family Foundation.
背景
中风、缺血性心脏病和痴呆症有共同的风险因素，且相互影响，对大脑健康有重大影响。非洲有限的医疗资源可能会加剧这些疾病的负担，对大脑健康造成严重后果。我们分析了1990年至2021年的趋势，以制定优化的预防策略。
方法
利用《2021年全球疾病、伤害及风险因素负担研究》的数据，我们评估了这些疾病的负担，以归因于12种风险因素的伤残调整生命年（DALYs）来衡量，并分析了它们从1990年到2021年的变化。贝叶斯模型基于500次后验分布抽样的第2.5百分位数和第97.5百分位数生成均值和95%不确定性区间（UIs）。
结果
2021年在非洲，因中风损失了1730万（95% UI 1550万 - 1920万）伤残调整生命年，因缺血性心脏病损失了1760万（1550万 - 1960万），因痴呆症损失了180万（80万 - 400万）。从1990年到2021年，新发病例和现患病例增加了一倍，三分之二的伤残调整生命年发生在70岁之前。在五大洲中，非洲每10万人口中中风（2628.1 [2367.4 - 2893.0]）和缺血性心脏病（2743.5 [2451.8 - 3033.6]）的年龄标准化伤残调整生命年率最高，痴呆症的年龄标准化伤残调整生命年率最低（423.4 [190.6 - 934.6]）。在区域层面，非洲中部和南部的中风伤残调整生命年率较高，北非的缺血性心脏病率最高，非洲中部和北部的痴呆症率最高。在12种可改变的风险因素中，收缩压高、不健康饮食和空气污染对伤残调整生命年的贡献最大。由于高体重指数、高空腹血糖、高LDL胆固醇、低身体活动和高收缩压，中风导致的伤残调整生命年显著增加。
解读
非洲面临着来自中风、心脏病和痴呆症的重大挑战，包括全球最高的伤残调整生命年率，且在过去三十年中呈恶化趋势，发病年龄也越来越小。这些情况加上有限的卫生资源，需要采取紧急且有针对性的策略来保护、维护和促进非洲的大脑健康。
资助
韦斯顿家族基金会
Zotero 插件