Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.
Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.
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DOI：
10.1016/s0140-6736(12)61729-2
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发表时间：
2012-12-15
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通讯作者：
Memish ZA
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Vos T;Flaxman AD;Naghavi M;Lozano R;Michaud C;Ezzati M;Shibuya K;Salomon JA;Abdalla S;Aboyans V;Abraham J;Ackerman I;Aggarwal R;Ahn SY;Ali MK;Alvarado M;Anderson HR;Anderson LM;Andrews KG;Atkinson C;Baddour LM;Bahalim AN;Barker-Collo S;Barrero LH;Bartels DH;Basáñez MG;Baxter A;Bell ML;Benjamin EJ;Bennett D;Bernabé E;Bhalla K;Bhandari B;Bikbov B;Bin Abdulhak A;Birbeck G;Black JA;Blencowe H;Blore JD;Blyth F;Bolliger I;Bonaventure A;Boufous S;Bourne R;Boussinesq M;Braithwaite T;Brayne C;Bridgett L;Brooker S;Brooks P;Brugha TS;Bryan-Hancock C;Bucello C;Buchbinder R;Buckle G;Budke CM;Burch M;Burney P;Burstein R;Calabria B;Campbell B;Canter CE;Carabin H;Carapetis J;Carmona L;Cella C;Charlson F;Chen H;Cheng AT;Chou D;Chugh SS;Coffeng LE;Colan SD;Colquhoun S;Colson KE;Condon J;Connor MD;Cooper LT;Corriere M;Cortinovis M;de Vaccaro KC;Couser W;Cowie BC;Criqui MH;Cross M;Dabhadkar KC;Dahiya M;Dahodwala N;Damsere-Derry J;Danaei G;Davis A;De Leo D;Degenhardt L;Dellavalle R;Delossantos A;Denenberg J;Derrett S;Des Jarlais DC;Dharmaratne SD;Dherani M;Diaz-Torne C;Dolk H;Dorsey ER;Driscoll T;Duber H;Ebel B;Edmond K;Elbaz A;Ali SE;Erskine H;Erwin PJ;Espindola P;Ewoigbokhan SE;Farzadfar F;Feigin V;Felson DT;Ferrari A;Ferri CP;Fèvre EM;Finucane MM;Flaxman S;Flood L;Foreman K;Forouzanfar MH;Fowkes FG;Franklin R;Fransen M;Freeman MK;Gabbe BJ;Gabriel SE;Gakidou E;Ganatra HA;Garcia B;Gaspari F;Gillum RF;Gmel G;Gosselin R;Grainger R;Groeger J;Guillemin F;Gunnell D;Gupta R;Haagsma J;Hagan H;Halasa YA;Hall W;Haring D;Haro JM;Harrison JE;Havmoeller R;Hay RJ;Higashi H;Hill C;Hoen B;Hoffman H;Hotez PJ;Hoy D;Huang JJ;Ibeanusi SE;Jacobsen KH;James SL;Jarvis D;Jasrasaria R;Jayaraman S;Johns N;Jonas JB;Karthikeyan G;Kassebaum N;Kawakami N;Keren A;Khoo JP;King CH;Knowlton LM;Kobusingye O;Koranteng A;Krishnamurthi R;Lalloo R;Laslett LL;Lathlean T;Leasher JL;Lee YY;Leigh J;Lim SS;Limb E;Lin JK;Lipnick M;Lipshultz SE;Liu W;Loane M;Ohno SL;Lyons R;Ma J;Mabweijano J;MacIntyre MF;Malekzadeh R;Mallinger L;Manivannan S;Marcenes W;March L;Margolis DJ;Marks GB;Marks R;Matsumori A;Matzopoulos R;Mayosi BM;McAnulty JH;McDermott MM;McGill N;McGrath J;Medina-Mora ME;Meltzer M;Mensah GA;Merriman TR;Meyer AC;Miglioli V;Miller M;Miller TR;Mitchell PB;Mocumbi AO;Moffitt TE;Mokdad AA;Monasta L;Montico M;Moradi-Lakeh M;Moran A;Morawska L;Mori R;Murdoch ME;Mwaniki MK;Naidoo K;Nair MN;Naldi L;Narayan KM;Nelson PK;Nelson RG;Nevitt MC;Newton CR;Nolte S;Norman P;Norman R;O'Donnell M;O'Hanlon S;Olives C;Omer SB;Ortblad K;Osborne