Population ageing and mortality during 1990-2017: A global decomposition analysis
Population ageing and mortality during 1990-2017: A global decomposition analysis
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DOI：
10.1371/journal.pmed.1003138
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发表时间：
2020-06-01
期刊：
影响因子：
15.8
通讯作者：
Hu, Guoqi
中科院分区：
文献类型：
--
作者：
Cheng, Xunjie;Yang, Yang;Hu, Guoqi
随着全球老年人数量的增加，卫生系统需要进行改革，以满足对医疗资源日益增长的需求。以前的一些研究报告了人口老龄化对健康的不同影响，但它们只关注有限的国家和疾病。方法与结果本研究使用《2017年全球疾病负担研究》（GBD 2017）的数据，推算了1990年至2017年期间每年的死亡总人数和人口规模。使用分解方法将195个国家/地区和按世界银行经济发展水平分组的国家的总死亡人数的变化归因于1990年和随后1991年至2017年每年的人口增长、人口老龄化和死亡率变化。对于与人口老龄化有关的死亡增加的国家，我们计算了归因于死亡率变化的死亡与归因于人口老龄化的死亡的比率。1990年至2017年，全球65岁及以上人口的比例从6.1%增加到8.8%，全球死亡人数增加了900万。与1990年相比，2017年全球新增1200万例死亡与人口老龄化有关，占全球死亡总数的27.9%。在高收入、中上收入和中低收入国家，人口老龄化与死亡人数增加有关，但在低收入国家则不然。在195个国家/地区中，男性因人口老化而死亡的比例由-43.9%至117.4%不等，女性则由-30.1%至153.5%不等。1990年至2017年期间，人口老龄化对全球疾病特异性死亡的两大贡献是缺血性心脏病（320万）和中风（220万）。人口老龄化与1990年至2017年期间152个国家男性和159个国家女性的死亡人数增加以及43个国家男性和36个国家女性的死亡人数减少有关。从1990年到2017年，由于死亡率变化导致的死亡人数减少超过了全球人口老龄化导致的死亡人数增加，在人口老龄化导致死亡负担增加的国家中，男性占55.3%（84/152），女性占47.8%（76/159）。由于GBD 2017没有提供估计死亡人数的差异，我们无法量化归因估计的不确定性。结论在本研究中，我们发现人口老龄化与1990年至2017年期间死亡人数的大幅变化有关，但归因死亡比例因国家收入水平、国家和死因而异。应在不同国家和地区实施具体的预防和治疗技术，以满足与人口老龄化有关的日益增长的健康需求，特别是针对与老年人死亡人数增加最多的疾病。与人口老龄化相关的死亡人数变化的证据对于每个政府改善其医疗保健系统以满足老年人日益增长的医疗保健需求非常重要。以前的研究评估健康指标的变化（例如，受人口老龄化影响的死亡人数、死亡率）仅限于特定国家或特定疾病。以往研究中采用的死亡总数变化的定量分解方法对人口增长、人口老龄化和年龄别死亡率这三个因素的分解顺序的选择以及参照组的选择都很敏感，研究人员做了什么，发现了什么？使用不受3个因素的分解顺序选择和参考组选择影响的分解方法，我们进行了综合分析，以量化1990年至2017年195个国家/地区的人口老龄化对死亡人数变化的影响，以及169种死亡原因。在195个国家/地区，与人口老化有关的死亡人数的变动有很大差异;男性的归因比例由-43.9%至117.4%不等，女性则由-30.1%至153.5%不等。1990年至2017年期间，人口老龄化与全球死亡人数增加最多的死亡原因是缺血性心脏病（320万）和中风（220万）。1990年至2017年间，全球因死亡率变化而导致的死亡人数下降幅度超过了与人口老龄化相关的死亡人数增加幅度，其中55.3%（84/152）的男性国家和47.8%（76/159）的女性国家的人口老龄化与死亡负担增加有关。这些发现意味着什么？在全球范围内，人口老龄化与死亡人数增加有关，这突出表明改善卫生系统以满足老年人健康需求的重要性和紧迫性。与人口老龄化有关的死亡负担各不相同，这表明灵活的卫生政策应针对不同国家/地区归因死亡负担的主要原因。与人口老龄化有关的死亡负担可以通过实施循证干预措施来减轻甚至克服，以降低死亡率。
Background As the number of older people globally increases, health systems need to be reformed to meet the growing need for medical resources. A few previous studies reported varying health impacts of population ageing, but they focused only on limited countries and diseases. We comprehensively quantify the impact of population ageing on mortality for 195 countries/territories and 169 causes of death.Methods and findings Using data from the Global Burden of Disease Study 2017 (GBD 2017), this study derived the total number of deaths and population size for each year from 1990 to 2017. A decomposition method was used to attribute changes in total deaths to population growth, population ageing, and mortality change between 1990 and each subsequent year from 1991 through 2017, for 195 countries/territories and for countries grouped by World Bank economic development level. For countries with increases in deaths related to population ageing, we calculated the ratio of deaths attributed to mortality change to those attributed to population ageing. The proportion of people aged 65 years and older increased globally from 6.1% to 8.8%, and the number of global deaths increased by 9 million, between 1990 and 2017. Compared to 1990, 12 million additional global deaths in 2017 were associated with population ageing, corresponding to 27.9% of total global deaths. Population ageing was associated with increases in deaths in high-, upper-middle-, and lower-middle-income countries but not in low-income countries. The proportions of deaths attributed to population ageing in 195 countries/territories ranged from -43.9% to 117.4% for males and -30.1% to 153.5% for females. The 2 largest contributions of population ageing to disease-specific