Surgically avertable burden of digestive diseases at first-level hospitals in low and middle-income regions
Surgically avertable burden of digestive diseases at first-level hospitals in low and middle-income regions
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DOI：
10.1016/j.surg.2014.07.009
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发表时间：
2015-03-01
期刊：
影响因子：
3.8
通讯作者：
Vos, Theo
中科院分区：
文献类型：
--
作者：
Higashi, Hideki;Barendregt, Jan J.;Vos, Theo
背景。量化低收入和中等收入国家 (LMIC) 一级医院可通过手术治疗避免的消化系统疾病负担。方法。我们检查了 2010 年全球疾病负担 (GBD) 研究中的 4 种消化系统疾病：阑尾炎、肠梗阻、腹股沟和股疝以及胆囊和胆管疾病。利用 GBD 2010 研究中的人口和流行病学数据，我们计算出了如果一级医院普遍提供优质外科服务，消化系统疾病负担可能会减少。假设所有 GBD 地区每个年龄和性别分组的最低病死率反映了全面手术覆盖和治疗的最佳状态。这些最佳情景率适用于所有 LMIC 地区的 GBD 2010 结果，以估计手术可避免的负担。结果。总体而言，中低收入国家的一级外科护理可以避免 480 万伤残调整生命年 (DALY) 或 65% 与 4 种消化系统疾病相关的负担。就绝对伤残调整生命年（170 万）和可避免比例（83%）而言，撒哈拉以南非洲地区的可避免负担最大。在 4 种消化系统疾病中，肠梗阻占可避免负担的最大部分（220 万 DALY；64% 可避免）。结论。提高一级医院的外科服务能力对于减轻中低收入国家消化系统疾病的负担至关重要。扩大农村地区手术能力的可行策略是可行的，必须给予应有的重视。
Background. To quantify the burden of digestive diseases avertable by surgical care at first-level hospitals in low- and middle-income countries (LMICs).Methods. We examined 4 digestive diseases from the Global Burden of Disease (GBD) 2010 Study: Appendicitis, intestinal obstruction, inguinal and femoral hernia, and gallbladder and bile duct disease. Using demographic and epidemiologic data from the GBD 2010 Study, we calculated the potential decrease in burden of digestive diseases if quality surgical services were available universally and accessible at first-level hospitals. The lowest case fatality rates for each age and sex grouping from all GBD regions were assumed to reflect the best possible state of full surgical coverage and treatment. These best scenario rates were applied to the GBD 2010 results from all LMIC regions to estimate surgically avertable burden.Results. Overall, 4.8 million disability-adjusted life-years (DALYs) or 65% of burden related to the 4 digestive diseases are avertable potentially with first-level surgical care in LMICs. Sub-Saharan Africa has the greatest avertable burden in absolute DALYs (1.7 million) and avertable proportion (83%). Intestinal obstruction accounted for the largest portion of avertable burden among the 4 digestive diseases (2.2 million DALYs; 64% avertable).Conclusion. Improving the capacity of surgical services at first-level hospitals is essential for averting the burden of digestive diseases in LMICs. Practicable strategies for scaling up surgical capacities in rural districts are available potentially, which must be given due attention.