R;Ozgediz D;Page A;Pahari B;Pandian JD;Rivero AP;Patten SB;Pearce N;Padilla RP;Perez-Ruiz F;Perico N;Pesudovs K;Phillips D;Phillips MR;Pierce K;Pion S;Polanczyk GV;Polinder S;Pope CA 3rd;Popova S;Porrini E;Pourmalek F;Prince M;Pullan RL;Ramaiah KD;Ranganathan D;Razavi H;Regan M;Rehm JT;Rein DB;Remuzzi G;Richardson K;Rivara FP;Roberts T;Robinson C;De Leòn FR;Ronfani L;Room R;Rosenfeld LC;Rushton L;Sacco RL;Saha S;Sampson U;Sanchez-Riera L;Sanman E;Schwebel DC;Scott JG;Segui-Gomez M;Shahraz S;Shepard DS;Shin H;Shivakoti R;Singh D;Singh GM;Singh JA;Singleton J;Sleet DA;Sliwa K;Smith E;Smith JL;Stapelberg NJ;Steer A;Steiner T;Stolk WA;Stovner LJ;Sudfeld C;Syed S;Tamburlini G;Tavakkoli M;Taylor HR;Taylor JA;Taylor WJ;Thomas B;Thomson WM;Thurston GD;Tleyjeh IM;Tonelli M;Towbin JA;Truelsen T;Tsilimbaris MK;Ubeda C;Undurraga EA;van der Werf MJ;van Os J;Vavilala MS;Venketasubramanian N;Wang M;Wang W;Watt K;Weatherall DJ;Weinstock MA;Weintraub R;Weisskopf MG;Weissman MM;White RA;Whiteford H;Wiersma ST;Wilkinson JD;Williams HC;Williams SR;Witt E;Wolfe F;Woolf AD;Wulf S;Yeh PH;Zaidi AK;Zheng ZJ;Zonies D;Lopez AD;Murray CJ;AlMazroa MA;Memish ZA
疾病和伤害造成的非致命健康后果是促进和监测个人和人口健康的关键考虑因素。1990年和2000年进行的全球疾病负担（GBD）研究是在全球和区域一级对一系列详尽疾病的非致命性健康结果进行量化的唯一研究。两项努力都没有量化患病率或残疾生活年数（YLDs）的不确定性。在GBD原因列表中的291种疾病和伤害中，有289种会导致残疾。对于289种疾病和损伤的1160例后遗症，我们对患病率、发病率、缓解、持续时间和超额死亡率进行了系统的分析。来源包括已发表的研究、病例通报、基于人群的癌症登记、其他疾病登记、产前诊所服务监测、医院出院数据、门诊护理数据、住户调查、其他调查和队列研究。对于大多数后遗症，我们使用了贝叶斯元回归方法DisMod-MR，旨在解决描述性流行病学数据的主要局限性，包括数据缺失、不一致和数据源之间的大方法差异。对于某些疾病，我们使用了自然历史模型、地理空间模型、反向计算模型（从人口死亡率和病死率计算发病率的模型）或注册完整性模型（根据卫生系统可及性和其他协变量调整未完全注册的模型）。使用220种独特健康状态的残疾权重来捕捉健康损失的严重程度。通过模拟方法调整年龄、性别、国家和年份等原因的死亡率。我们在分析的所有阶段都包括了不确定性估计。2010年，1160种后遗症在所有年龄段的全球流行率从每100万人中不到1例到每100万人中35万例不等。健康损失的发生率与严重程度呈弱相关（相关系数为- 0.37）。2010年，因各种原因造成的农业用地数量从1990年的5.83亿增加到7.77亿。全球死亡人数的主要来源是精神和行为障碍、肌肉骨骼疾病以及糖尿病或内分泌疾病。2010年死亡的主要具体原因与1990年基本相同：腰痛、重度抑郁症、缺铁性贫血、颈部疼痛、慢性阻塞性肺病、焦虑症、偏头痛、糖尿病和跌倒。在所有区域，儿童猝死症的年龄特异性患病率随着年龄的增长而增加，从1990年到2010年略有下降。与因过早死亡而丧失的生命年数相比，死亡死亡主要原因的区域格局更为相似。在撒哈拉以南非洲，被忽视的热带病、艾滋病毒/艾滋病、结核病、疟疾和贫血是造成幼儿死亡的重要原因。随着时间的推移，每10万人的土地拥有量基本保持不变，但随着年龄的增长而稳步上升。在过去的二十年里，人口增长和老龄化增加了YLD数量和原油价格。导致儿童死亡的最常见原因，如精神和行为障碍以及肌肉骨骼疾病的患病率没有下降。卫生系统将需要满足越来越多的患有一系列疾病的个人的需求，这些疾病在很大程度上导致残疾，但不会导致死亡。对非致命性健康后果负担进行量化，对于了解卫生系统应对这些挑战的情况至关重要。应对这一日益加重的负担的有效和负担得起的战略是世界大多数地区卫生系统的紧迫优先事项。比尔和梅林达·盖茨基金会。
Non-fatal health outcomes from diseases and injuries are a crucial consideration in the promotion and monitoring of individual and population health. The Global Burden of Disease (GBD) studies done in 1990 and 2000 have been the only studies to quantify non-fatal health outcomes across an exhaustive set of disorders at the global and regional level. Neither effort quantified uncertainty in prevalence or years lived with disability (YLDs). Of the 291 diseases and injuries in the GBD cause list, 289 cause disability. For 1160 sequelae of the 289 diseases and injuries, we undertook a systematic analysis of