Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017
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DOI：
10.1016/s2213-2600(20)30105-3
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发表时间：
2020-06-01
影响因子：
76.2
通讯作者：
Zhang, Yunquan
中科院分区：
文献类型：
--
作者：
Soriano, Joan B.;Kendrick, Parkes J.;Zhang, Yunquan
背景 以前描述慢性呼吸系统疾病负担特征的尝试仅集中于特定疾病状况，例如慢性阻塞性肺病（COPD）或哮喘。在这项研究中，我们旨在描述全球慢性呼吸道疾病的负担，对 1990 年至 2017 年的地理和时间趋势进行全面、最新的分析。 方法 使用 2017 年全球疾病、伤害和危险因素负担研究 (GBD) 的数据，我们通过分析死亡、伤残调整生命年 (DALY) 和死亡率，估计了慢性呼吸道疾病的患病率、发病率和死亡率。 1990 年至 2017 年 GBD 大区域的生命损失年数 (YLL)，按年龄和性别分层。分析的具体疾病包括哮喘、慢性阻塞性肺病、间质性肺病和肺结节病、尘肺和其他慢性呼吸道疾病。我们还评估了风险因素（吸烟、二手烟、环境颗粒物和臭氧污染、固体燃料造成的家庭空气污染以及职业风险）对慢性呼吸道疾病归因的DALY的影响。结果显示，2017年，全球有5.449亿人（95%不确定性区间[UI] 506.9-584.8）患有慢性呼吸道疾病，与1990年相比增加了39.8%。 GBD各超级区域的慢性呼吸道疾病患病率存在很大差异，高收入地区的男性和女性患病率最高，撒哈拉以南非洲和南亚患病率最低。 2017 年每种慢性呼吸道疾病的年龄、性别患病率在地理上也存在很大差异。慢性呼吸道疾病是 2017 年第三大死因（占所有死亡的 7.0% [95% UI 6.8-7 .2]），仅次于心血管疾病和肿瘤。 2017 年，慢性呼吸道疾病死亡人数为 3 914 196 人（95% UI 3 790 578-4 044 819），自 1990 年以来增加了 18.0%，而伤残调整生命年总数增加了 13.3%。然而，考虑到老龄化和人口增长，年龄标准化患病率（下降 14.3%）、年龄标准化死亡率（42.6%）和年龄标准化伤残调整生命年率（38.2%）均出现下降。在男性和女性中，大多数慢性呼吸道疾病导致的死亡和伤残调整生命年 (DALY) 是由于慢性阻塞性肺病 (COPD)。在区域分析中，慢性呼吸道疾病的死亡率在南亚最高，在撒哈拉以南非洲最低，男女死亡率也是如此。值得注意的是，尽管南亚的绝对患病率低于大多数其他超级区域，但整个次大陆慢性呼吸道疾病的 YLL 却是世界上最高的。在所有超级区域，间质性肺病和肺结节病导致的死亡率均高于尘肺病导致的死亡率。吸烟是所有地区男性慢性呼吸道疾病相关残疾的主要危险因素。对于南亚和撒哈拉以南非洲地区的女性来说，固体燃料造成的家庭空气污染是慢性呼吸道疾病的主要危险因素，而环境颗粒物则是东南亚、东亚和大洋洲以及中东和北非大区域的主要危险因素。 解释 我们的研究表明，慢性呼吸道疾病仍然是全世界死亡和残疾的主要原因，自 1990 年以来，慢性呼吸道疾病的绝对数量有所增长，但几个年龄标准化估计值却急剧下降。 慢性呼吸道疾病导致的过早死亡按人均计算，卫生系统资源匮乏的地区的疾病发病率似乎最高。版权所有 (C) 2020 作者。由爱思唯尔有限公司出版
Background Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017.Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs.Findings In 2017, 544.9 million people (95% uncertainty interval [UI] 506.9- 584.8) worldwide had a chronic respiratory disease, representing an increase of 39.8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex- specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7.0% [95% UI 6.8-7 .2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578-4 044 819) in 2017, an increase of 18.0% since 1990, while total DALYs increased by 13.3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14.3% decrease), agestandardised death rates (42.6%), and age-standardised DALY rates (38.2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region.Interpretation Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.