deaths globally between 1990 and 2017 were for ischemic heart disease (3.2 million) and stroke (2.2 million). Population ageing was related to increases in deaths in 152 countries for males and 159 countries for females, and decreases in deaths in 43 countries for males and 36 countries for females, between 1990 and 2017. The decreases in deaths attributed to mortality change from 1990 to 2017 were more than the increases in deaths related to population ageing for the whole world, as well as in 55.3% (84/152) of countries for males and 47.8% (76/159) of countries for females where population ageing was associated with increased death burden. As the GBD 2017 does not provide variances in the estimated death numbers, we were not able to quantify uncertainty in our attribution estimates.Conclusions In this study, we found that population ageing was associated with substantial changes in numbers of deaths between 1990 and 2017, but the attributed proportion of deaths varied widely across country income levels, countries, and causes of death. Specific preventive and therapeutic techniques should be implemented in different countries and territories to address the growing health needs related to population ageing, especially targeting the diseases associated with the largest increase in number of deaths in the elderly.Author summaryWhy was this study done?Evidence on the change in number deaths related to population ageing is important for each individual government to improve its healthcare system to address the increasing healthcare needs of older adults. Previous research assessing changes in health indicators (e.g., number of deaths, mortality) influenced by population ageing was limited to specific countries or specific diseases. Quantitative methods for decomposing changes in the total number of deaths that were adopted by previous studies are sensitive to the choice of the decomposition order of the 3 factors-population growth population ageing, and age-specific mortality rate-and the selection of reference group.What did the researchers do and find?Using a decomposition method that is not influenced by the selection of decomposition order of the 3 factors and the choice of the reference group, we conducted a comprehensive analysis to quantify the impact of population ageing on changes in the number of deaths in 195 countries/territories, and for 169 causes of death, from 1990 to 2017. Changes in the number of deaths related to population ageing varied greatly across the 195 countries/territories; the attributed proportion ranged from -43.9% to 117.4% for males and -30.1% to 153.5% for females. The causes of death for which population ageing was associated with the greatest increases in global deaths between 1990 and 2017 were ischemic heart disease (3.2 million) and stroke (2.2 million). The decreases in deaths attributed to mortality change exceeded the increases in deaths related to population ageing between 1990 and 2017 for the whole world, as well as in 55.3% (84/152) of countries for males and 47.8% (76/159) of countries for females where population ageing was associated with increased death burden.What do these findings mean?Globally, population ageing was related to increases in deaths, highlighting the importance and urgency of improving health systems to meet the health needs of older adults. Varying death burden related to population ageing suggests flexible health policies should target the leading causes of attributed death burden in different countries/territories. The death burden related to population ageing could be alleviated or even overcome through implementation of evidence-based interventions to reduce mortality.