The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
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DOI：
10.1016/s2468-1253(19)30333-4
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发表时间：
2020-01-01
影响因子：
35.7
通讯作者：
Naghavi, Mohsen
中科院分区：
文献类型：
--
作者：
Alatab, Sudabeh;Sepanlou, Sadaf G.;Naghavi, Mohsen
背景全球炎症性肠道疾病（IBD）的负担正在上升，不同国家和地区的疾病水平和趋势存在很大差异。了解这些地理差异对于制定预防和治疗IBD的有效策略至关重要。我们报告了1990年至2017年间195个国家和地区IBD的患病率、死亡率和总体负担，基于2017年全球疾病、伤害和风险因素负担研究（GBD）的数据。为了估计非致命性负担，我们使用了主要研究、出院和索赔数据中的数据，并使用了DisMod-MR 2.1（贝叶斯元回归工具），以确保测量之间的一致性。估计了死亡率、患病率、过早死亡导致的寿命损失年数（YLLs）、残疾生存年数（YLDs）和残疾调整寿命年数（DLDs）。所有估计值均报告为每10万人的数量和比率，95%不确定区间（UI）。结果2017年，全球有680万例IBD病例（95%UI 6.4-7.3）。年龄标准化患病率由1990年的每10万人口79.5人（75.9-83.5）上升至2017年的每10万人口84.3人（79.2-89.9）。年龄标准化死亡率由一九九零年的每十万人口0.61（0.55-0.69）下降至二零一七年的每十万人口0.51（0.42-0.54）。在GBD区域层面，2017年最高的年龄标准化患病率发生在高收入的北美（每10万人422.0 [398.7-446.1]），加勒比地区的年龄标准化患病率最低（每10万人6.7 [6.3-7.2]）。高社会人口指数（SDI）地区的年龄标准化患病率最高，而低SDI地区的年龄标准化患病率最低。在全国范围内，美国的年龄标准化患病率最高（每10万人464.5 [438.6-490.9]），其次是英国（每10万人449.6 [420.6-481.6]）。瓦努阿图在2017年的年龄标准化死亡率最高（每10万人口1.8 [0.8-3.2]），新加坡最低（每10万人口0.08 [0.06-0.14]）。在研究期间，IBD导致的YLD总数几乎翻了一番，从1990年的56万（0.39-0.77）增加到2017年的102万（0.71-1.38）。残疾人的年龄标准化比率从26.5从1990年的每10万人21.0-33.0人降至23.2人（19.1-27.8）/100 000人口。解释从1990年到2017年，许多地区的IBD患病率大幅增加，这可能在今后几年给各国政府和卫生系统造成巨大的社会和经济负担。我们的研究结果可能有助于政策制定者制定应对IBD的策略，包括教育专业人员以解决这种复杂疾病的负担。版权所有（C）2019作者。由Elsevier Ltd.发布，这是CC BY 4.0许可下的开放获取文章。
Background The burden of inflammatory bowel disease (IBD) is rising globally, with substantial variation in levels and trends of disease in different countries and regions. Understanding these geographical differences is crucial for formulating effective strategies for preventing and treating IBD. We report the prevalence, mortality, and overall burden of IBD in 195 countries and territories between 1990 and 2017, based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017.Methods We modelled mortality due to IBD using a standard Cause of Death Ensemble model including data mainly from vital registrations. To estimate the non-fatal burden, we used data presented in primary studies, hospital discharges, and claims data, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to ensure consistency between measures. Mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were estimated. All of the estimates were reported as numbers and rates per 100 000 population, with 95% uncertainty intervals (UI).Findings In 2017, there were 6.8 million (95% UI 6.4-7.3) cases of IBD globally. The age-standardised prevalence rate increased from 79.5 (75.9-83.5) per 100 000 population in 1990 to 84.3 (79.2-89.9) per 100 000 population in 2017. The age-standardised death rate decreased from 0.61 (0.55-0.69) per 100 000 population in 1990 to 0.51 (0.42-0.54) per 100 000 population in 2017. At the GBD regional level, the highest age-standardised prevalence rate in 2017 occurred in high-income North America (422.0 [398.7-446.1] per 100 000) and the lowest age-standardised prevalence rates were observed in the Caribbean (6.7 [6.3-7.2] per 100 000 population). High Sociodemographic Index (SDI) locations had the highest age-standardised prevalence rate, while low SDI regions had the lowest age-standardised prevalence rate. At the national level, the USA had the highest age-standardised prevalence rate (464.5 [438.6-490.9] per 100 000 population), followed by the UK (449.6 [420.6-481.6] per 100 000). Vanuatu had the highest age-standardised death rate in 2017 (1.8 [0.8-3.2] per 100 000 population) and Singapore had the lowest (0.08 [0.06-0.14] per 100 000 population). The total YLDs attributed to IBD almost doubled over the study period, from 0.56 million (0.39-0.77) in 1990 to 1.02 million (0.71-1.38) in 2017. The age-standardised rate of DALYs decreased from 26.5 (21.0-33.0) per 100 000 population in 1990 to 23.2 (19.1-27.8) per 100 000 population in 2017.Interpretation The prevalence of IBD increased substantially in many regions from 1990 to 2017, which might pose a substantial social and economic burden on governments and health systems in the coming years. Our findings can be useful for policy makers developing strategies to tackle IBD, including the education of specialised personnel to address the burden of this complex disease. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.