Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
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DOI：
10.1016/s0140-6736(17)32130-x
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发表时间：
2017-09-16
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通讯作者：
GBD 2016 DALYs and HALE Collaborators
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作者：
GBD 2016 DALYs and HALE Collaborators
衡量各地健康状况的变化有助于比较和对比不断变化的流行病学模式与卫生系统的业绩，并确定研究、政策制定和方案决策中资源分配的具体需求。利用2016年全球疾病、伤害和风险因素负担研究，我们借鉴了两种广泛使用的概括性指标来监测人口健康的此类变化：残疾调整寿命年（DALs）和健康预期寿命（黑尔）。我们使用这些措施来跟踪趋势，并根据社会人口指数（SDI）将进展与预期趋势进行比较。我们使用2016年全球疾病、伤害和风险因素负担研究的结果，计算了1990年至2016年195个国家和地区的全因死亡率、死因特异性死亡率和非致命性疾病负担，以得出按性别分列的黑尔和DALs。我们通过对每个地区、年龄组、性别和年份的寿命损失年数和残疾寿命年数进行求和来计算残疾率。我们使用特定年龄死亡率和人均残疾寿命来估计黑尔。我们探讨了DALOS和黑尔与SDI相比与预期趋势的差异：人均收入的几何平均数，15岁以上人口的教育程度和总生育率。全球观察到的女性和男性出生时黑尔最高的是新加坡，女性为75.2岁（95%不确定性区间71.9 - 78.6），男性为72.0岁（68.8 - 75.1）。中非共和国的女性寿命最短（45.6岁[42.0 - 49.5]），莱索托的男性寿命最短（41.5岁[39.0 - 44.0]）。从1990年到2016年，全球黑尔平均增加了6.24年（5.97 - 6.48）。男性的总体黑尔增加了6.04年（5.74 - 6.27），女性增加了6.49年（6.08 - 6.77），而男性65岁时的黑尔增加了1.78年（1.61 - 1.93），女性增加了1.96年（1.69 - 2.13）。从1990年到2016年，全球总死亡率基本保持不变（-2统计3%[-5统计9至0.9]），传染性、孕产妇、新生儿和营养性（CMNN）疾病死亡率的下降被非传染性疾病（NCD）死亡率的增加所抵消。2016年观察到的与预期年龄标准化DALY比率最低的五个国家是尼加拉瓜、哥斯达黎加、马尔代夫、秘鲁和以色列。全球导致糖尿病的三大原因是缺血性心脏病、脑血管疾病和下呼吸道感染，占所有糖尿病的16.1%。从1990年到2016年，由于大多数CMNN原因导致的总DALY和年龄标准化DALY率下降。相反，大多数非传染性疾病的DALY总负担上升;然而，全球非传染性疾病导致的年龄标准化DALY率下降。在全球一级，残疾人和黑尔继续显示出改善。与此同时，我们注意到，许多人口正面临着日益严重的功能性健康损失。SDI的增加与累积残疾生活年数的增加以及CMNN DALs的减少相关，这些减少被NCD DALs的增加所抵消。发病率的相对压缩突出表明了持续保健干预措施的重要性，在大多数地方，保健干预措施随着人均国内生产总值、教育和计划生育的变化而变化。对残疾人和黑尔及其与空间数据基础设施的关系的分析是一个强有力的框架，可以用来对特定地点的健康绩效进行基准测试。各国的疾病负担驱动因素，特别是疾病负担高于预期的原因，应成为卫生政策、卫生系统改进举措、有针对性的预防工作和卫生发展援助的依据，包括所有国家的财政和研究投资，无论其社会人口发展水平如何。一些国家的表现大大优于其他国家，这表明需要加强对经证实的最佳做法范例的审查，这有助于扩大成果，而一些国家的表现不佳，则表明需要对需要更有力支持的卫生系统给予额外关注。比尔和梅林达·盖茨基金会。
Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9–78·6) for females and 72·0 years (68·8–75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0–49·5]) and for males was in Lesotho (41·5 years [39·0–44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97–6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74–6·27) for males and 6·49 years (6·08–6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61–1·93) for males and 1·96 years (1·69–2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (–2·3% [–5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. Bill & Melinda Gates Foundation.