Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990-2017
Global, Regional, and National Burden of Calcific Aortic Valve and Degenerative Mitral Valve Diseases, 1990-2017
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DOI：
10.1161/circulationaha.119.043391
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发表时间：
2020-05-26
期刊：
影响因子：
37.8
通讯作者：
Roth, Gregory A.
中科院分区：
文献类型：
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作者：
Yadgir, Simon;Johnson, Catherine Owens;Roth, Gregory A.
背景：非风湿性瓣膜病很常见，但是，没有研究估计其全球或国家负担。作为2017年全球疾病负担研究的一部分，估计了1990年至2017年195个国家和地区的钙化性主动脉瓣疾病（CAVD）、退行性二尖瓣疾病和其他非风湿性瓣膜疾病的死亡率、患病率和残疾调整生命年（DADs）。生命登记数据、流行病学调查数据，使用全球疾病负担研究模型框架，使用行政医院数据来估计疾病负担，以确保不同地点的可比性。地理空间统计方法用于估计所有国家的疾病，因为世界上一些地区（如撒哈拉以南非洲和南亚）的非风湿性瓣膜疾病数据极其有限。结果解释了疾病严重程度的估计水平以及瓣膜修复或置换手术的估计可用性。从1990年至2017年，生成了两种性别和每个5岁年龄组、地点和年份的DADs和其他健康相关负担指标。结果：在全球范围内，CAVD和退行性二尖瓣疾病分别造成102 700例（95%不确定区间[UI]，82 700-107 900）和35 700例（95%UI，30 500-42 500）死亡，2017年分别存在1260万例（95%UI，1140万-1380万）和1810万例（95%UI，1760万-1860万）流行病例。据估计，全球共有250万例（95% UI，230万-280万）DAF由非风湿性瓣膜疾病引起，占2017年所有疾病造成的健康损失总数的0.10%（95% UI，0.09%-0.11%）。1990年至2017年期间，CAVD和退行性二尖瓣疾病的DAF数量分别增加了101%（95% UI，79%-117%）和35%（95% UI，23%-47%）。有显着的地理变化的患病率，死亡率和这些疾病的总体负担，最高的年龄标准化DALY率CAVD估计为高收入countries.Conclusions：这些全球和国家的估计表明，CAVD和退行性二尖瓣疾病是老年人疾病负担的重要原因。如果要在减少并最终消除这些高度可治疗疾病的负担方面取得进展，就必须努力澄清可改变的风险因素并改善瓣膜介入治疗的可及性。
Background:Nonrheumatic valvular diseases are common; however, no studies have estimated their global or national burden. As part of the Global Burden of Disease Study 2017, mortality, prevalence, and disability-adjusted life-years (DALYs) for calcific aortic valve disease (CAVD), degenerative mitral valve disease, and other nonrheumatic valvular diseases were estimated for 195 countries and territories from 1990 to 2017.Methods:Vital registration data, epidemiologic survey data, and administrative hospital data were used to estimate disease burden using the Global Burden of Disease Study modeling framework, which ensures comparability across locations. Geospatial statistical methods were used to estimate disease for all countries, because data on nonrheumatic valvular diseases are extremely limited for some regions of the world, such as Sub-Saharan Africa and South Asia. Results accounted for estimated level of disease severity as well as the estimated availability of valve repair or replacement procedures. DALYs and other measures of health-related burden were generated for both sexes and each 5-year age group, location, and year from 1990 to 2017.Results:Globally, CAVD and degenerative mitral valve disease caused 102 700 (95% uncertainty interval [UI], 82 700-107 900) and 35 700 (95% UI, 30 500-42 500) deaths, and 12.6 million (95% UI, 11.4 million-13.8 million) and 18.1 million (95% UI, 17.6 million-18.6 million) prevalent cases existed in 2017, respectively. A total of 2.5 million (95% UI, 2.3 million-2.8 million) DALYs were estimated as caused by nonrheumatic valvular diseases globally, representing 0.10% (95% UI, 0.09%-0.11%) of total lost health from all diseases in 2017. The number of DALYs increased for CAVD and degenerative mitral valve disease between 1990 and 2017 by 101% (95% UI, 79%-117%) and 35% (95% UI, 23%-47%), respectively. There is significant geographic variation in the prevalence, mortality rate, and overall burden of these diseases, with highest age-standardized DALY rates of CAVD estimated for high-income countries.Conclusions:These global and national estimates demonstrate that CAVD and degenerative mitral valve disease are important causes of disease burden among older adults. Efforts to clarify modifiable risk factors and improve access to valve interventions are necessary if progress is to be made toward reducing, and eventually eliminating, the burden of these highly treatable diseases.