Regional contributions of six preventable risk factors to achieving the 25 x 25 non-communicable disease mortality reduction target: a modelling study
Regional contributions of six preventable risk factors to achieving the 25 x 25 non-communicable disease mortality reduction target: a modelling study
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DOI：
10.1016/s2214-109x(15)00179-5
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发表时间：
2015-12-01
影响因子：
34.3
通讯作者：
Ezzati, Majid
中科院分区：
文献类型：
--
作者：
Kontis, Vasilis;Mathers, Colin D.;Ezzati, Majid
各国已同意到2025年将四种主要非传染性疾病（NCD）导致的过早死亡率从2010年的水平降低25%（称为25 x25目标）。各国还商定了一套针对某些非传染性疾病风险因素的全球自愿目标。以往的分析表明，实现风险因素目标可大大有助于在全球一级实现25 x25死亡率目标。我们估计了实现全球商定的六个风险因素目标对实现25 x 25死亡率目标的贡献，按region.Methods我们估计了实现六个风险因素（烟草和酒精使用，盐摄入量，肥胖，血压和血糖升高）的目标对2010年至2025年非传染性疾病死亡率的影响。我们的方法考虑到了非传染性疾病的多重因果性，并考虑到当风险因素暴露增加或减少时，对非传染性疾病的有害或有益影响会逐渐累积。我们使用的风险因素和死亡率趋势数据来自对现有国家数据的系统分析。个体和多种风险的影响的相对风险，以及风险减少或增加后的风险变化，来自流行病学研究的再分析和荟萃分析。结果2010年，年龄在30岁至70岁之间死于四种主要非传染性疾病的概率从美洲地区的19%到东南亚地区的29%不等。女性的比例从欧洲的13%上升到东南亚的21%。如果目前的趋势继续下去，预计非洲区域因四种主要非传染性疾病而过早死亡的可能性将增加，但在其他五个区域则会减少。如果实现了风险因素目标，欧洲的男性和女性都将超过25 x25的目标，西太平洋的女性也将实现（男性几乎实现）;美洲、东地中海和东南亚地区将接近目标;非洲的上升趋势将得到扭转。在大多数地区，更雄心勃勃的烟草控制方法（相对于2010年减少50%，而不是商定的30%）将最有助于减少男性非传染性疾病过早死亡，其次是解决血压升高和商定的烟草目标。对妇女而言，在除欧洲和美洲以外的所有区域，导致非传染性疾病过早死亡率目标实现的最大风险因素将是血压升高，因为雄心勃勃（但尚未商定）的烟草减少将在这两个区域产生最大效益。实现六个风险因素的商定目标将使一些区域能够实现25 x25的目标，而其他区域则接近这一目标，在非洲实现25 x25的目标需要其他干预措施，包括应对与感染有关的癌症和心血管疾病的干预措施。资助英国医学研究理事会。版权所有（C）Kontis等人。根据CC BY的条款分发的开放获取文章。
Background Countries have agreed to reduce premature mortality from the four main non-communicable diseases (NCDs) by 25% from 2010 levels by 2025 (referred to as the 25 x 25 target). Countries also agreed on a set of global voluntary targets for selected NCD risk factors. Previous analyses have shown that achieving the risk factor targets can contribute substantially towards meeting the 25 x 25 mortality target at the global level. We estimated the contribution of achieving six of the globally agreed risk factor targets towards meeting the 25 x 25 mortality target by region.Methods We estimated the effect of achieving the targets for six risk factors (tobacco and alcohol use, salt intake, obesity, and raised blood pressure and glucose) on NCD mortality between 2010 and 2025. Our methods accounted for multicausality of NCDs and for the fact that, when risk factor exposure increases or decreases, the harmful or beneficial effects on NCDs accumulate gradually. We used data for risk factor and mortality trends from systematic analyses of available country data. Relative risks for the effects of individual and multiple risks, and for change in risk after decreases or increases in exposure, were from reanalyses and meta-analyses of epidemiological studies.Findings The probability of dying between the ages 30 years and 70 years from the four main NCDs in 2010 ranged from 19% in the region of the Americas to 29% in southeast Asia for men, and from 13% in Europe to 21% in southeast Asia for women. If current trends continue, the probability of dying prematurely from the four main NCDs is projected to increase in the African region but decrease in the other five regions. If the risk factor targets are achieved, the 25 x 25 target will be surpassed in Europe in both men and women, and will be achieved in women (and almost achieved in men) in the western Pacific; the regions of the Americas, the eastern Mediterranean, and southeast Asia will approach the target; and the rising trend in Africa will be reversed. In most regions, a more ambitious approach to tobacco control (50% reduction relative to 2010 instead of the agreed 30%) will contribute the most to reducing premature NCD mortality among men, followed by addressing raised blood pressure and the agreed tobacco target. For women, the highest contributing risk factor towards the premature NCD mortality target will be raised blood pressure in every region except Europe and the Americas, where the ambitious (but not agreed) tobacco reduction would have the largest benefit.Interpretation No WHO region will meet the 25 x 25 premature mortality target if current mortality trends continue. Achieving the agreed targets for the six risk factors will allow some regions to meet the 25 x 25 target and others to approach it. Meeting the 25 x 25 target in Africa needs other interventions, including those addressing infectionrelated cancers and cardiovascular disease. Funding UK Medical Research Council. Copyright (C) Kontis et al. Open Access article distributed under the terms of CC BY.