Alternative projections of mortality and disability by cause 1990-2020: Global burden of disease study
Alternative projections of mortality and disability by cause 1990-2020: Global burden of disease study
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DOI：
10.1016/s0140-6736(96)07492-2
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发表时间：
1997-05-24
期刊：
影响因子：
168.9
通讯作者：
Lopez, AD
中科院分区：
文献类型：
--
作者：
Murray, CJL;Lopez, AD
对未来死亡率和残疾的合理预测有助于决定卫生研究、资本投资和培训的优先事项。健康不良的比率和模式取决于社会经济发展、受教育程度、技术发展及其在人口中的分布，以及接触烟草等危害等因素。作为全球疾病负担研究（GBD）的一部分，我们针对不同的年龄、性别群体、病因和地区制定了未来死亡率和残疾的三种情景。方法：我们使用了自1950年以来9个死因集群中最重要的疾病和伤害趋势，根据人均国内生产总值（以国际美元计）建立了每个区域集群死亡率的回归方程。平均受教育年数、时间（以年为单位，代替技术变化）和吸烟强度，根据1950- 1990年47个国家的数据显示了累积效应。分别对自变量进行乐观、悲观和基线预测。我们将详细原因的死亡率与原因集群的死亡率联系起来，以预测更详细的原因。根据按原因分列的预计死亡人数，根据伤残寿命与丧失寿命的不同关系模型推算伤残寿命。人口预测是根据世界银行对生育率和死亡率的预测编制的。在所有三种情况下，预计妇女出生时的预期寿命都会增加；在成熟的市场经济中，到2020年将达到90岁左右。预计男性预期寿命的增长远小于女性；在欧洲以前的社会主义经济体中，男性的预期寿命可能根本不会增加。在基线情景下，全球传染性孕产妇、围产期和营养失调造成的死亡预计将从1990年的1720万例下降到2020年的1030万例。我们预计，非传染性疾病死亡人数将从1990年的2810万人增加到2020年的4970万人。受伤死亡人数可能从510万增加到840万。基线模型预测的残疾调整生命年（DALYs）的主要原因（按降序排列）是：缺血性心脏病、单极重度抑郁症、道路交通事故、脑血管疾病、慢性阻塞性肺病、下呼吸道感染、结核病、战争伤害、腹泻病和艾滋病毒。预计烟草导致的死亡将从1990年的300万例增加到2020年的840万例。未来25年的健康趋势将主要由以下因素决定：世界人口的老龄化、传染病、孕产妇、围产期和营养失调造成的特定年龄死亡率的下降、艾滋病毒的传播以及与烟草有关的死亡率和残疾率的增加。从本质上讲，预测是高度不确定的，但我们发现了一些对卫生政策有影响的有力结果。
Background Plausible projections of future mortality and disability are a useful aid in decisions on priorities for health research, capital investment, and training. Rates and patterns of ill health are determined by factors such as socioeconomic development, educational attainment, technological developments, and their dispersion among populations, as well as exposure to hazards such as tobacco. As part of the Global Burden of Disease Study (GBD), we developed three scenarios of future mortality and disability for different age-sex groups, causes, and regions.Methods We used the most important disease and injury trends since 1950 in nine cause-of-death clusters, Regression equations for mortality rates for each cluster by region were developed from gross domestic product per person (in international dollars). average number of years of education, time (in years, as a surrogate for technical change), and smoking intensity,which shows the cumulative effects based on data for 47 countries in 1950-90. Optimistic, pessimistic, and baseline projections of the independent variables were made. We related mortality from detailed causes to mortality from a cause cluster to project more detailed causes. Based on projected numbers of deaths by cause, years of life lived with disability (YLDs) were projected from different relation models of YLDs to years of life lost (YLLs). Population projections were prepared from World Bank projections of fertility and the projected mortality rates.Findings Life expectancy at birth for women was projected to increase in all three scenarios; in established market economies to about 90 years by 2020. Far smaller gains in male life expectancy were projected than in females; in formerly socialist economies of Europe, male life expectancy may not increase at all. Worldwide mortality from communicable maternal, perinatal, and nutritional disorders was expected to decline in the baseline scenario from 17.2 million deaths in 1990 to 10.3 million in 2020. We projected that non-communicable disease mortality wilt increase from 28.1 million deaths in 1990 to 49.7 million in 2020. Deaths from injury may increase from 5.1 million to 8.4 million. Leading causes of disability-adjusted life years (DALYs) predicted by the baseline model were (in descending order): ischaemic heart disease, unipolar major depression, road-traffic accidents, cerehrovascular disease, chronic obstructive pulmonary disease, lower respiratory infections, tuberculosis, war injuries, diarrhoeal diseases, and HIV. Tobacco-attributable mortality is projected to increase from 3.0 million deaths in 1990 to 8.4 million deaths in 2020.Interpretation Health trends in the next 25 years will he determined mainly by the ageing of the world's population, the decline in age-specific mortality rates from communicable, maternal, perinatal, and nutritional disorders, the spread of HIV, and the increase in tobacco-related mortality and disability. Projections, by their nature, are highly uncertain, but we found some robust results with implications for health policy.