Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
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DOI：
10.1016/s0140-6736(16)31773-1
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发表时间：
2016-11-12
期刊：
影响因子：
168.9
通讯作者：
Lozano, Rafael
中科院分区：
文献类型：
--
作者：
Gomez-Dantes, Hector;Fullman, Nancy;Lozano, Rafael
背景自1990年以来，墨西哥的儿童和孕产妇健康状况有了显著改善，而成人死亡率的上升打破了传统的流行病学转变模式，在这种模式下，所有年龄段的死亡率都会下降。这些趋势表明，墨西哥正在经历一场比历史上观察到的更复杂、更不和谐的健康转型。各州之间持久的不平等进一步强调了随着时间的推移进行更详细的健康评估的必要性。《2013年全球疾病、伤害和风险因素负担研究》(GBD 2013)提供了一个全面的、可比较的框架，通过该框架可以进行国家和国家以下各级的分析。这项研究首次提供了墨西哥疾病负担和风险因素归因的州级量化。方法我们从GBD 2013中提取数据，评估墨西哥及其32个州以及美洲8个比较国家的死亡率、死亡原因、寿命损失年数(YLLS)、残疾寿命年数(YLDs)、残疾调整寿命年(DALYs)和健康预期寿命(Hale)。各州根据边际化指数得分进行分组，以比较社会经济层面的国家以下负担。我们将提取的数据按州分开，并应用GBD方法来生成对行为、代谢、环境或职业风险造成的负担和可归因性负担的估计。我们公布了306个原因、2337个后遗症和79个风险因素的结果。从1990年到2013年，墨西哥人的出生预期寿命增加了3.4年(95%不确定区间3.1-3.8)，从72.1岁(71.8-72.3)增加到75.5岁(75.3-75.7)，这些增长在边缘化程度较高的州更加明显。在全国范围内，自1990年以来，年龄标准化死亡率下降了13.3%(11.9%-14.6%)，但州一级全因死亡率的降幅各不相同，根据Hale的衡量，预期寿命与完全健康生活的年限之间的差距在几个州扩大了。妇女预期寿命的进步超过了男子，自2000年以来，男子的预期寿命几乎没有改善。对于许多州来说，这一趋势与人际暴力和慢性肾脏疾病导致的YLL比率上升相对应。在全国范围内，年龄标准化的腹泻疾病和蛋白质能量营养不良的年长寿率显著下降，使墨西哥远远高于对照国家。然而，随着墨西哥在防治传染病方面取得进展，慢性肾脏疾病的负担迅速攀升，到2013年，按年龄标准化的YLL和DALY比率增加了130%以上。对于女性来说，乳腺癌的DALY比率自1990年以来也有所上升，上升了12.1%(4.6-23.1%)。2013年，引起DALY的五大原因是糖尿病、缺血性心脏病、慢性肾脏疾病、腰背和颈部疼痛以及抑郁症；后三种原因不在1990年的五大原因之列，这进一步突显了墨西哥在流行病学上的快速转变。1990年导致疾病负担的主要风险因素，如营养不良，到2013年被高空腹血糖和高体重指数所取代。2013年，由于饮食风险造成的可归因性负担也有所增加，占DALYs的10%以上。据介绍，墨西哥由于几个原因，如腹泻病，以及主要与妇幼保健干预有关的营养不良和卫生条件差等风险因素，大大减轻了负担。然而，自2000年以来，由于慢性肾脏疾病、糖尿病、肝硬变以及人际暴力导致的成人死亡率不断上升，导致健康状况恶化，特别是在男性中。尽管国家与传染病的不平等随着时间的推移而缩小，但非传染性疾病和伤害负担在地方一级差别很大。墨西哥及其32个州正在经历流行病转型，这种不协调可能会给卫生系统的反应和绩效带来压力，这强调了与每个州的卫生需求相联系的及时、有证据的卫生政策和方案的重要性。
Background Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time.Methods We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors.Findings From 1990 to 2013, life expectancy from birth in Mexico increased by 3.4 years (95% uncertainty interval 3.1-3.8), from 72.1 years (71.8-72.3) to 75.5 years (75.3-75.7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13.3% (11.9-14.6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12.1% (4.6-23.1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013.Interpretation Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state.