Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.
Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.
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DOI：
10.1016/s0140-6736(16)31460-x
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发表时间：
2016-10-08
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GBD 2015 DALYs and HALE Collaborators
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作者：
GBD 2015 DALYs and HALE Collaborators
健康预期寿命（黑尔）和残疾调整生命年（DALs）提供了跨地域和时间的健康汇总指标，可以为流行病学模式和卫生系统绩效的评估提供信息，有助于优先考虑研发投资，并监测可持续发展目标（SDG）的进展情况。我们的目标是为全球各地提供最新的黑尔和DALLS，并评估疾病负担如何随发展而变化。我们使用2015年全球疾病、伤害和风险因素负担研究（GBD 2015）的全因死亡率、特定原因死亡率和非致命性疾病负担的结果，得出1990年至2015年195个国家和地区按性别划分的黑尔和DALLS。我们通过对每个地区、年龄组、性别和年份的寿命损失年数（YLL）和残疾寿命年数（YLD）进行求和来计算残疾寿命。我们使用Sullivan方法估计黑尔，该方法来自年龄特定的死亡率和人均YLD。然后，我们评估了观察到的DALs和黑尔水平与社会人口指数（SDI）计算的预期趋势之间的差异，SDI是一个综合指标，由人均收入，平均受教育年限和总生育率构成。从1990年到2015年，全球疾病死亡率基本保持不变，传染性、新生儿、孕产妇和营养（第1组）疾病死亡率的下降被非传染性疾病（NCD）死亡率的增加所抵消。这种流行病的转变在很大程度上是由人口增长和老龄化的变化造成的，但由于可持续发展指数的普遍改善而加速了这种转变，这也与非传染性疾病日益重要密切相关。到2015年，由于大多数第1组原因导致的总DALY和年龄标准化DALY率均显著下降，尽管大多数非传染性疾病的总负担上升，但由于非传染性疾病导致的年龄标准化DALY率下降。尽管如此，由于几种高负担非传染性疾病（包括骨关节炎、药物使用障碍、抑郁症、糖尿病、先天性出生缺陷以及皮肤、口腔和感觉器官疾病）而导致的年龄标准化DALY率要么增加要么保持不变，导致其相对排名上升在许多地区。从2005年到2015年，男性出生时的黑尔平均增加了2.9年（95%不确定区间2.9 - 3.0），女性增加了3.5年（3.4 - 3.7），而65岁时的黑尔分别增加了0.85年（0.78 - 0.92）和1.2年（1.1 - 1.3）。SDI的升高与持续较高的黑尔和较小比例的功能性健康损失相关;然而，SDI的升高与总残疾的增加有关。中美洲和撒哈拉以南非洲东部的许多国家和领土的疾病负担率越来越低，低于其SDI的预期。与此同时，一部分地区的观察到的残疾人人数与预期人数之间的差距越来越大，这一趋势主要是由战争、人际暴力和各种非传染性疾病造成的负担增加造成的。全球的健康状况正在改善，但这意味着更多的人口将花费更多的时间在功能性健康损失上，这是发病率的绝对扩张。生活在不健康中的比例随着SDI的增加而有所下降，这是一种相对压缩的发病率，支持继续努力提高个人收入，改善教育和限制生育。我们对DALF和黑尔及其与SDI的关系的分析代表了一个强大的框架，可以在此基础上对特定地理区域的卫生绩效和SDG进展进行基准测试。国家特有的疾病负担驱动因素，特别是疾病负担高于预期的原因，应该为沿着发展连续体的所有国家的财政和研究投资、预防工作、卫生政策和卫生系统改进举措提供信息。比尔和梅林达·盖茨基金会。
Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9–3·0) for men and 3·5 years (3·4–3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78–0·92) and 1·2 years (1·1–1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. Bill & Melinda Gates Foundation.