prevalence, incidence, remission, duration, and excess mortality. Sources included published studies, case notification, population-based cancer registries, other disease registries, antenatal clinic serosurveillance, hospital discharge data, ambulatory care data, household surveys, other surveys, and cohort studies. For most sequelae, we used a Bayesian meta-regression method, DisMod-MR, designed to address key limitations in descriptive epidemiological data, including missing data, inconsistency, and large methodological variation between data sources. For some disorders, we used natural history models, geospatial models, back-calculation models (models calculating incidence from population mortality rates and case fatality), or registration completeness models (models adjusting for incomplete registration with health-system access and other covariates). Disability weights for 220 unique health states were used to capture the severity of health loss. YLDs by cause at age, sex, country, and year levels were adjusted for comorbidity with simulation methods. We included uncertainty estimates at all stages of the analysis. Global prevalence for all ages combined in 2010 across the 1160 sequelae ranged from fewer than one case per 1 million people to 350 000 cases per 1 million people. Prevalence and severity of health loss were weakly correlated (correlation coeffi cient –0·37). In 2010, there were 777 million YLDs from all causes, up from 583 million in 1990. The main contributors to global YLDs were mental and behavioural disorders, musculoskeletal disorders, and diabetes or endocrine diseases. The leading specific causes of YLDs were much the same in 2010 as they were in 1990: low back pain, major depressive disorder, iron-deficiency anaemia, neck pain, chronic obstructive pulmonary disease, anxiety disorders, migraine, diabetes, and falls. Age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010. Regional patterns of the leading causes of YLDs were more similar compared with years of life lost due to premature mortality. Neglected tropical diseases, HIV/AIDS, tuberculosis, malaria, and anaemia were important causes of YLDs in sub-Saharan Africa. Rates of YLDs per 100 000 people have remained largely constant over time but rise steadily with age. Population growth and ageing have increased YLD numbers and crude rates over the past two decades. Prevalences of the most common causes of YLDs, such as mental and behavioural disorders and musculoskeletal disorders, have not decreased. Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality. Quantifi cation of the burden of non-fatal health outcomes will be crucial to understand how well health systems are responding to these challenges. Effective and affordable strategies to deal with this rising burden are an urgent priority for health systems in most parts of the world. Bill & Melinda Gates Foundation.