Estimates of global and regional potential health gains from reducing multiple major risk factors
Estimates of global and regional potential health gains from reducing multiple major risk factors
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DOI：
10.1016/s0140-6736(03)13968-2
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发表时间：
2003-07-26
期刊：
影响因子：
168.9
通讯作者：
Murray, CJL
中科院分区：
文献类型：
--
作者：
Ezzati, M;Vander Hoorn, S;Murray, CJL
背景：对多种危险因素造成的疾病负担的估计可以显示联合预防措施的潜在收益。但很少有人尝试过这样的调查，更没有在全球范围内进行过。我们的目的是估计去除多种主要危险因素对健康的潜在益处。方法：我们评估了世界14个流行病学次区域中20个选定的主要危险因素的共同作用所导致的疾病和损伤负担。我们根据风险因素流行率和危害大小的数据估计了人口归因分数，定义为如果暴露于风险因素减少到另一个水平，将发生的疾病或死亡率的比例减少。对于每一种疾病，我们根据年龄和性别，从个体危险因素的直接贡献估计了多重危险因素的联合人群归因分数。为了获得直接危害，我们回顾了出版物并重新分析了队列数据，以解释通过其他风险介导的那部分危害。结果在全球范围内，2000年估计47%的过早死亡和39%的总疾病负担是由所考虑的风险因素的共同影响造成的。这些风险导致了相当大比例的重要疾病，包括腹泻（92%-94%）、下呼吸道感染（55-62%）、肺癌（72%）、慢性阻塞性肺病（60%）、缺血性心脏病（83-89%）和中风（70-76%）。消除这些风险将使全球健康预期寿命增加9.3岁（17%），范围从西太平洋发达国家的4.4岁（6%）到撒哈拉以南非洲部分地区的16.1岁（43%）。消除主要风险因素不仅可以提高每个区域的健康预期寿命，还可以缩小区域之间的一些差异，同时解决已知的主要风险，在预防疾病和增进健康方面的潜力将是巨大的。
Background Estimates of the disease burden due to multiple risk factors can show the potential gain from combined preventive measures. But few such investigations have been attempted, and none on a global scale. Our aim was to estimate the potential health benefits from removal of multiple major risk factors.Methods We assessed the burden of disease and injury attributable to the joint effects of 20 selected leading risk factors in 14 epidemiological subregions of the world. We estimated population attributable fractions, defined as the proportional reduction in disease or mortality that would occur if exposure to a risk factor were reduced to an alternative level, from data for risk factor prevalence and hazard size. For every disease, we estimated joint population attributable fractions, for multiple risk factors, by age and sex, from the direct contributions of individual risk factors. To obtain the direct hazards, we reviewed publications and re-analysed cohort data to account for that part of hazard that is mediated through other risks.Results Globally, an estimated 47% of premature deaths and 39% of total disease burden in 2000 resulted from the joint effects of the risk factors considered. These risks caused a substantial proportion of important diseases, including diarrhoea (92%-94%), lower respiratory infections (55-62%), lung cancer (72%), chronic obstructive pulmonary disease (60%), ischaemic heart disease (83-89%), and stroke (70-76%). Removal of these risks would have increased global healthy life expectancy by 9.3 years (17%) ranging from 4.4 years (6%) in the developed countries of the western Pacific to 16.1 years (43%) in parts of sub-Saharan Africa.Interpretation Removal of major risk factors would not only increase healthy life expectancy in every region, but also reduce some of the differences between regions, The potential for disease prevention and health gain from tackling major known risks simultaneously would be substantial.