Murray C J, Lopez A D
Harvard School of Public Health, Boston, MA, USA.
Lancet. 1997 May 10;349(9062):1347-52. doi: 10.1016/S0140-6736(96)07494-6.
Information on non-fatal health outcomes of disease and injury has been largely neglected in health planning because of the conceptual and definitional complexity of measuring morbidity and disability in populations. One of our major objectives was to quantify disability for inclusion in health policy debates. We analysed these health outcomes in terms of disability-free life expectancy (DFLE) and disability-adjusted life expectancy (DALE).
Published and unpublished data were systematically reviewed to estimate the incidence, prevalence, and duration of 483 disabling sequelae of 107 diseases and injuries. To ensure internal consistency of these estimates, a software programme (DISMOD) was applied many times until consistent parameters were identified. The severity of disability, on a scale of 0 (perfect health) to 1 (death), was measured in a deliberate manner by the person-trade-off method. Spearman's and Pearson's correlation coefficients were used to measure disability weights among groups. Prevalence of seven classes of disability was back-calculated from the distribution of each disabling sequela across disabilities. Prevalence for each class of disability for different age-sex groups was used to calculate seven forms of DFLE and DALE based on Sullivan's method.
Prevalence of most disability classes is highest in sub-Saharan Africa and lowest in established market economies. Low-severity disabilities (class I and class II) are the most common. The expectation at birth of class I disability ranges from 6.5 years in established market economies to 14.7 years in sub-Saharan Africa, and for class II disabilities, from 8.5-18.4 years. DFLE varies significantly among regions: DFLE for class I disabilities at birth ranges from 9.9 years in sub-Saharan Africa to 47.7 years in established market economies for females and DFLE for class V disabilities ranges from 43.4 years for men in sub-Saharan Africa to 74.8 years for women in established market economies. The proportion of expected life span at birth lived with disability adjusted for severity, varies from about 8% in established market economies to 15% in sub-Saharan Africa, with little difference between men and women. In high-income regions, nearly 90% of expected disability is due to non-communicable diseases and most of the remainder to injuries. In poorer regions, almost half of expected disability is due to communicable diseases and injuries.
The higher proportion of lifespan spent disabled in high-mortality populations is consistent with the compression of morbidity hypothesis. The threshold definition of disability used substantially affects the results of DFLE, DALE, which incorporates severity weights for disabilities, is a useful summary measure of the burden of disability and mortality.
由于在人群中测量发病率和残疾存在概念和定义上的复杂性，疾病和伤害的非致命健康结局信息在卫生规划中一直被很大程度地忽视。我们的一个主要目标是量化残疾情况，以纳入卫生政策辩论。我们根据无残疾预期寿命（DFLE）和残疾调整预期寿命（DALE）分析了这些健康结局。
系统回顾已发表和未发表的数据，以估计107种疾病和伤害的483种致残后遗症的发病率、患病率和持续时间。为确保这些估计的内部一致性，多次应用一个软件程序（DISMOD），直到确定一致的参数。通过个人权衡法以0（完全健康）至1（死亡）的量表来衡量残疾的严重程度。使用斯皮尔曼和皮尔逊相关系数来衡量不同组之间的残疾权重。从每种致残后遗症在各类残疾中的分布情况反推七类残疾的患病率。根据沙利文方法，利用不同年龄 - 性别组各类残疾的患病率来计算七种形式的DFLE和DALE。
大多数残疾类别的患病率在撒哈拉以南非洲最高，在发达市场经济体最低。低严重程度残疾（I类和II类）最为常见。I类残疾的出生时预期寿命在发达市场经济体中为6.5岁，在撒哈拉以南非洲为14.7岁；对于II类残疾，预期寿命在8.5 - 18.4岁之间。DFLE在各地区之间差异显著：出生时I类残疾的女性DFLE在撒哈拉以南非洲为9.9岁，在发达市场经济体中为47.7岁；V类残疾的男性DFLE在撒哈拉以南非洲为43.4岁，在发达市场经济体中女性为74.8岁。出生时因残疾而度过的预期寿命经严重程度调整后的比例，在发达市场经济体中约为8%，在撒哈拉以南非洲为15%，男性和女性之间差异不大。在高收入地区，近90%的预期残疾归因于非传染性疾病，其余大部分归因于伤害。在较贫困地区，几乎一半的预期残疾归因于传染病和伤害。
高死亡率人群中因残疾度过的寿命比例较高，这与发病率压缩假说一致。所使用的残疾阈值定义对DFLE结果有很大影响，DALE纳入了残疾严重程度权重，并是残疾和死亡率负担的一个有用汇总指标。
