Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition
Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition
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DOI：
10.1016/s0140-6736(15)61340-x
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发表时间：
2015-11-28
期刊：
影响因子：
168.9
通讯作者：
Vos, Theo
中科院分区：
文献类型：
--
作者：
Murray, Christopher J. L.;Barber, Ryan M.;Vos, Theo
2013年全球疾病负担研究（GBD 2013）旨在使用一致的测量框架，标准化的估计方法和透明的数据来源汇集所有可用的流行病学数据，以便比较随时间推移的健康损失以及不同原因，年龄-性别组和国家。GBD可用于生成残疾调整生命年（DALs）和健康预期寿命（黑尔）等汇总指标，从而可以对各国和各时期的广泛流行病学模式进行比较评估。这些概括的措施也可以用来量化的流行病学的变化，这是有关sociodemographic development.Methods的组成部分，我们使用了已公布的GBD 2013年数据的年龄别死亡率，年寿命损失由于过早死亡（YLLs），和年生活残疾（YLDs），计算DALLS和黑尔为1990年，1995年，2000年，2005年，2010年，2013年为188个国家。我们使用Sullivan方法计算黑尔; 95%不确定区间（UI）代表每个国家、年龄、性别和年份的年龄特异性死亡率和每人YLD的不确定性。我们估计每个国家的306个原因的DURs为YLL和YLD的总和; 95%的UI代表YLL和YLD率的不确定性。我们用社会人口状况的综合指标量化了流行病转变的模式，我们从人均收入、15岁以后的平均受教育年限、总生育率和人口平均年龄构建了这一指标。我们对各国的DALY率进行了分层回归分析，以分解与社会人口状况变量、国家和时间相关的方差。（95% UI 5.6-6.6），65.3岁（65.0-65.6）至71.5岁（71.0-71.9）2013年，出生时黑尔上升了5.4岁（4.9-5.8），56.9岁（54.5-59.1）至62.3岁（59.7-64.8），总DALY下降了3.6%（0.3-7.4），每10万人的年龄标准化DALY率下降了26.7%（24.6-29.1）。对于传染性疾病、孕产妇疾病、新生儿疾病和营养性疾病，全球DALY数量、粗比率和年龄标准化比率在1990年至2013年期间都有所下降，而对于非传染性疾病，全球DALY一直在增加，DALY比率几乎保持不变，年龄标准化DALY比率在同一时期有所下降。从2005年到2013年，大多数特定非传染性疾病的DALY数量都有所增加，除了登革热、食源性吸虫病和利什曼病之外，还包括心血管疾病和肿瘤;几乎所有其他原因的DALY都有所减少。到2013年，导致糖尿病的五大原因是缺血性心脏病、下呼吸道感染、脑血管疾病、腰痛和颈痛以及道路伤害。社会人口状况解释了腹泻、下呼吸道感染和其他常见传染病、孕产妇疾病、新生儿疾病、营养缺乏症、其他传染病、孕产妇疾病、新生儿疾病和营养疾病、肌肉骨骼疾病和其他非传染性疾病在国家之间和时间上的差异的50%以上。然而，社会人口状况对心血管疾病、慢性呼吸系统疾病、肝硬化、糖尿病、泌尿生殖系统疾病、血液和内分泌疾病、意外伤害、自残和人际暴力的DALY率的解释不足10%。可以预见的是，社会人口状况的增加与YLL向YLD的负担转移有关，这是由YLL下降和肌肉骨骼疾病、神经系统疾病以及精神和物质使用障碍引起的YLD增加所驱动的。在大多数针对具体国家的估计数中，预期寿命的增长大于黑尔率。导致糖尿病的主要原因因国家而异。解释全球健康状况正在改善。人口增长和老龄化使残疾人人数增加，但粗比率保持相对稳定，表明卫生方面的进步并不意味着对卫生系统的需求减少。流行病学转变的概念--社会人口学地位的提高带来疾病负担的结构性变化--是有用的，但疾病负担的巨大变化与社会人口学地位无关。这进一步突出表明，需要针对具体国家对残疾人和黑尔进行评估，以便为卫生政策决定和相关行动提供适当的信息。
Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development.Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time.Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6.2 years (95% UI 5.6-6.6), from 65.3 years (65.0-65.6) in 1990 to 71.5 years (71.0-71.9) in 2013, HALE at birth rose by 5.4 years (4.9-5.8), from 56.9 years (54.5-59.1) to 62.3 years (59.7-64.8), total DALYs fell by 3.6% (0.3-7.4), and age-standardised DALY rates per 100 000 people fell by 26.7% (24.6-29.1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries.Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition-in which increasing sociodemographic status brings structured change in disease burden-is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions.